Basic Investigations Research Articles

Complications of Induction of Labour with Foley's Catheter in Patients with a Previous Cesarean Section

Background: Management of IUFD has immense significance in today’s obstetric practice. To summarize, dinoprostone gel, misoprostol and intra cervical catheter can be used for induction of labour in second and third trimester IUFD. Mechanical methods, i.e. the use of Foley’s catheter balloon, though effective have not gained much popularity because of the fear of infection. Objective: To observed the complications of induction of labor with Foley's catheter in patients with a previous cesarean section. Materials and Methods: The observational study was carried out in the Department of Obstetrics & Gynecology, Dhaka Medical College Hospital. Dhaka, Bangladesh. Total 52 patients with singleton pregnancy with IUFD, at ≥28 weeks of gestation was attending in the Department of Obstetrics & Gynae were included in this study. Details of history, general physical and systemic examination, ultrasonography, basic laboratory investigations like haemoglobin level, and DIC profile were recorded. Results: Forty three (82.7%) received augmentation with oxytocin, 3(5.8%) developed scar tenderness and 8(15.4%) had failed induction. Failed ICC was found 8 cases, among them 5(62.5%) had dinoprostone gel used followed by vaginal birth, 2(25.0%) had LUCS and 1(12.5%) had laparotomy. Induction delivery interval was found 16.3±5.5 hours. Regarding maternal outcome 49(94.2%) patients had normal vaginal delivery, 4(7.7%) had PPH, 3(5.8%) had fever, 2(3.8%) were ICU admission, 1(1.9%) had laparotomy and 1(1.9%) had rupture uterus. Conclusion: Common maternal complications were PPH, fever, ICU admission, laparotomy and rupture uterus. Induction can be done safely in carefully selected cases of previous LSCS with Foley’s Balloon.

Microalbuminuria in Children With Sickle Cell Disease in the Eastern Province of Saudi Arabia.

Sickle cell disease (SCD) complications, such as sickle cell nephropathy (SCN), may begin in childhood and progress insidiously to chronic kidney disease in adulthood. In Saudi Arabia (SA), there is a lack of studies evaluating kidney function in children with SCD. This study aims to assess microalbuminuria (MA) as an early marker of renal dysfunction in SCD children living in the Eastern region of SA, to potentially institute appropriate early treatment. A prospective cross-sectional study was conducted on 114 Saudi children with SCD under the age of 14 years who attended the pediatric hematology clinic for routine follow-up. Demographic and clinical information were collected from the patients and their parents, who provided informed consent. Morning urine samples were collected and tested for the presence of MA using the urinary albumin/creatinine ratio (ACR). Blood samples were also collected for basic laboratory investigations. The prevalence of MA and its correlation with various clinical and laboratory data were analyzed. Additionally, a comparison of clinical characteristics and MA was conducted between children originating from the Southwestern (SW) and Eastern regions of the country, all of whom lived in the Eastern Province. A total of 114 children with SCD were included in the study. The mean age was 8.8 ± 3.2 years, with a male-to-female ratio of 1.3:1. Based on their region of origin, they were divided into two groups: Eastern (n = 26/114) and SW (n = 88/114). MA was detected in 28 patients (24.6%), with no significant difference in prevalence between the two groups. There was no significant statistical difference in clinical and laboratory data between the groups, except for hemoglobin F (HBF) levels and the use of hydroxyurea (HU). HBF levels were significantly higher in children from the Eastern region, while more SW patients used HU. No correlation was found between MA and any of the studied variables. MA is common in children with SCD in the Eastern region of SA, with no difference in its prevalence between children of the two different ancestries carrying the Arab-Indian (AI) and African haplotypes. It is not associated with any of the studied clinical variables in this report. Further studies are needed to confirm these findings.

General dermatology and dermatology in primary health care.

