Search results for: patient reported symptom burden

Authors: Keshari Shrestha, Philip Vatterott

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Introduction: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare and potentially fatal drug-related syndrome. DRESS classically presents with a diffuse maculopapular rash, fevers, and eosinophilia more than three weeks after drug exposure. DRESS can present with multi-organ involvement, with liver damage being the most common and severe. Pulmonary involvement is a less common manifestation and is associated with poor clinical outcomes. Chest imaging is often nonspecific, and symptoms can range from mild cough to acute respiratory distress syndrome (ARDS) . This is a case of a 49-year-old female with a history of recent clostridium difficile colitis status post treatment with oral vancomycin who presented with rash, acute liver and kidney failure, as well as diffuse nodular alveolar lung opacities concerning for DRESS syndrome with multi-organ involvement. Clinical Course: This patient initially presented to an outside hospital with clostridium difficile colitis, acute liver injury, and acute kidney injury. She developed a desquamating maculopapular rash in the setting of recent oral vancomycin, meloxicam, and furosemide initiation. She was hospitalized on two additional occasions with worsening altered mental status, liver injury, and acute kidney injury and was initiated on intermittent hemodialysis. Notably, she was found to have systemic eosinophilia (4100 cells/microliter) several weeks prior. She was transferred to this institution for further management where she was found to have encephalopathy, jaundice, lower extremity edema, and diffuse bilateral rhonchorous breath sounds on pulmonary examination. The patient was started on methylprednisolone for suspected DRESS syndrome. She underwent an evaluation for alternative causes of her organ failure. Her workup included a negative infectious, autoimmune, metabolic, toxic, and malignant work-up. Abdominal computed tomography (CT) and ultrasound were remarkable for evidence of hepatic steatosis and possible cirrhotic morphology. Additionally, a chest CT demonstrated diffuse and symmetric nodular alveolar lung opacities with peripheral sparing not consistent with acute respiratory distress syndrome or edema. Ultimately, her condition continued to decline, and she required intubation on several occasions. On hospital day 25 she succumbed to distributive shock in the setting of probable sepsis and multi-organ failure. Discussion: DRESS syndrome occurs in 1 in 1,000 to 10,000 patients with a mortality rate of around 10%. Anti-convulsant, anti-bacterial, anti-viral, and sulfonamide drugs are the most common drugs implicated in the development of DRESS syndrome; however, the list of offending agents is extensive . The diagnosis of DRESS syndrome is made after excluding other causes of disease such as infectious and autoimmune etiologies. The RegiSCAR scoring system is used to diagnose DRESS syndrome with 2-3 points indicating possible disease, 4-5 probable disease, and >5 definite disease. This patient scored a 7 on the RegiSCAR scale for eosinophilia, rash, organ involvement, and exclusion of other causes (infectious and autoimmune). While the pharmacologic trigger in this case is unknown, it is speculated to be caused by vancomycin, meloxicam, or furosemide due to the favorable timeline of initiation. Despite aggressive treatment, DRESS syndrome can often be fatal. Because of this, early diagnosis and treatment of patients with suspected DRESS syndrome is imperative.

Keywords: drug reaction with eosinophilia and systemic symptoms, multi-organ failure, pulmonary involvement, renal failure

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Authors: Rajendra Kumar Kanojia

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Correction of the gap created by the resection of large juxtra-articular tumours of the femur would be difficult to manage, several bone substitutes, bone grafts, and artificial bone granules were tried but the results were not as good as with the distraction osteogensis, by the help of either Ilizarov ring fixator or the mono-rail fixators. We are presenting a small study of five cases of malignant tumours of the distal femur, removed, custom made mega prosthesis was applied and that failed twice in a span of five years. We had no better option left then to apply mono-rail fixator, and start the process of distraction osteogeneis, we got the union, gap was filled with new bone and patient has been made walking in few months.

Keywords: distal femur tumour, resection, defect non-union, mono-rail fixator

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Authors: Tracey Lion-Cachet

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Eating disorders typically manifest in adolescence and are notoriously difficult to treat. There are two notable reasons for this. Firstly, research consistently demonstrates that early intervention is a critical mediator of prognosis, with early intervention leading to a better prognosis. However, because eating disorders do not originate as full-syndrome diagnoses but rather as prodromal cases, they often go undetected; by the time symptoms meet diagnostic criteria, they have become recalcitrant. Another interrelated issue is motivation to change. Research demonstrates that in the early stages of an eating disorder, adolescents are highly resistant to change, and motivation increases only once symptoms have shifted from egosyntonic to egodystonic in nature. The purpose of this project was to design a prevention model based on the social psychology paradigm of Entertainment-Education, which embeds messages within the genre of film as a means of affecting change. The resulting project was a narrative screenplay targeting teenagers/young adults from diverse backgrounds. The goals of the project were to create a film script that, if ultimately made into a film, could serve to: 1) interrupt symptom progression and improve prognosis through early intervention; 2) incorporate techniques from third-wave cognitive behavioral treatment models, acceptance and commitment therapy (ACT) and rational recovery (RR), with a focus on the effects of mindfulness as a means of informing recovery; 3) target issues to do with motivation to change by shifting the perception of eating disorders from culturally specific psychiatric illnesses to habit-based brain wiring issues. Nine licensed clinicians were asked to evaluate two excerpts taken from the final script. They subsequently provided feedback on a Likert-scale, which assessed whether the script had achieved its goals. Overall, evaluators agreed that the project’s etiological and intervention models have the potential to inspire change and serve as an effective means of prevention and treatment of eating disorders. However, one-third of the evaluators did not find the content developmentally appropriate. This is a notable limitation to the study and will need to be addressed in the larger script before the final project can potentially be targeted to a teenage and young adult audience.

Keywords: adolescents, eating disorders, pediatrics, entertainment-education, mindfulness-based intervention, prevention

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Authors: Mohammad Ali Rajaeifar, Oliver Heidrich

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Nowadays, Li-ion batteries are vastly disseminated and the battery market is expected to experience a huge growth during next decade especially in terms of traction batteries. As the automotive industry moving towards the electrification of the powertrain, more raw/critical materials and energy are extracted while on the other hand, concerns are made regarding the scarcity of the materials as well as environmental issues regarding the destiny of the spent batteries. In this regards, recycling could play a vital role in the supply chain, leading reutilization of key battery materials and also reducing environmental burden related to the use of batteries. The aim of this paper is to review the previous and state-of-the-art treatments for recycling of Li-ion batteries. All the treatments method from mechanical, mild-thermal, pyrometallurgical and hydrometallurgical as well as combined methods for recycling of Li-ion batteries were considered in the study. There are various treatment methods that are economical, but they are not environmentally friendly or vice versa. This is due to the fact that the benefits of the Li-ion batteries recycling could be affected by different factors such as the amount of spent batteries available, the quality of the recovered material, the energy and material consumption by the process itself and environmental burdens caused by required logistics. Finally, a preliminary work sheet of possible route for recycling of spent Li-ion batteries was presented through the course of this study. Overall, it is worth quoting that recycling processes generally consumes a great deal of energy and auxiliary materials. Moreover, the collection of spent products from waste streams represents additional environmental efforts. Therefore, developing and optimizing efficient collection and separation technologies is essential to achieve sustainability goals.

