Rajesh Varma
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Synchronous seminoma and Langerhans cell histiocytosis with a multilocular thymic cyst: A rare case report
No full textA 28-year-old man with an anterior mediastinal mass underwent total thymectomy. The surgical specimen showed multilocular cysts and nodules. On microscopic examination, the cysts were lined by squamoid epithelium, consistent with thymic cysts and tumors showing two different histologic features were identified. One tumor component was composed of sheets of monotonous, oval-to-round nuclei with pale cytoplasm and indistinct cell borders. The other tumor component comprised sheets of grooved cells admixed with eosinophils. Immunohistochemical analysis revealed different staining patterns in each component: the former was positive for D2-40, c-kit and OCT3/4; and the latter was positive for S100 protein and CD1a. Based on these histopathological and immunohistochemical findings, we diagnosed the tumor as a synchronous seminoma and Langerhans cell histiocytosis along with a thymic cyst. To the best of our knowledge, this is the first case of the coexistence of these lesions in the thymus. Coronavirus Disease 2019 (COVID-19) is caused by the Severe Acute Respiratory Syndrome Coronavirus 2(SARS-CoV-2) that is associated with several inflammatory and vascular endothelial complications. Ocular vascular occlusive events were reported in COVID-19 patients including both Central Retinal Vein Occlusion (CRVO) and Central Retinal Artery Occlusion (CRAO). We report a case of a 34-years-old patient with right CRVO after 14 days of COVID-19 infection presenting with decreased vision. In addition, we provide a summary of both CRVO and CRAO reported in the literature.</p
Stools for Stools-combining a multi-disciplinary approach with conservative measures to reduce constipation in the elderly inpatient population
No full textIntroduction: Constipation is a common cause of morbidity in the elderly. Its management is particularly challenging in the inpatient population where many factors exacerbate constipation. We describe a Quality Improvement Project to reduce constipation in a Care of the Elderly ward, including conservative measures to complement medical treatment.Aims: To increase bowel motion frequency to at least once every two days in elderly inpatients, and to increase bowel chart documentation.Methods: Weekly monitoring of ward inpatients. Measurements taken were: days since last bowel motion, laxatives prescribed, documentation on bowel charts and ward rounds, and episodes of diarrhea. A new intervention was introduced every two weeks, over a total of 10 weeks.Interventions: The 4 interventions introduced were: 1) Recording bowel motions at the daily ‘Board Round’ Multi-Disciplinary Meeting. 2) Ward staff education sessions. 3) Footstools for use with commodes and toilets. 4) High-fibre foods for patients with constipation.Results: Bowel motion frequency improved, with 100% of patients moving bowels every 2 days from a baseline of 66.6%. Ward round and bowel chart documentation improved to 100% and 92.9% (from 41.6% and 33.3%). Laxative prescriptions increased from 50% to 78.6%, with no increase in episodes of diarrhea. Conclusions: Constipation improved with our interventions but was accompanied by increased laxative prescriptions, which carry a risk of side effects. Our next steps will be to optimize our conservative measures to reduce laxative prescriptions, and to this end, we have developed high-fiber snack boxes to aid constipation in elderly patients.</p
Jump-landings that supersede bone health threshold requirements for premenopausal women
No full textOsteoporosis is a disease characterized by a reduction in the density and quality of bone leading to a weakness of the skeleton and associated increased risk of fracture [1]. The most common type of osteoporosis is termed primary osteoporosis and includes both postmenopausal and age-related osteoporosis, </p
Two examples of environmental problems from Chinese state planning
No full textWe present two recent and environmentally potentially catastrophic but otherwise politically decisive and perhaps even praiseworthy governmental actions of the Peoples Republic of China. One is China’s world-renowned Three Gorges Dam project. This is perhaps one of the world’s largest hydroelectric dams as yet and most certainly the daring and even audacious construction project. Sadly, it also defies the understanding of atmospheric circulation patterns. The other is the construction and use of atoll reefs to house military bases. This too is certainly a brilliantly conceived novel idea but its time has been unfortunately ushered perhaps a couple of million years too early. Both these are examples of the most brilliantly executed but otherwise ill-conceived notions that should not have been undertaken in the first place.</p