Young boy with high output diarrhea, who was extremely lethargic and irritable, presented with unusual peri-anal plaques extending to thighs. Close clinical examination and basic laboratory investigation clinched the diagnosis of acrodematitis enteropathica. Oral zinc supplementation resulted in rapid resolution of skin lesions and improvement in altered mental status, within 72 hours, which is pathognomonic.

The Diverse Aspects of Uterine Serous Cancer: An NCI workshop on the status of and opportunities for advancement of research.

The marked increase in incidence and mortality in endometrial cancer over the last two decades is driven in part by rising rates of higher grade, more aggressive endometrial cancers with mutations in TP53, uterine serous cancers and their dedifferentiated component, uterine carcinosarcomas (collectively USC). USC rates have been increasing among all racial and ethnic groups, with higher rates of this aggressive uterine cancer in Black women. The National Cancer Institute (NCI) hosted a workshop in June 2023 to examine the diverse aspects of USC across epidemiology, biology, and molecular genetics, and to advance knowledge from basic to preclinical and translational efforts. Key stakeholders came together including basic scientists, clinical investigators, and patient advocates to identify critical research gaps that, when addressed, would facilitate more comprehensive and rapid progress in understanding and ultimately treating USC across all patients. NCI released a supplemental funding opportunity (NOT-CA-24-044) in Spring 2024 to facilitate rapid translation of these recommendations.

Innovations in Phytoremediation: Application of Artificial Wetlands for the Contaminated Water Treatment and Heavy Metals Removal

Objective: The objective of this study was a review to compile research on phytoremediation methods—including phytoextraction, rhizofiltration, phytostabilisation, phytodegradation, and phytovolatilisation—using primary sources to address heavy metal contamination in water. Theoretical Framework: The study is a basic investigation that includes a contextualization regarding the water issue, as well as the treatment of wastewater. A description of the characteristics and quality indicators of water was carried out, along with the importance of the removal of contaminants such as heavy metals using different technologies like phytoextraction, rhizofiltration, phytostabilization, phytodegradation, and phytovolatilization. This led to a detailed description of artificial wetland techniques as a viable and sustainable alternative. Method: The methodology adopted for this research includes data collection and compilation of existing information; regarding the different techniques related to wastewater treatment with artificial wetlands, these systems utilize natural processes involving vegetation, soil, and microbial activity to remove contaminants from water. More than 100 articles have been legally downloaded, and systematised in the database to paraphrase sentences and cite appropriately. Results and Discussion: Phytoremediation is an environmentally friendly technical choice because of its low cost to remediate water and soil contamination through methods of phytoextraction, rhizofiltration, phytostabilisation, phytodegradation and phytovolatilisation for organic contaminants, pesticides, oil waste, heavy metals, antibiotics, etc. It is relevant to choose transgenic plant methods to insert DNA genes and conduct molecular mechanisms through experimental optimisation studies for lightened growth and hyperaccumulation of heavy metals, generating space for metal and biomass storage, and prior knowledge of the physiology and biochemical processes of the plants. Research Implications: The results can be applied or influence practices in environmental protection using Phytoremediation, which is based on a natural technique of plants and their microbiota associated with roots and tissues, endophytic bacteria as Aeromonas sp, Pseudomonas sp, Bacillus sp, Sinorhizobium meliloti, Chryseomonas sp, Curtobacterium sp, Sphingomonas sp, Erwinia sp, Flavimonas sp retain contaminants. On the other hand, aquatic macrophytes such as Lemna spp, Typha spp, Potamogeton spp, Azolla filiculoides, Ceratophyllum demersm, Eichhornia crassipes, and Phragmites australis constitute an effective and feasible complementary alternative for the treatment of contaminated waters. Originality/Value: This study contributes to the literature There are different phytoremediation methods such as phytoextraction, rhizofiltration, phytostabilisation, phytodegradation, and hytovolatilisation for organic contaminants, pesticides, petroleum waste, heavy metals, pharmaceutical antibiotics, etc. Each of the elements has specific applications depending on the conditions of the place and the type of contaminants in an ecosystem.