Keywords: hydrometallurgical treatment, Li-ion batteries, mild-thermal treatment, mechanical treatment, recycling, pyrometallurgical treatment

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Authors: Hamida Hamed Said Al Harthi

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Background: Illegal drug use is a rising problem that affects Omani youth. This research aimed to study a group of young Omani men who were imprisoned more than once for illegal drug use, focusing on exploring their lifestyle experiences inside and outside the prison and whether these contributed to their early relapse and re-imprisonment. This is the first study of its kind from Oman conducted in a prison setting. Methods: 19 Omani males aged 18–35 years imprisoned in Oman Central Prison were recruited using purposive sampling. Focused ethnography was conducted over 8 months to explore the drug-related experiences outside the prison and during imprisonment. Face-to-face semi-structured interviews with the participants yielded detailed transcripts and field notes. These were thematically analyzed, and the results were compared with the existing literature. Results: The participants’ voices yielded new insights into the lives of young Omani men imprisoned for illegal drug use, including their sufferings and challenges in prison. These included: entry shock, timing and boredom, drug trafficking in prison, as well as physical and psychological health issues. Overall, imprisonment was reported to have negatively impacted the participants’ health, personality, self-concept, emotions, attitudes, behavior and life expectations. The participants reported how their efforts to reintegrate into the Omani community after release from prison were rebuffed due to stigmatization and rejection from society and family. They also experienced frequent unemployment, police surveillance, accommodation problems and a lack of rehabilitation facilities. The immensity of the accumulated psychophysiological trauma contributed to their early relapse and re-imprisonment. Conclusion: This thesis concludes that imprisonment is largely ineffective in controlling drug use in Oman. Urgent action is required across multiple sectors to improve the lives and prospects of users of illegal drugs within and outside the prison to minimize factors contributing to early relapse. Key Words: illegal drugs, drug users, Oman, addiction, Omani culture, prisoners, relapse, re-imprisonment, qualitative research, ethnography.

Keywords: illigal drugs, Prison, Omani culture lifestyle, post prison life

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Authors: Ann Ukachi Madukwe, Juliana Chinwendu Njoku

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Marital conflict, conceptualized in this study as the ongoing lack of peace and satisfaction in a marital union which threatens marital stability, has become quite prevalent in modern Igbo communities. The frequent incidences of spousal battery, spousal sexual abuse, domestic violence, long term separation and in some cases outright divorce are worrisome indicators of the endemic challenge marital conflict poses in most Igbo communities. This study examined marital expectations, marital infidelity (self and spouse), and neuroticism as predictors of marital conflict. Marital expectation was described as a married person’s appraisal of how well their pre-marital desires were being met by their spouses and within the marriage relationship. It assessed different aspects of personal and interpersonal positive outcomes in a marital union. Marital infidelity referred to the likelihood that married individuals or their spouses could have indulged in intimate activities like passionate kisses and romantic dates with someone other than their spouses. Participants reported on themselves as well as their spouses. The last predictor variable neuroticism was measured as a personality trait that addresses issues of emotional instability especially as it relates to a person’s interactions. Neurotic persons were considered to have high emotional reactivity; they would have strong emotional response to issues that emotionally stable persons might overlook. Participants comprised of Igbo male and female spouses selected from Imo state using randomized cluster sampling method. The study utilized the cross sectional survey design and Stepwise linear multiple regression for data analyses. Findings showed that though marital infidelity by spouse was generally below average and spouses marital expectations were being fulfilled; marital expectations followed by marital infidelity – spouse proved to be significant predictors of marital conflict. Marital conflict reduced as marital expectations got fulfilled and increased as the level of likelihood of marital infidelity by the spouse increased. Spouses in this study also reported an increased level of neuroticism, with males being more neurotic than females. Neuroticism was found to be the least significant predictor of marital conflict compared to marital expectations and marital infidelity – spouse. Finally, the article made recommendations to spouses and marital counsellors regarding especially the need to manage the neurotic tendencies of Igbo spouses.

Keywords: Igbo spouses, marital conflict, marital expectations, Nigeria

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Authors: Elaine Wong Yee-Sing

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Older adults are at high risk of chronic health conditions in Singapore. A closer examination at all facets of their aging process has revealed that they may not be necessary aging well. This demands for an increasing healthcare services brought to their home environment due to limited mobility and in the interest of time management. The home environment is an ideal setting to implement self-directed health promoting activities at their convenience and enable family’s support and motivation. This research protocol aims to explore their healthcare concerns, and creation of age appropriate interventions targeted to improve their chronic disease biomarkers. Convenience sampling of 130 families residing in private housing within five major districts in Singapore will be selected to participate in the health intervention. Statistical Package for Social Science 25 will be used to examine the pre and post screening results of their lipid, glycaemia and anthropometric outcomes. Using focus interviews, data results will be translated and transcribed to investigate on enablers, barriers and improvement on these services. Both qualitative and quantitative research outcomes are crucial to examine the impact of these services for these older adults living in private housing as they are not exposed to government subsidized community health programs. It is hypothesized that provision of relevant yet engaging health programs at their homes may mitigate the rising burden of chronic health conditions and result in successful aging outcomes among older Singaporeans.

Keywords: chronic diseases, health program, older adults, residential homes

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Authors: Nidia Thalia Alva Rangel, Ferran Padros Blazquez, Ma. Ines Gomez Del Campo Del Paso

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Happiness has been since antiquity a concept of interest around the world. Positive psychology is the science that begins to study happiness in a more precise and controlled way, obtaining wide amount of research which can be applied. One of the central constructs of Positive Psychology is Carol Ryff’s psychological well-being model as eudaimonic happiness, which comprehends six dimensions: autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance. Humanistic psychology is a clear precedent of Positive Psychology, which has studied human development topics and it features a great variety of intervention techniques nevertheless has little evidence with controlled research. Therefore, the present research had the aim to evaluate the efficacy of a humanistic intervention program to increase psychological well-being in healthy adults through a mixed methods study. Before and after the intervention, it was applied Carol Ryff’s psychological well-being scale (PWBS) and the Symptom Check List 90 as pretest and posttest. In addition, a questionnaire of five open questions was applied after each session. The intervention program was designed in experiential workshop format, based on the foundational attitudes defined by Carl Rogers: congruence, unconditional positive regard and empathy, integrating humanistic intervention strategies from gestalt, psychodrama, logotherapy and psychological body therapy, with the aim to strengthen skills in the six dimensions of psychological well-being model. The workshop was applied to six volunteer adults in 12 sessions of 2 hours each. Finally, quantitative data were analyzed with Wilcoxon statistic test through the SPSS program, obtaining as results differences statistically significant in pathology symptoms between prettest and postest, also levels of dimensions of psychological well-being were increased, on the other hand for qualitative strand, by open questionnaires it showed how the participants were experiencing the techniques and changing through the sessions. Thus, the humanistic psychology program was effective to increase psychological well-being. Working to promote well-being prompts to be an effective way to reduce pathological symptoms as a secondary gain. Experiential workshops are a useful tool for small groups. There exists the need for research to count with more evidence of humanistic psychology interventions in different contexts and impulse the application of Positive Psychology knowledge.