Features of the use of ungulates by oxpeckers (Buphagus) in central Kenya
No full textA detailed multi-year observational study of Red-Billed (RB) oxpecker (Buphagus erythrorhynchus) and yellow-billed (YB) oxpecker (B. Africanus) occurrence on a range of ungulate species was performed in two Kenyan national parks. Surprisingly observation of over 2100 individual Kongoni, in group sizes of 1 to > 50, revealed a total absence of oxpeckers, of either species, on Kongoni (Alcephalus buselaphus: subfamily Alcephalinae) in Nairobi National Park (NNP), although it was one of the most common bovid species present. There is no population of A. buselaphus at the second study site in central Kenya, Lake Nakuru National Park (LNNP). By contrast, the Impala (Aepyceros melampus), a smaller species, whose taxonomic status is phylogenetically ambiguous, but is widely considered to have evolved relatively recently in Africa, was a frequent oxpecker host in both NNP (29% of animals observed) and LNNP (12.9% of individual animals observed. Two species of gazelle Thompson’s gazelle (Gazella rufifrons)) and Grant’s gazelle (G. granti), subfamily Gazellinae, which were present in both parks but in relatively low abundance, were also not observed to host oxpeckers. The reason for these bovid subfamilies, apparently not being utilized as oxpecker hosts in central Kenya, is unclear and requires further research. </p
High-precision blood glucose prediction and hypoglycemia warning based on the LSTM-GRU model
No full textObjective: The performance of blood glucose prediction and hypoglycemia warning based on the LSTM-GRU (Long Short Term Memory - Gated Recurrent Unit) model was evaluated.Methods: The research objects were 100 patients with Diabetes Mellitus (DM) who were chosen from Henan Provincial People’s Hospital. Their continuous blood glucose curves of 72 hours were acquired by a Continuous Glucose Monitoring System (CGMS). The blood glucose levels were predicted based on the LSTM, GRU and LSTM-GRU models, respectively. Analyses of the best predictive model were performed using Root Mean Square Error (RMSE), Mean Absolute Percentage Error (MAPE), Mean Absolute Error (MAE) and correlation analysis between the prediction blood glucose level and the original blood glucose level acquired by CGMS and Clark Error Grid Analysis (EGA). Repeated-measures analysis of variance (ANOVA) was used to analyze whether the RMSE values of the three models were statistically significant. 60 patients who had experienced hypoglycemia among 100 cases were selected for hypoglycemia warning. The sensitivity, false-positive rate and false-negative rate were used to evaluate the hypoglycemia warning performance of the LSTM-GRU model. This paper explored the changing relationship of the hypoglycemia warning performance of the model over time.Results: The predicted blood glucose levels of the three models were strongly correlated with the blood glucose levels acquired by CGMS (p < 0.001). The correlation coefficient (R-value) of the LSTM-GRU model remained stable over time (R = 0.995), nevertheless, a reduction in the R-value of the LSTM and GRU models when the Prediction Horizon (PH) was 30 min or longer. When PH was 15min, 30min, 45min and 60min, the mean RMSE values of the LSTM-GRU model were 0.259, 0.272, 0.275 and 0.278 (mmol/l), respectively, which were lower than the LSTM and GRU models and the RMSE values were statistically significant (p < 0.001). The EGA results showed the LSTM-GRU model had the highest proportion in zones A and B, as the PH extended. When PH was 30min or longer, the sensitivity and false-negative rate of the hypoglycemia warning of the LSTM-GRU model had subtle changes and the false-positive rate remained stable over time.Conclusions: The LSTM-GRU model demonstrated good performance in blood glucose prediction and hypoglycemia warning. </p
Efficacy of olfactory training program in conjunction with nasal steroid irrigation in treating persistent smell loss in COVID-19 patients