Determination of the mechanical properties of the sacroiliac joint of a dog by imaging measurement methods and model update in a multi‐body model

AbstractThe sacroiliac joint (SIJ) is the articulated connection between the sacrum and the ilium and is a tight, combined, and only slightly mobile joint. In many dogs, the joint becomes stiff with age. As a result, the animal experiences pain while moving. Too little information is known about the degree of stiffening and the physiological range of motion for therapy. Consequently, recording the range of motion of different individuals (healthy and diseased) is a step toward a better understanding of the SIJ syndrome. For the basic investigation of the mechanical properties of the SIJ, post‐mortem examinations are performed on different individuals. To determine the mobility of the joint, the sacrum is fixed and a movement is forced on the ilium using actuators and recording the required forces. In addition, the spatial movement of the ilium and sacrum is measured. The kinematic and dynamic variables can be used to determine the translational and rotational stiffness of the SIJ. As it is not possible to apply directed loads to the ilium, the measurement data is used to determine the elastic parameters of the joint ligaments using heuristic methods. The multi‐body model includes the ilium, the ligaments, and the actuators of the test rig with their spatial orientation.

Investigation of Coffee Instant Premium by Subcritical Water Hydrolysis: Enhance of Caffeine and Antioxidant Contents

The current study observed a basic investigation into instant coffee production through subcritical water (SBW) hydrolysis. A series of SWB research in lab-scale were carried out to optimize the product qualities by adjusting the process parameters such as temperature, solvent amounts, and time for hydrolysis. The caffeine, antioxidant, pH changes, and morphologies of modified and unmodified coffee powder (commercial products) were also evaluated by SEM. The result showed that the optimum conditions were observed for SBW process at 170°C/11.18 ml/20 min with obtained 0.48 mg/ml and 29.40 µg/ml for antioxidant and caffeine, respectively. SEM images represented physical degradation of coffee extracted powder during hydrolysis. Further, the amount of coffee in the blend with mineral amount could be important sources of minerals to the human diet, as evident by EDX analysis. Further, the change of chemistry surface was also confirmed by FTIR. In summary, flow-through SBW hydrolysis of coffee extract promises for enhance caffeine and antioxidant.

Intra-orbital Foreign Body

Abstract Background: This case report describes a young man with an intra-orbital foreign body (FB) in both eyes. Case Report: Intra-orbital FBs are rare, with few cases reported in the literature. This is because the orbit protects the globe from external forces, and the orbit is a closed cavity with one opening. This report details the case of a 28-year-old man who presented to the emergency unit with an 11-hour history of an intra-orbital FB. The patient was lying on a bench when a stationary motorcycle fell on him. He noticed that he was unable to open both eyes and was rushed to a peripheral hospital, then subsequently referred to this tertiary center. On examination, he was ill-looking and anxious but not febrile or pale. Systemic examination did not reveal any abnormality. Unaided visual acuity in the right eye (OD) was nil perception of light, while left eye visual acuity (OS) was counting fingers. The right eyelid was ptotic due to edema. He underwent basic laboratory investigations that were all normal. A plain X-ray revealed a radio-opaque FB penetrating the left orbit, fracturing the medial walls into the right orbit, with the round end positioned behind the right globe. The FB was identified as a broken part of a brake/clutch lever from the motorcycle. A computerized tomography scan showed a metallic object in both orbits, accompanied by pneumocephalus, and suggested transection of the right optic nerve. The patient was prepared for FB removal and repair of the lid penetration under general anesthesia, following review by the ENT surgeon and neurosurgeon. The brake lever was successfully removed, and the patient was administered antibiotics. Post-operatively, visual acuity in the right eye remained at nil perception of light, while that in the left eye improved to 6/9 upon discharge. Conclusion: There is no established protocol for managing intra-orbital FBs, as removal depends on factors such as the size, composition, and potential compression damage to structures around the globe, which could further compromise vision or function. Small inert objects may be left in place if removal would cause damage. However, in this case, removal was deemed necessary for several reasons.