Keywords: happiness, humanistic psychology, positive psychology, psychological well-being, workshop

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Authors: Djamila Meghraoui, Bachir Boudraa, Thouraya Meksen, M.Boudraa

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Parkinson's disease is a pathology that involves characteristic perturbations in patients’ voices. This paper describes a proposed method that aims to diagnose persons with Parkinson (PWP) by analyzing on line their voices signals. First, Thresholds signals alterations are determined by the Multi-Dimensional Voice Program (MDVP). Principal Analysis (PCA) is exploited to select the main voice principal componentsthat are significantly affected in a patient. The decision phase is realized by a Mul-tinomial Bayes (MNB) Classifier that categorizes an analyzed voice in one of the two resulting classes: healthy or PWP. The prediction accuracy achieved reaching 98.8% is very promising.

Keywords: Parkinson’s disease recognition, PCA, MDVP, multinomial Naive Bayes

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Authors: Shigenori Togashi, Kei Takenaka

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We developed new processes which can collect and detect rapidly airborne pathogens such as the avian flu virus for the pandemic prevention. The fluorescence antibody technique is known as one of high-sensitive detection methods for viruses, but this needs up to a few hours to bind sufficient fluorescence dyes to viruses for detection. In this paper, we developed a mist-labeling can detect substitution viruses in a short time to improve the binding rate of fluorescent dyes and substitution viruses by the micro reaction process. Moreover, we developed the rapid detection system with the above 'mist labeling'. The detection system set with a sampling bag collecting patient’s breath and a cartridge can detect automatically pathogens within 10 minutes.

Keywords: viruses, sampler, mist, detection, fluorescent dyes, microreaction

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Authors: Madhavi-Priya Singh, Liam Lowe, Farouk Arnaout, Ludmilla Pillay, Giordan Perez, Luke Mischker, Steve Costa

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An Emergency Department consultant identified the failure of medical students to complete the task of clerking a patient in its entirety. As six medical students on our first clinical placement, we recognised our own failure and endeavoured to examine why this failure was consistent among all medical students that had been given this task, despite our best motivations as adult learner. Our aim is to understand and investigate the elements which impeded our ability to learn and perform as medical students in the clinical environment, with reference to the prescribed task. We also aim to generate a discussion around the delivery of medical education with potential solutions to these barriers. Six medical students gathered together to have a comprehensive reflective discussion to identify possible factors leading to the failure of the task. First, we thoroughly analysed the delivery of the instructions with reference to the literature to identify potential flaws. We then examined personal, social, ethical, and cultural factors which may have impacted our ability to complete the task in its entirety. Through collation of our shared experiences, with support from discussion in the field of medical education and ethics, we identified two major areas that impacted our ability to complete the set task. First, we experienced an ethical conflict where we believed the inconvenience and potential harm inflicted on patients did not justify the positive impact the patient interaction would have on our medical learning. Second, we identified a lack of confidence stemming from multiple factors, including the conflict between preclinical and clinical learning, perceptions of perfectionism in the culture of medicine, and the influence of upward social comparison. After discussions, we found that the various factors we identified exacerbated the fears and doubts we already had about our own abilities and that of the medical education system. This doubt led us to avoid completing certain aspects of the tasks that were prescribed and further reinforced our vulnerability and perceived incompetence. Exploration of philosophical theories identified the importance of the role of doubt in education. We propose the need for further discussion around incorporating both pedagogic and andragogic teaching styles in clinical medical education and the acceptance of doubt as a driver of our learning. Doubt will continue to permeate our thoughts and actions no matter what. The moral or psychological distress that arises from this is the key motivating factor for our avoidance of tasks. If we accept this doubt and education embraces this doubt, it will no longer linger in the shadows as a negative and restrictive emotion but fuel a brighter dialogue and positive learning experience, ultimately assisting us in achieving our full potential.

Keywords: medical education, clinical education, andragogy, pedagogy

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Authors: Jun Young Chong, Seung Whan Kim

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Introduction: The use of personal protective equipment for respiratory infection control in cardiopulmonary resuscitation (CPR) is a physical burden to healthcare providers. It matters how long CPR quality according to recommended guidelines can be maintained under these circumstances. It was investigated whether chest compression time was appropriate for a 2-minute shift and how long it was maintained in accordance with the guidelines under such conditions. Methods: This prospective crossover simulation study was performed at a single center from September 2020 to October 2020. Five indicators of CPR quality were measured during the first and second sessions of the study period. All participants wore a Level D powered air-purifying respirator (PAPR), and the experiment was conducted using a Resusci Anne manikin, which can measure the quality of chest compressions. Each participant conducted two sessions. In session one, 2-minutes of chest compressions followed by a 2-minute rest was repeated twice; in session two, 1-minute of chest compressions followed by a 1-minute rest was repeated four times. Results: All 34 participants completed the study. The deep and sufficient compression rate was 65.9 ± 13.1 mm in the 1-minute shift group and 61.5 ± 30.5 mm in the 2-minute shift group. The mean depth was 52.8 ±4.3 mm in the 1-minute shift group and 51.0 ± 6.1 mm in the 2-minute shift group. In these two values, there was a statistically significant difference between the two sessions. There was no statistically significant difference in the other CPR quality values. Conclusions: It was suggested that the different standard of current 2-minute to 1-minute cycles due to a significant reduction in the quality of chest compression in cases of CPR with PAPR.