No full textBackground: Smell loss is a challenging clinical problem. There is still no evidence-based medical intervention to treat patients with persistent smell loss as a result of Coronavirus Disease 2019 (COVID-19). The aim is to analyze the efficacy of treating patients with persistent smell loss due to COVID-19 using olfactory training (OT) combined with nasal steroid irrigation. Methods: A cross-sectional study enrolled 196 COVID-19 patients with persistent smell loss were recruited. All patients underwent two testing sessions. At the first session, patients were examined by a history taking followed by an Otorhinolaryngological examination including, a thorough nasal endoscopy. In addition, an olfactory performance assessment was performed to assess the severity of smell loss. All patients were then treated with OT and nasal steroid irrigation with budesonide for 12 weeks. The second session includes an olfactory performance assessment to assess if there is an improvement in olfactory function. Results: Patients after treatment showed improvement in overall Threshold-Detection-Identification (TDI) score, odor detection threshold score, odor discrimination score, and odor identification score, which were higher than before treatment. Statistically significant differences before and after treatment results were very pronounced for the overall TDI score (p = 0.014) and odor detection threshold score (p = 0.003). There was no significant difference in odor discrimination (p = 0.08) or odor identification (p = 0.126) scores before and after treatment. Conclusion: The results of this study support the efficacy of the combination of budesonide nasal irrigation and OT in treating persistent smell loss due to COVID-19 infection.</p
Proportion and associated factors of sexual violence among female night junior school students in Gondar town, Northwest, Ethiopia, 2019
No full textIntroduction: Sexual violence is a series public of health problems and human right issues affecting millions of people each year throughout the world with short and long-term impacts on women and girls’ physical, mental, sexual, and reproductive health. Therefore, this study aims to assess the magnitude of sexual violence and associated factors among night school female students in the study area. Methods: Institution-based cross-sectional study design was conducted among 422 night junior school female students in Gondar town, Northwest, Ethiopia. Participants were selected by using simple random sampling and data were collected by self - administered structured questionnaire. Data entry and analysis was done by EPI info version 7 and SPSS statistical packages version 20 respectively and descriptive statistics were done. Moreover, binary logistic regression analyses were also carried out to identify factors associated with sexual violence.Results: In this study, the mean age (+_SD) study participants was 19.3±3.1years. The the proportion of school life sexual violence in this study was found to be 63.4% with a 95% the confidence interval of (57.9, 67.1). the overall 91 (21.9%) of the participants were faced attempted rape in their school life. Regarding sexual harassment at least one form of sexual harassment was reported among 244 (58.8%) from these 135 (32.5%) unwanted sexual Act/asked to have sex, about 152(36.6%) faced unwelcome touching body parts like breast, and 131 (31.6%) faced unwelcome kissing. School life sexual violence was positively associated with those females who had ever started sexual intercourse (AOR= 0.58, 95%CI, 0.362, 0.924), being rural child-hood residence (AOR=) 1.9, 95%CI 1.2,2.9) and traveling more than 30 minutes from school to home (AOR= 2.2,95%CI, 1.124, 4.452).Conclusion: The proportion of sexual violence in this study area was relatively high and it was significantly associated with being a rural child -hood residence. Therefore, appropriate intervention is needed Especially those students who grew up in a rural areas during the child-hood period.</p
The amazing systemic structure of Mathematics
No full textStarting with the works of Ludwig von Bertalanffy, the general systems theory went from being applied to biological systems to identifying systemic structures in different natural, technological and social phenomena, even systemic structures are appreciated in different branches of science.</p
Holistic and individualized interventions for behavioral and psychological symptoms of dementia
No full textSince “living well with dementia” is a concept that varies from person to person, the care provided is expected to be customized to the individual needs of each person with dementia. Support is expected to involve shared decision-making between people with dementia and their caregivers, and a comprehensive geriatric assessment within the framework of the International Classification of Functioning, Disability, and Health is expected to be conducted to help these persons with dementia realize their goals. Additionally, the Plan-Do-Check-Act cycle is expected to be regularly implemented to verify the effectiveness of the intervention. Although the disability of the individual with dementia increases as the disease progresses, it is important to support them to live positively by reducing their difficulties in daily living.</p