Clinical Significance of IL-6 Gene Polymorphism on Erythropoietin Responsiveness in Hemodialysis Patients

Abstract Background The plasma levels of the cytokine interleukin-6 (IL-6) have been reported to be associated with risk of chronic kidney disease (CKD) and erythropoietin (EPO) responsiveness. The G/C promoter polymorphism of IL-6 is associated with expression and levels of IL-6, so it may confer increased risk to CKD and modulate EPO responsiveness. Aim of the Work This study aims to evaluate the frequency of 174G/C IL-6 gene promoter polymorphism in hemodialysis (HD) patients and to assess the impact of this allelic variation on erythropoietin (EPO) responsiveness. Patients and Methods This study was conducted on fifty Chronic Kidney Disease (CKD) patients undergoing hemodialysis (HD) recruited from Nephrology Medicine Department at Ain Shams University hospitals, and ten healthy age and sex matched controls. All patients received recombinant human erythropoeitin (rHu-Epo) regimens for treatment of anemia. All the patients were subjected to full history taking, basic laboratory investigations (CBC, Iron profile and kidney function tests) as well as determination of IL-6 rs1800795 (-174 G/C) gene polymorphism using Real time-polymerase chain reaction technique (RT-PCR). The patient’s group was further classified into two subgroups according to Hb level in response to erythropoietin stimulating agents (ESAs) in accordance with the European Best Practice Guidelines, in which responders have a Hb level ≥11 g/dl, and ESA non-responders have a Hb level<11 g/dl. The Erythropoietin resistance index (ERI) was calculated for all patients, with a median (IQR) of 16.5 (14.31 - 19.96). Accordingly all patients were further classified into tertiles according to the ERI. The higher tertile group is classified as more hypo-responsive/resistant. Results In the present study, The IL-6 -174 G/G genotype was the most common among the cases group. Seventy four percent of the patients had the wild GG genotype and 24% had heterozygous GC genotype while only 2% had the homozygous CC genotype. In the control group the G/G genotype was detected in (80%) of subjects followed by G/C genotype (20%). No statistically significant difference was observed between the control and cases group regarding the IL-6 genotype frequencies. Only eight out of fifty (16%) patients reached the target Hb, 4 of them (50%) had the GG genotype and the other 4 (50%) had the GC genotype. The non-responders genotypes were distributed as 78.6% GG genotype, 19% GC genotype and 2.4% with CC genotype. There was no statistical significant difference regarding the genotype frequencies of IL-6 gene polymorphism between the two groups. Similarly no statistically significant association was found between the IL-6 gene genotypes and the ERI tertiles. Conclusion IL-6 -174 G/C gene polymorphism was not found to be associated with EPO hypo-responsiveness in CKD patients in the studied group nor with the increased Erythropoeitin resistance index (ERI) values among them.

The Remarkable X-Ray Spectra and Variability of the Ultraluminous Weak-line Quasar SDSS J1521+5202

We present a focused X-ray and multiwavelength study of the ultraluminous weak-line quasar (WLQ) SDSS J1521+5202, one of the few X-ray weak WLQs that is amenable to basic X-ray spectral and variability investigations. J1521+5202 shows striking X-ray variability during 2006–2023, by up to a factor of ≈32 in 0.5–2 keV flux, and our new 2023 Chandra observation caught it in its brightest X-ray flux state to date. Concurrent infrared/optical observations show only mild variability. The 2023 Chandra spectrum can be acceptably described by a power law with intrinsic X-ray absorption, and it reveals a nominal intrinsic level of X-ray emission relative to its optical/ultraviolet emission. In contrast, an earlier Chandra spectrum from 2013 shows apparent spectral complexity that is not well fit by a variety of models, including ionized absorption or standard Compton-reflection models. Overall, the observations are consistent with the thick-disk plus outflow model previously advanced for WLQs, where a nominal level of underlying X-ray emission plus variable absorption leads to the remarkable observed X-ray variability. In the case of J1521+5202, it appears likely that the outflow, and not the thick disk itself, lies along our line of sight and causes the X-ray absorption.