Keywords: cardiopulmonary resuscitation, chest compression, personal protective equipment, powered air-purifying respirator

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Authors: Vanlounni Sibounheuang, Wanarat Anusornsangiam, Pattarin Kittiboonyakun, Chanthanom Manithip

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In worldwide, one of the most common use of oral anticoagulant is warfarin. Its margin between therapeutic inhibition of clot formation and bleeding complications is narrow. Mahosot Hospital, warfarin clinic had not been established yet. The descriptive study was conducted by investigating drug-related problems of outpatients using warfarin, the value of the international normalized ratio (INR) higher than normal ranges (25.40 % of the total 272 outpatients) were mostly identified at Lao-Luxembourg Heart Centre, Mahosot Hospital, Lao PDR. This result led to the present study conducting qualitative interviews in order to help establish a warfarin clinic at Mahosot Hospital for the better outcomes of patients using warfarin. The purpose of this study was to explore perspectives of healthcare professional providing services for outpatients using warfarin. The face to face, in-depth interviews were undertaken among nine healthcare professionals (doctor=3, nurse=3, pharmacist=3) working at out-patient clinic, Lao-Luxembourg Heart Centre, Mahosot Hospital, Lao PDR. The interview guides were developed, and they were validated by the experts in the fields of qualitative research. Each interview lasted approximately 20 minutes. Three major themes emerged; healthcare professional’s experiences of current practice problems with warfarin therapy, healthcare professionals’ views of medical problems related to patients using warfarin, and healthcare professionals’ perspectives on ways of service improvement. All healthcare professionals had the same views that it’s difficult to achieve INR goal for individual patients because of some important patient barriers especially lack of knowledge about to use warfarin properly and safety, patients not regularly follow-up due to problems with transportations and financial support. Doctors and nurses agreed to have a pharmacist running a routine warfarin clinic and provided counselling to individual patients on the following points: how to take drug properly and safety, drug-drug and food-drug interactions, common side effects and how to manage them, lifestyle modifications. From the interviews, some important components of the establishment of a warfarin clinic included financial support, increased human resources, improved the system of keeping patients’ medical records, short course training for pharmacists. This study indicated the acceptance of healthcare professionals on the important roles of pharmacists and the feasibility of setting up warfarin clinic by working together with the multidisciplinary health care team in order to help improve health outcomes of patients using warfarin at Mahosot Hospital, Lao PDR.

Keywords: perspectives, healthcare professional, warfarin therapy, Mahosot Hospital

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Authors: Adil Mustafa, Ahmet Erten, Alper Kiraz, Melikhan Tanyeri

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Work presented here is based on a novel experimental technique used to hydrodynamically trap oil microdroplets inside a microfluidic chip at the junction of microchannels known as stagnation point. Hydrodynamic trapping has been recently used to trap and manipulate a number of particles starting from microbeads to DNA and single cells. Benzyl Benzoate (BB) is used as droplet material. The microdroplets are trapped individually at stagnation point and their dissolution was observed. Experiments are performed for two concentrations (10mM or 10µM) of AOT surfactant (Docusate Sodium Salt) and two flow rates for each case. Moreover, experimental data is compared with Zhang-Yang-Mao (ZYM) model which studies dissolution of liquid microdroplets in the presence of a host fluid experiencing extensional creeping flow. Industrial processes like polymer blending systems in which heat or mass transport occurs experience extensional flow and an insight into these phenomena is of significant importance to many industrial processes. The experimental technique exploited here gives an insight into the dissolution of liquid microdroplets under extensional flow regime. The comparison of our experimental results with ZYM model reveals that dissolution of microdroplets at lower surfactant concentration (10µM) fits the ZYM model at saturation concentration (Cs) value reported in literature (Cs = 15×10⁻³Kg\m³) while for higher surfactant concentration (10mM) which is also above the critical micelle concentration (CMC) of surfactant (5mM) the data fits ZYM model at (Cs = 45×10⁻³Kg\m³) which is 3X times the value reported in literature. The difference in Cs value from the literature shows enhancement in dissolution rate of sparingly soluble BB microdroplets at surfactant concentrations higher than CMC. Enhancement in the dissolution of sparingly soluble materials is of great importance in pharmaceutical industry. Enhancement in the dissolution of sparingly soluble drugs is a key research area for drug design industry. The experimental method is also advantageous because it is robust and has no mechanical contact with droplets under study are freely suspended in the fluid as compared existing methods used for testing dissolution of drugs. The experiments also give an insight into CMC measurement for surfactants.

Keywords: extensional flow, hydrodynamic trapping, Zhang-Yang-Mao, CMC

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Authors: Giovana Longo-Silva, Risia Cristina Egito de Menezes, Renan Serenini, Márcia de Oliveira Lima, Júlia Souza de Melo, Larissa de Lima Soares

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Introduction: Sleep duration and quality have been increasingly recognized as important factors affecting overall health and well-being, including their potential impact on body weight and composition. Previous research has shown inconsistent results regarding the association between sleep patterns and body mass index (BMI), particularly among diverse populations such as Brazilian adults. Understanding these relationships is crucial for developing targeted interventions to address obesity and related health issues. Objective: This study aimed to investigate the association between sleep duration, insomnia, and BMI among Brazilian adults using data from a large national survey focused on chronic nutrition and sleep habits. Materials and Methods: The study included 2050 participants from a population-based virtual survey. BMI was calculated using self-reported weight and height measurements. Participants also reported usual bedtime and wake time on weekdays and weekends and whether they experienced symptoms of insomnia. The average sleep duration across the entire week was calculated as follows: [(5×sleep duration on weekdays) + (2×sleep duration on weekends)]/7. Linear regression analyses were conducted to assess the association between sleep duration, insomnia, and BMI, adjusting for potential confounding factors, including age, sex, marital status, physical exercise duration, and diet quality. Results: After adjusting for confounding variables, the study found that BMI decreased by 0.19 kg/m² for each additional hour of sleep duration (95% CI = -0.37, -0.02; P = 0.03). Conversely, individuals with insomnia had a higher BMI, with an increase of 0.75 kg/m² (95% CI = 0.28, 1.22; P = 0.002) compared to those without insomnia. Conclusions: The findings suggest a significant association between sleep duration, insomnia, and BMI among Brazilian adults. Longer sleep duration was associated with lower BMI, while insomnia was associated with higher BMI. These results underscore the importance of considering sleep patterns in strategies aimed at preventing and managing obesity in this population. Further research is needed to explore the underlying mechanisms and potential interventions targeting sleep-related factors to promote healthier body weight outcomes.

Keywords: sleep, obesity, chronobiology, nutrition

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Authors: Carmen Axisa, Louise Nash, Patrick Kelly, Simon Willcock

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Introduction: Doctors experience high levels of burnout, stress and psychiatric morbidity. This can affect the health of the doctor and impact patient care. Study Aims: To evaluate the effectiveness of a workshop intervention to promote wellbeing for Australian Physician Trainees. Methods: A workshop was developed in consultation with specialist clinicians to promote health and wellbeing for physician trainees. The workshop objectives were to improve participant understanding about factors affecting their health and wellbeing, to outline strategies on how to improve health and wellbeing and to encourage participants to apply these strategies in their own lives. There was a focus on building resilience and developing long term healthy behaviours as part of the physician trainee daily lifestyle. Trainees had the opportunity to learn practical strategies for stress management, gain insight into their behaviour and take steps to improve their health and wellbeing. The workshop also identified resources and support systems available to trainees. The workshop duration was four and a half hours including a thirty- minute meal break where a catered meal was provided for the trainees. Workshop evaluations were conducted at the end of the workshop. Sixty-seven physician trainees from Adult Medicine and Paediatric training programs in Sydney Australia were randomised into intervention and control groups. The intervention group attended a workshop facilitated by specialist clinicians and the control group did not. Baseline and post intervention measurements were taken for both groups to evaluate the impact and effectiveness of the workshop. Forty-six participants completed all three measurements (69%). Demographic, personal and self-reported data regarding work/life patterns was collected. Outcome measures include Depression Anxiety Stress Scale (DASS), Professional Quality of Life Scale (ProQOL) and Alcohol Use Disorders Identification Test (AUDIT). Results: The workshop was well received by the physician trainees and workshop evaluations showed that the majority of trainees strongly agree or agree that the training was relevant to their needs (96%) and met their expectations (92%). All trainees strongly agree or agree that they would recommend the workshop to their medical colleagues. In comparison to the control group we observed a reduction in alcohol use, depression and burnout but an increase in stress, anxiety and secondary traumatic stress in the intervention group, at the primary endpoint measured at 6 months. However, none of these differences reached statistical significance (p > 0.05). Discussion: Although the study did not reach statistical significance, the workshop may be beneficial to physician trainees. Trainees had the opportunity to share ideas, gain insight into their own behaviour, learn practical strategies for stress management and discuss approach to work, life and self-care. The workshop discussions enabled trainees to share their experiences in a supported environment where they learned that other trainees experienced stress and burnout and they were not alone in needing to acquire successful coping mechanisms and stress management strategies. Conclusion: These findings suggest that physician trainees are a vulnerable group who may benefit from initiatives that promote wellbeing and from a more supportive work environment.

Keywords: doctors' health, physician burnout, physician resilience, wellbeing workshop

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Authors: Subhash Nerella, Ziyuan Guan, Azra Bihorac, Parisa Rashidi

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Intensive care units (ICUs) provide care to critically ill patients in severe and life-threatening conditions. However, patient monitoring in the ICU is limited by the time and resource constraints imposed on healthcare providers. Many critical care indices such as mobility are still manually assessed, which can be subjective, prone to human errors, and lack granularity. Other important aspects, such as environmental factors, are not monitored at all. For example, critically ill patients often experience circadian disruptions due to the absence of effective environmental “timekeepers” such as the light/dark cycle and the systemic effect of acute illness on chronobiologic markers. Although the occurrence of delirium is associated with circadian disruption risk factors, these factors are not routinely monitored in the ICU. Hence, there is a critical unmet need to develop systems for precise and real-time assessment through novel enabling technologies. We have developed the mobility and circadian disruption quantification system (Mobi-DiQ) by augmenting biomarker and clinical data with pervasive sensing data to generate mobility and circadian cues related to mobility, nightly disruptions, and light and noise exposure. We hypothesize that Mobi-DiQ can provide accurate mobility and circadian cues that correlate with bedside clinical mobility assessments and circadian biomarkers, ultimately important for delirium risk assessment and prevention. The collected multimodal dataset consists of depth images, Electromyography (EMG) data, patient extremity movement captured by accelerometers, ambient light levels, Sound Pressure Level (SPL), and indoor air quality measured by volatile organic compounds, and the equivalent CO₂ concentration. For delirium risk assessment, the system recognizes mobility cues (axial body movement features and body key points) and circadian cues, including nightly disruptions, ambient SPL, and light intensity, as well as other environmental factors such as indoor air quality. The Mobi-DiQ system consists of three major components: the pervasive sensing system, a data storage and analysis server, and a data annotation system. For data collection, six local pervasive sensing systems were deployed, including a local computer and sensors. A video recording tool with graphical user interface (GUI) developed in python was used to capture depth image frames for analyzing patient mobility. All sensor data is encrypted, then automatically uploaded to the Mobi-DiQ server through a secured VPN connection. Several data pipelines are developed to automate the data transfer, curation, and data preparation for annotation and model training. The data curation and post-processing are performed on the server. A custom secure annotation tool with GUI was developed to annotate depth activity data. The annotation tool is linked to the MongoDB database to record the data annotation and to provide summarization. Docker containers are also utilized to manage services and pipelines running on the server in an isolated manner. The processed clinical data and annotations are used to train and develop real-time pervasive sensing systems to augment clinical decision-making and promote targeted interventions. In the future, we intend to evaluate our system as a clinical implementation trial, as well as to refine and validate it by using other data sources, including neurological data obtained through continuous electroencephalography (EEG).

Keywords: deep learning, delirium, healthcare, pervasive sensing

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Authors: L. Korpinen, P. Taskinen, P. Rautio

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This study aimed to describe procedures that we developed to use in the quantitative, bone-specific SPECT/CT at our hospital. Our procedures included the following questions for choosing imaging protocols, which were based on a clinical doctor's referral: (1) Is she/he a cancer patient or not? (2) Are there any indications of inflammatory rheumatoid arthritis? We performed about 1,106 skeletal scintigraphies over two years. About 394 patients were studied with quantitative bone-specific single-photon emission computed tomography/computerized tomography (SPECT/CT) (i.e., about 36% of all bone scintigraphies). Approximately 64% of the patients were studied using the conventional Anterior-Posterior/Posterior-Anterior imaging. Our procedure has improved efficiency and decreased cycle times.

Keywords: skeletal scintigraphy, SPECT/CT, imaging, procedure

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Authors: Rebecca K. Blais, Lindsey Monteith, Hallie Tannahill

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Military sexual trauma (MST) includes sexual harassment or assault that occurred during military service. Studies conducted to date on the association of MST with mental health and suicide outcomes are generally circumscribed to either active duty or veteran samples, precluding a thorough analysis of developmental trajectories of distress following MST within the context of ongoing (vs. discharged from) military service. The Military Social Science Laboratory has collected data on mixed service samples of men and women service members, addressing this important literature gap. The purpose of this study was to examine the association of MST, suicide risk, PTSD, depression, alcohol use, and posttraumatic cognitions using two separate samples, which collectively allow for a comprehensive examination of the development of distress following MST. The first sample consisted of 1389 men and women service members and veterans with varying levels of MST severity, including no MST, harassment-only MST, and assault MST. The second sample consisted of 400 men and women service members, all reporting the highest severity of MST, assault MST. In both samples, roughly half reported being discharged from service. Participants completed self-report measures of MST exposure severity, suicide ideation, suicide risk, PTSD, depression, alcohol misuse, and posttraumatic cognitions, as well as perceptions of how the military responded to their MST. Relative to those still serving in the US military, veterans were more likely to endorse suicidal ideation, higher PTSD symptoms, and higher depression symptoms if they felt the military mishandled their experience of MST (referred to as perceived institutional betrayal). However, among those reporting the most severe MST, veterans reported lower alcohol misuse and more adaptive posttraumatic cognitions. These findings suggest that those separated from the military experience different posttraumatic aftermath following MST relative to those who are currently serving in the military. Such findings suggest critical differences in the developmental trajectory of distress, necessitating different interventions to successfully reduce distress and dysfunction. Additional analyses will explore the impact of gender on these associations and explore full mechanistic models of distress grouped by discharged status.