Clinical assessment of ectopic pregnancy in a tertiary care hospital: An observational study

Background: Ectopic pregnancy is defined as pregnancy that occurs outside normal uterine cavity that occurs due to implantation of fertilized ovum in an aberrant site which is conducive to its growth and development. In developing countries like India, late presentations with tubal rupture and hemodynamic instability, late presentations with tubal rupture causes first trimester maternal morbidity and mortality. For early diagnosis, a clinician should be well aware about the various presentations of ectopic pregnancy. Aims and Objectives: (a) To estimate the incidence, risk factors, clinical manifestations and outcome following different management protocol. (b) To estimate the morbidity and mortality with respect to different types of presentation and management. (c) To understand the need for clinical assessment in order to diagnose early and provide urgent intervention and also to lean toward the possibility of conservative approach in order to preserve fertility. Materials and Methods: The current study was a time bound, Observational descriptive study with Longitudinal design. It was conducted in the Department of Obstetrics and Gynecology, R. G. Kar Medical College and Hospital, between March 2021 and August 2022. One hundred and thirty-eight participants, suspected to have ectopic pregnancy were enrolled for the study. Data collection was done by detailed history taking and physical examination. The basic investigations including hemoglobin, ABO and Rhesus typing, urine pregnancy test, and ultrasound (USG) examination were done. All data were collected on a structural data form and analyzed for descriptive statistics. Post-operative histopathological examination (HPE) reports were collected and final diagnosis was made. Results: About 63.8% of the study population belonged to 21–30 years of age. About 63.7% patients presented with >5–8 weeks of amenorrhea. About 18.1% of the study population were sterilized and the duration between the sterilization and the occurrence of ectopic was 4–10 years in 64% patients. The most common risk factor was h/o Previous C-section (31.8%). The most common clinical symptom was abdominal pain present in 131 (94.9%), 44 (31.9%) participants had all the three classical symptoms with 100% specificity. On examination, forniceal fullness/tenderness was the most specific finding. The most common USG finding was Adnexal mass with empty Uterine cavity with Free fluid (49.2%). Most of the patients were managed with Partial Salpingectomy (30.4%). The final diagnosis of ectopic was made in 129 patients, which was confirmed by HPE reports in 124 patients. Five patients underwent medical treatment. Conclusion: Early diagnosis before rupture and referral are the key factor in reducing the maternal morbidity and mortality.

Using Cerebrospinal Fluid Biomarkers To Enhance Diagnostic Testing For Alzheimer's Disease In A Tertiary Memory Service

Abstract Background Cerebrospinal Fluid (CSF) biomarkers are useful in the definitive diagnosis of Alzheimer’s disease (AD) when basic investigations and neuroimaging are inconclusive. In our tertiary memory clinic, the standard CSF biomarker panel consists of Amyloid Beta (AB) 42, Total tau, and Phosphorylated tau. AB42/40 is an additional CSF biomarker which has been shown to improve diagnostic accuracy for AD but is not part of our standard CSF biomarker panel (1). We examined the use of AB42/40 in patients attending our service. Methods In our service, diagnosis of dementia is based on a multidisciplinary consensus meeting (including Geriatricians, Neurologists, Psychiatrists) who review clinical presentation and neuroimaging. In a minority of cases, CSF analysis is performed. We retrospectively evaluated how the addition of AB40/42 to our standard CSF panel impacted diagnostic accuracy for AD, taking a ratio of <0.067 to indicate AD (2). Results Of 1853 patients attending the Memory service between September 2022 and December 2023, CSF was available for 107 patients. Of these 107, average age was 68. 56 were female (52%) and 51 were male (48%). At the multidisciplinary consensus meeting, 81 of these 107 patients were diagnosed with AD (75%), with the remaining 26 (24%) patients being diagnosed with a non-AD process (Vascular disease, Lewy Body etc) or an inconclusive diagnosis. After the addition of AB42/40 to CSF, 8 of the 26 patients (31%) with non-AD or an inconclusive diagnosis were identified as potential AD. Of the 81 with a diagnosis of AD, none were reclassified after addition of AB42/40. Receiver Operating Characteristic (ROC) curve analysis was performed to determine relevant cut off values. Conclusion This study suggests the addition of AB42/40 ratio to our standard CSF biomarker panel improves identification of potential AD cases in our sample. This biomarker is being added to the standard CSF panel for our Memory service.