Keywords: military sexual trauma, PTSD, suicide, developmental trajectories, depression

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Authors: A. Belmokhtar, A. Yahiaoui, A. Benyoucef, M. Belbachir

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We reported the synthesis and characterization of nanocomposite poly (4,4’ methylenedianiline) via chemical polymerization of monomers 4,4’ methylenedianiline by ammonium persulfate (APS) at room temperature catalyzed by Maghnite-H+. A facile method was demonstrated to grow poly (4,4’ methylenedianiline) nanocomposite, which was carried out by mixing Ammonium Persulfate (APS) aqueous and 4,4’ methylenedianiline solution in the presence of Maghnite-H+ at room temperature The effect of amount of catalyst and time on the polymerization yield of the polymers was studied. Structure was confirmed by elemental analysis, UV vis, RMN-1H, and voltammetry cyclique.

Keywords: charaterization, maghnite-h+, polymerization, poly (4, 4’ methylenedianiline)

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Authors: Belaynesh Tsegay, Teklay Gebrecherkos, Atsebaha Gebrekidan Kahsay, Mahmud Abdulkader

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Background: Hepatitis B and C viruses are important health and socioeconomic problem across the globe, with a remarkable number of diseases and deaths in sub-Saharan African countries. The burden of hepatitis is unknown in the prison settings of Tigray. Therefore, we aimed to describe the seroprevalence and associated factors of hepatitis B and C viruses among prisoners in Tigray, Ethiopia. Methods: A cross-sectional study was carried out from February 2020 to May 2020 at the prison facilities of Tigray. Demographics and associated factors were collected from 315 prisoners prospectively. Five milliliters of blood were collected and tested using rapid tests kits of HBsAg (Zhejiang orient Gene Biotech Co., Ltd., China) and HCV antibodies (Volkan Kozmetik Sanayi Ve Ticaret Ltd. STI, Turkey). Positive samples were confirmed using ELISA (Beijing Wantai Biological Pharmacy Enterprise Co. Ltd). Data were analyzed using the SPSS version 20, and p<0.05 was considered statistically significant. Results: The overall seroprevalence of HBV and HCV were 25 (7.9%) and 1 (0.3%), respectively. The majority of hepatitis B viral infections were identified from the age groups of 18–25 years (10.7%) and unmarried prisoners (11.8%). Prisoners greater than 100 per cell (AOR=3.95, 95% CI=1.15–13.6, p=0.029) and with a history of alcohol consumption (AOR=3.01, 95% CI=1.17–7.74, p=0.022) were significantly associated with HBV infections. Conclusion: The seroprevalence of HBV among prisoners was nearly high or borderline, with a very low HCV prevalence. HBV was most prevalent among young adults, those housed with a large number of prisoners per cell, and those who had a history of alcohol consumption. This study recommends that there should be prison-focused intervention, including regular health education, with the emphasis on the mode of transmission and introducing HBV screening policy for prisoners, especially when they enter the prison.

Keywords: seroprevalence, HBV, HCV, prisoners, tigray

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Authors: Benghezel Hichem

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Thyroid dysfunction in hemodialysis subjects is represented mainly by hypothyroidism. The objective of our work is to determine the thyroid profile of our hemodialysis patients and to highlight the prevalence of different thyroid disorders. Methods: This is a retrospective study performed on a mono centric 2 months (February and March 2013) on 42 hemodialysis patients (11 male and 31 female). We made the dosage of thyroid hormones Thyrotropin (TSH) ((free thyroxin ) FT4 and free Triodothyronin ) FT3) by chemiluminescence immunoassay method on cobas 6000 Roche Diagnostics. The results: The prevalence of biological hypothyroidism was 18% (7% with a high TSH isolated and a mean +/- SD 9.44 +/- 6.29, 5% with high TSH, and with low FT4 a mean +/- SD is 8.18 +/- 0.53 for TSH and 9.69 +/- 0.22 for FT4, One patient with a high TSH, and low FT4, FT3. 4% of patients with a low T3 syndrome with a mean +/- SD of 3.93 +/- 0,3 for FT3), we notice that 5% of patients with hyperthyroidism TSH collapsed and mean +/- SD of TSH is 0.017 +/- 0,001. Conclusion: The biological Hypothyroidism is a common endocrine disorder in chronic hemodialysis.

Keywords: hypothyroidism, hemodialysis, thyréostimulin, free thyroxin, triodothyronin

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Authors: Awad Mohamed Elkhadir, Rajab M. Ben Yousef

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Background/Aim: Radiological technologists are medical professionals who perform diagnostic imaging tests such as X-rays, magnetic resonance imaging (MRI) scans, and computer tomography (CT) scans. Despite the recognition of image interpretation by British radiologists, it is still considered a problem in the Arab world. This study evaluates the perceptions of radiologists in the Middle East concerning the plain image interpretation of adults by radiologic technologist specialists. Methods: This is a cross-sectional study that follows a quantitative approach. A close-ended questionnaire was distributed among 103 participants who were radiologists by profession from various hospitals in Saudi Arabia and Sudan. The gathered data was then analyzed through Statistical Package for Social Sciences (SPSS). Results: The results showed that 29% recognized the Radiologic Technologist Specialist (RTS) role of writing image reports, while 61% did not. A total of 38% of participants believed that RTS image interpretation would help diagnose unreported radiographs. 47% of the sample responded that the workload and stress on radiologists would reduce by allowing reporting for RTS, while 37% did not. Lastly, 43% believe that image interpretation by RTS can be introduced into the Middle East in the future. Conclusion: The study's findings reveal that the combination of image reporting and radiography improves the care of the patients. The study's outcomes also show that the burden of the medical practitioners reduces due to image reporting of the radiographers. Further researches need to be conducted in the Arab World to obtain and measure the associated factors of the desired criteria.