Biological characteristics of marine Streptomyces SK3 and optimization of cultivation conditions for production of compounds against Vibiriosis pathogen isolated from cultured white shrimp (Litopenaeus vannamei).

Antibiotic resistance in shrimp farms has emerged as an extremely serious situation worldwide. The main aim of this study was to optimize the cultural conditions for producing new antibiotic agents from marine Streptomyces species. Streptomyces SK3 was isolated from marine sediment and was identified by its 16S rDNA as well as biochemical characteristics. This microbe produced the highest concentration of bioactive secondary metabolites (BSMs) when cultured in YM medium (YM/2). It produced the maximum total protein (41.8 ± 6.36 mg/ml) during the late lag phase period. The optimum incubation temperature was recorded at 30 °C; BSMs were not produced at ≤10 °C within an incubation period of 3-4 days. The suitable agitation speed was found to be 200 rpm with pH 7.00. The proper carbon, nitrogen, and trace elements supplementation consisted of starch, malt extract, calcium carbonate (CaCO3), and magnesium sulfate (MgSO4). The ethyl acetate extract was found to act strongly against three vibriosis pathogens, Vibrio harveyi, Vibrio parahaemolyticus, and Vibrio vunificus, as indicated by the inhibition zones at 34.5, 35.4, and 34.3 mm, respectively. The extract showed the strongest anti-V. harveyi activity, as indicated by minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) values of 0.101 ± 0.02 and 0.610 ± 0.04 mg/ml, respectively. Basic chemical investigation of the crude extract using thin layer chromatography (TLC), bioautography, liquid chromatography tandem mass spectrometry (LC‒MS/MS), Fourier transform infrared spectroscopy (FTIR), and proton nuclear magnetic resonance (1H-NMR) revealed that the active components were the terpenoid and steroid groups of compounds. They showed carboxylic acid and ester functions in their molecules.

Fueling the Heart: What Are the Optimal Dietary Strategies in Heart Failure?

Heart failure (HF) is a global health concern with rising incidence and poor prognosis. While the essential role of nutritional and dietary strategies in HF patients is acknowledged in the existing scientific guidelines and clinical practice, there are no comprehensive nutritional recommendations for optimal dietary management of HF. In this review, we discuss results from recent studies on the obesity paradox and the effects of calorie restriction and weight loss, intermittent fasting, the Western diet, the Mediterranean diet, the ketogenic diet, and the DASH diet on HF progression. Many of these strategies remain under clinical and basic investigation for their safety and efficacy, and there is considerable heterogeneity in the observed response, presumably because of heterogeneity in the pathogenesis of different types of HF. In addition, while specific aspects of cardiac metabolism, such as changes in ketone body utilization, might underlie the effects of certain dietary strategies on the heart, there is a critical divide between supplement strategies (i.e., with ketones) and dietary strategies that impact ketogenesis. This review aims to highlight this gap by exploring emerging evidence supporting the importance of personalized dietary strategies in preventing progression and improving outcomes in the context of HF.

Prevalence of bacterial vaginosis and its associated factors among pregnant women attending antenatal care clinics at public hospitals in West Shoa Zone, Oromia, Ethiopia

Bacterial vaginosis is a polymicrobial syndrome characterized by the decrease of Lactobacilli and an overgrowth of facultative and anaerobic bacteria in vaginal fluid. Though it has received little attention, it has been associated with poor pregnancy outcomes, such as pre-term labor and delivery, premature rupture of membranes, low birth weight, spontaneous abortion, and postpartum infections. This study aimed to determine the prevalence of bacterial vaginosis and its associated factors among pregnant women attending antenatal care clinics from September 15 to December 14, 2021, at public hospitals in West Shoa Zone, Oromia, Ethiopia. An institutional-based cross-sectional study was conducted on 260 pregnant women, and systematic random sampling was employed to recruit the study participants. Data were collected through a structured questionnaire and the vaginal swab was collected using a sterile cotton swab. The gram staining result was interpreted using the Nugent scoring system. Data was entered into an Excel spreadsheet and exported to STATA-14 for analysis. Data were presented using tables and graphs. Binary and multivariable logistic regressions were performed. Variables with a P value ≤ 0.25 at the binary logistic regression were entered into the multivariable logistic regression. Finally, variables with a P value ≤ 0.05 were considered predictors of bacterial vaginosis and interpreted using adjusted Odds Ratios (AOR) with a 95% confidence interval (CI). A total of 260 pregnant women attending antenatal care were included in the study. The prevalence of bacterial vaginosis according to the Nugent scoring system was 22.3% (95% CI 17.4 to 27.9%). Pregnant women with other marital status were at reduced risk of bacterial vaginosis as compared with married pregnant women (AOR = 0.260, 95% CI 0.068 to 0.9995; P = 0.05). Rural residence (AOR = 2.1, 95% CI 1.05 to 4.24; P = 0.036), use of one pant per week (AOR = 2.7, 95% CI 1.04 to 7.2; P = 0.041), and use of two or more pants per week (AOR = 4.96, 95% CI 1.49 to 16.57; P = 0.009) were significantly associated with bacterial vaginosis. In the current study, a high magnitude of bacterial vaginosis was reported. Residence, marital status, and number of pants used per week were found significantly associated among pregnant women. Hence, screening for the disease should be integrated into the recommended basic laboratory investigations during antenatal visits.

A Comparison of the Alvarado Score and the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) Score in the Diagnosis of Acute Appendicitis: A Prospective Cohort Study.

Background Diagnosing acute appendicitis remains a problem, especially in teenagers with right lower quadrant pain.Imaging studies aid in accurate diagnosis but have limitations such as cost and availability. The Modified Alvarado Scoring System (MASS) is simple and cost-effective with fewer parameters. The Raja Isteri Pengiran Anak Saleha Appendicitisscoring system (RIPASA), designed for Asian populations, includes more parameters. This study compares the effectiveness of RIPASA and Alvarado scores in diagnosing acute appendicitis in a specific clinical setting. Objectives To compare the scoring systems of RIPASA and Alvarado in the diagnosis of acute appendicitis at a tertiary care hospital. Methods Data has been collected from all patients who attended the NRI general hospital emergency department and outpatient wing with acute appendicitis, admitted as inpatients based on clinical history and relevant investigations. Patients satisfying inclusion and exclusion criteria were selected and the basic investigations were done. Summary statistics were done using mean, standard deviation and proportions. Inferential statistics were done by using an independent t-test, kappa statistic, sensitivity and specificity with a 95% confidence interval (CI). All the measurements are done using the statistical package for the social sciences (SPSS) software version 21.0 (IBM Corp., Armonk, NY, USA) and open epidemiological (OpenEpi) software 3.01. A probability (p) <0.05 is considered as statistically significant. Results A total of 110 patients were analyzed for this study with a majority (39%) of them in the 21-30 age group. In our study, females (53%) outnumbered males (47%). Ultrasound findings in our cohort were acute appendicitis (93%), chronic appendicitis (2%) and normal appendix (5%). However, histopathology reported acute appendicitis (75%), chronic appendicitis (9%) and negative/non-specific (15%). The probability of appendicitis as predicted by Alvarado and RIPASA were 40% and 51% respectively. Definitive diagnosis of appendicitis was made in 16.4% with RIPASA whereas only 5.5% with Alvarado. When comparing the Alvarado and RIPASA scores, the sensitivity or true positive rate was higher for RIPASA (73.63%) than for Alvarado (50.55%). Conclusion There was a significant difference between the mean scores in Alvarado and RIPASA inpatients with scores suggestive of appendicitis and no appendicitis. Diagnostic accuracy was higher in RIPASA scoring compared to ALVARDO scoring. There was a significant statistical difference between the two scoring systems. When it comes to diagnosing in low-resource countries the study recommends a combination of Alvarado and RIPASA scoring systems.