Keywords: Arab world, image interpretation, radiographer, radiologist, Saudi Arabia, Sudan

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Authors: Ali Kamal M. Sami, Safa Almukhtar, Alaa Al-Krush, Ismael Hama-Amin Akha Weas, Ruqaya Ahmed Alqais

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Introduction and Objectives Lower urinary tract symptoms (LUTS) are common among men with benign prostatic hyperplasia (BPH). The combination of 5 alpha-reductase inhibitors and alpha-blockers has been used as a conservative treatment of male LUTS secondary to BPH. Nanotechnology structured water magnalife is a type of water that is produced by modulators and specific frequency and energy fields that transform ordinary water into this Nanowater. In this study, we evaluated the use of Nano-water with the conservative treatment and to see if it improves the outcome and gives better results in those patients with LUTS/BPH. Material and methods For a period of 3 months, 200 men with International Prostate Symptom Score (IPSS)≥13, maximum flow rate (Qmax)≤ 15ml/s, and prostate volume > 30 and <80 ccs were randomly divided into two groups. Group A 100 men were given Nano-water with the (tamsulosindutasteride) and group B 100 men were given ordinary bottled water with the (tamsulosindutasteride). The water bottles were unlabeled and were given in a daily dose of 20ml/kg body weight. Dutasteride 0.5mg and tamsulosin 0.4 mg daily doses. Both groups were evaluated for the IPSS, Qmax, Residual Urine (RU), International Index of Erectile Function–Erectile Function (IIEF-EF) domain at the beginning (baseline data), and at the end of the 3 months. Results Of the 200 men with LUTS who were included in this study, 193 men were followed, and 7 men dropped out of the study for different reasons. In group A which included 97 men with LUTS, IPSS decreased by 16.82 (from 20.47 to 6.65) (P<0.00001) and Qmax increased by 5.73 ml/s (from 11.71 to 17.44) (P<0.00001) and RU <50 ml in 88% of patients (P<0.00001) and IIEF-EF increased to 26.65 (from 16.85) (P<0.00001). While in group B, 96 men with LUTS, IPSS decreased by 8.74(from 19.59 to 10.85)(P<0.00001) and Qmax increased by 4.67 ml/s(from 10.74 to 15.41)(P<0.00001), RU<50 ml in 75% of patients (P<0.00001), and IIEF-EF increased to 21(from 15.87)(P<0.00001). Group A had better results than group B. IPSS in group A decreased to 6.65 vs 10.85 in group B(P<0.00001), also Qmax increased to 17.44 in group A vs 15.41 in group B(P<0.00001), group A had RU <50 ml in 88% of patients vs 75% of patients in group B(P<0.00001).Group A had better IIEF-EF which increased to 26.65 vs 21 in group B(P<0.00001). While the differences between the baseline data of both groups were statistically not significant. Conclusion The use of nanotechnology structured water magnalife gives a better result in terms of LUTS and scores in patients with BPH. This combination is showing improvements in IPSS and even in erectile function in those men after 3 months.

Keywords: nano water, lower urinary tract symptoms, benign prostatic hypertrophy, erectile dysfunction

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Authors: Mrinalini Ranjan, Sudheesh Chethil

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Epilepsy is a common neurological disorder characterised by the recurrence of seizures. Electroencephalogram (EEG) signals are complex biomedical signals which exhibit nonlinear and nonstationary behavior. We use two methods 1) Detrended Fluctuation Analysis (DFA) and 2) Recurrence Plots (RP) to capture this complex behavior of EEG signals. DFA considers fluctuation from local linear trends. Scale invariance of these signals is well captured in the multifractal characterisation using detrended fluctuation analysis (DFA). Analysis of long-range correlations is vital for understanding the dynamics of EEG signals. Correlation properties in the EEG signal are quantified by the calculation of a scaling exponent. We report the existence of two scaling behaviours in the epileptic EEG signals which quantify short and long-range correlations. To illustrate this, we perform DFA on extant ictal (seizure) and interictal (seizure free) datasets of different patients in different channels. We compute the short term and long scaling exponents and report a decrease in short range scaling exponent during seizure as compared to pre-seizure and a subsequent increase during post-seizure period, while the long-term scaling exponent shows an increase during seizure activity. Our calculation of long-term scaling exponent yields a value between 0.5 and 1, thus pointing to power law behaviour of long-range temporal correlations (LRTC). We perform this analysis for multiple channels and report similar behaviour. We find an increase in the long-term scaling exponent during seizure in all channels, which we attribute to an increase in persistent LRTC during seizure. The magnitude of the scaling exponent and its distribution in different channels can help in better identification of areas in brain most affected during seizure activity. The nature of epileptic seizures varies from patient-to-patient. To illustrate this, we report an increase in long-term scaling exponent for some patients which is also complemented by the recurrence plots (RP). RP is a graph that shows the time index of recurrence of a dynamical state. We perform Recurrence Quantitative analysis (RQA) and calculate RQA parameters like diagonal length, entropy, recurrence, determinism, etc. for ictal and interictal datasets. We find that the RQA parameters increase during seizure activity, indicating a transition. We observe that RQA parameters are higher during seizure period as compared to post seizure values, whereas for some patients post seizure values exceeded those during seizure. We attribute this to varying nature of seizure in different patients indicating a different route or mechanism during the transition. Our results can help in better understanding of the characterisation of epileptic EEG signals from a nonlinear analysis.

Keywords: detrended fluctuation, epilepsy, long range correlations, recurrence plots

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Authors: Y. Teterin, S. Suleymanova, I. Dmitriev, P. Yartcev

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Introduction: One of the most common complications after pancreas transplantation are pancreatic fluid collections (PFCs), which are often complicated not only by infection and subsequent disfunction of the pancreatoduodenal graft (PDG), but also with a rather high mortality rate of recipients. Drainage is not always effective and often requires repeated open surgical interventions, which worsens the outcome of the surgery. Percutaneous drainage of PFCs combined with endoscopic stenting of the main pancreatic duct of the pancreatoduodenal graft (MPDPDG) showed high efficiency in the treatment of PFCs. Aims & Methods: From 01.01.2012 to 31.12.2021 at the Sklifosovsky Research Institute for Emergency Medicine were performed 64 transplantations of PDG. In 11 cases (17.2%), the early postoperative period was complicated by the formation of PFCs. Of these, 7 patients underwent percutaneous drainage of pancreonecrosis with high efficiency and did not required additional methods of treatment. In the remaining 4 patients, drainage was ineffective and was an indication for endoscopic stenting of the MPDPDG. They were the ones who made up the study group. Among them were 3 men and 1 woman. The mean age of the patients was 36,4 years.PFCs in these patients formed on days 1, 12, 18, and 47 after PDG transplantation. We used a gastroscope to stent the MPDPDG, due to anatomical features of the location of the duodenoduodenal anastomosis after PDG transplantation. Through the endoscope channel was performed selective catheterization of the MPDPDG, using a catheter and a guidewire, followed by its contrasting with a water-soluble contrast agent. Due to the extravasation of the contrast, was determined the localization of the defect in the PDG duct system. After that, a plastic pancreatic stent with a diameter of 7 Fr. and a length of 7 cm. was installed along guidewire. The stent was installed in such a way that its proximal edge completely covered the defect zone, and the distal one was determined in the intestinal lumen. Results: In all patients PDG pancreaticography revealed extravasation of a contrast in the area of the isthmus and body of the pancreas, which required stenting of the MPDPDG. In 1 (25%) case, the patient had a dislocation of the stent into the intestinal lumen (III degree according to Clavien-Dindo (2009)). This patient underwent repeated endoscopic stenting of the MPDPDG. On average 23 days after endoscopic stenting of the MPDPDG, the drainage tubes were removed and after approximately 40 days all patients were discharged in a satisfactory condition with follow-up endocrinologist and surgeon consultation. Pancreatic stents were removed after 6 months ± 7 days. Conclusion: Endoscopic stenting of the main pancreatic duct of the donor pancreas is by far the most highly effective and minimally invasive method in the treatment of PFCs after transplantation of the pancreatoduodenal complex.

Keywords: pancreas transplantation, endoscopy surgery, diabetes, stenting, main pancreatic duct

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Authors: C. Suphioglu , V. Simbag, J. Markham, C. Coady, S. Belward, G. Di Trapani, P. Chunduri, J. Chuck, Y. Hodgson, L. Lluka, L. Poladian, D. Watters

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Advances in science have made quantitative skills (QS) an essential graduate outcome for undergraduate science programs in Australia and other parts of the world. However, many students entering into degrees in Australian universities either lack these skills or have little confidence in their ability to apply them in their biological science units. It has been previously reported that integration of quantitative skills into life science programs appears to have a positive effect on student attitudes towards the importance of mathematics and statistics in biological sciences. It has also been noted that there is deficiency in QS resources available and applicable to undergraduate science students in Australia. MathBench (http://mathbench.umd.edu) is a series of online modules involving quantitative biology scenarios developed by the University of Maryland. Through collaboration with Australian universities, a project was funded by the Australian government through its Office for Learning and Teaching (OLT) to develop customized MathBench biology modules to promote the quantitative skills of undergraduate biology students in Australia. This presentation will focus on the assessment of changes in performance, perception and attitude of students in a third year Cellular Physiology unit after use of interactive online cellular diffusion modules modified for the Australian context. The modules have been designed to integrate QS into the biological science curriculum using familiar scenarios and informal language and providing students with the opportunity to review solutions to diffusion QS-related problems with interactive graphics. This paper will discuss results of pre and post MathBench quizzes composed of general and module specific questions that assessed change in student QS after MathBench; and pre and post surveys, administered before and after using MathBench modules to evaluate the students’ change in perception towards the influence of the modules, their attitude towards QS and on the development of their confidence in completing the inquiry-based activity as well as changes to their appreciation of the relevance of mathematics to cellular processes. Results will be compared to changes reported by Thompson et al., (2010) at the University of Maryland and implications for further integration of interactive online activities in the curriculum will be explored and discussed.

Keywords: quantitative skills, MathBench, maths in biology

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Authors: I. Bochev, A. Shterev, S. Kyurkchiev

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One of the factors associated with poor success rates in human in vitro fertilization (IVF) is the suboptimal culture conditions in which fertilization and early embryonic growth occur. Co-culture systems with helper cell lines appear to enhance the in vitro conditions and allow embryos to demonstrate improved in vitro development. The co-culture of human embryos with monolayers of autologous endometrial stromal cell (EnSCs) results in increased blastocyst development with a larger number of blastomeres, lower incidence of fragmentation and higher pregnancy rates in patients with recurrent implantation failure (RIF). The aim of the study was to examine the influence of autologous endometrial stromal cell (EnSC) co-culture on day 3 embryo quality by comparing the morphological status of the embryos from the same patients undergoing consecutive IVF/Intracytoplasmic sperm injection (ICSI) cycles without and with EnSC co-culture. This retrospective randomized study (2015-2017) includes 20 couples and a total of 46 IVF/ICSI cycles. Each patient couple included had at least two IVF/ICSI procedures – one with and one without autologous EnSC co-culture. Embryo quality was assessed at 68±1 hours in culture, according to Istanbul consensus criteria (2010). Day 3 embryos were classified into three groups: good – grade 1; fair – grade 2; poor – grade 3. Embryos from all cycles were divided into two groups (A – co-cultivated; B – not co-cultivated) and analyzed. Second, for each patient couple, embryos from matched IVF/ICSI cycles (with and without co-culture) were analyzed separately. When an analysis of co-cultivated day 3 embryos from all cycles was performed (n=137; group A), 43.1% of the embryos were graded as “good”, which was not significantly different from the respective embryo quality rate of 42.2% (p = NS) in group B (n=147) with non-co-cultivated embryos. The proportions of fair and poor quality embryos in group A and group B were similar as well – 11.7% vs 10.2% and 45.2% vs 47.6% (p=NS), respectively. Nevertheless, the separate embryo analysis by matched cycles for each couple revealed that in 65% of the cases the proportion of morphologically better embryos was increased in cycles with co-culture in comparison with those without co-culture. A decrease in this proportion after endometrial stromal cell co-cultivation was found in 30% of the cases, whereas no difference was observed in only one couple. The results demonstrated that there is no marked difference in the overall morphological quality between co-cultured and non-co-cultured embryos on day 3. However, in significantly greater percentage of couples the process of autologous EnSC co-culture could increase the proportion of morphologically improved day 3 embryos. By mimicking the in vivo relationship between embryo and maternal environment, co-culture in autologous EnSC system represents a perspective approach to improve the quality of embryos in cases with elevated risk for development of embryos with impaired morphology.

Keywords: autologous endometrial stromal cells, co-culture, day 3 embryo, morphological quality

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Authors: Karthikeyan M., Paul M. J.

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This abstract describes a case of central pancreatectomy (CP) for a 50-year-old woman with a neuroendocrine tumor in the mid-body of the pancreas. CP, a parenchyma-sparing surgical option, preserves the distal pancreas and spleen, reducing the risk of pancreatic endocrine and exocrine insufficiency compared to traditional resections. The patient, initially misdiagnosed with transient ischemic attack, presented with hypoglycemic symptoms and was found to have a pancreatic lesion. Post-operative results were positive, with a reduction in pancreatic drain volume and normalization of blood sugar levels. This case highlights CP's efficacy in treating centrally located pancreatic lesions while maintaining pancreatic function.

Keywords: central pancreatectomy without anastomosis, no endocrine deficiency on follow-op, less post-op hospital stay, less post-op complications

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Authors: Firas Gerges, Frank Y. Shih

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Malignant melanoma, known simply as melanoma, is a type of skin cancer that appears as a mole on the skin. It is critical to detect this cancer at an early stage because it can spread across the body and may lead to the patient's death. When detected early, melanoma is curable. In this paper, we propose a deep learning model (convolutional neural networks) in order to automatically classify skin lesion images as malignant or benign. Images underwent certain pre-processing steps to diminish the effect of the normal skin region on the model. The result of the proposed model showed a significant improvement over previous work, achieving an accuracy of 97%.

Keywords: deep learning, skin cancer, image processing, melanoma

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