Multifocal linear morphea - a rare presentation with rapid progression and deformities in a young adult: a case report

Morphea or localized scleroderma, is an uncommon skin disorder characterized by skin thickening and hardening. This case report describes a late 20s married woman working at a spinning mill, who presented with a unique and rare manifestation of morphea. Over two years, she developed a linear black color thickening of the skin on her right upper limb, left lower limb, and abdomen, accompanied by deformities and functional impairments. The patient reported a rapid progression of hyperpigmented lesions and weakness, prompting medical consultation. Cutaneous examination revealed distinctive hyperpigmented, atrophic plaques with xerotic changes and flexion deformities. A biopsy from the chest confirmed localized scleroderma. Basic investigations were within normal limits. The patient was managed with weekly pulse therapy involving corticosteroids, resulting in some relaxation of skin tightness. This case highlights the importance of recognizing and promptly treating rare multifocal morphea presentations to prevent severe deformities and enhance the patient's quality of life. Long-term follow-up is essential to monitor treatment outcomes and disease progression.

Angiogenesis and full thickness wound repair in a cell sheet-based vascularized skin substitute

Skin tissue engineering is undergoing tremendous expansion as a result from clinical needs, mandatory replacement of animal models and development of new technologies. Many approaches have been used to produce vascularized skin substitutes for grafting purposes showing the presence of capillary-like structures but with limited analysis of their in vitro maturation and plasticity. Such knowledge is however important for the development of tissue substitutes with improved implantation success as well as for validation of vascularization in vitro models, including as a readout in pharmacological analyses. For optimal interactions of cells with microenvironment and vasculature, we here used a cell sheet approach consisting in the sole production of matrix by the cells. In this context, we limited the density of endothelial cells seeded for self-assembly and rather relied on the stimulation of angiogenesis for the development of an extensive connected microvascular-like network. After detailed characterization of this network, we challenged its plasticity both during and after establishment of the skin substitute. We show that fine tuning of VEGF concentration and time of application differentially affects formation of capillary-like structures and their perivascular coverage. Furthermore, we performed a deep wound assay that displayed tissue repair and angiogenesis with unique characteristics of the physiological process. These studies demonstrate the importance of cell-derived microenvironment for the establishment of mature yet dynamic vascularized skin models allowing a wide range of pharmacological and basic investigations. Statement of significanceThe significant advancements in organ-on-chips and tissue engineering call for more relevant models including microvascularization with remodeling potential. While vascularized skin substitutes have been developed for years, focus has primarily been on the impact of microvascularization on implantation rather than on its in vitro characterization. We here developed a cell sheet-based vascularized skin substitute relying on angiogenesis, i.e. growth of vessel-like structures within the 3D model, rather than solely on endothelial cell self-assembly. We then characterized :1/ vascularization after modulation of angiogenic factor VEGF during the substitute construction; -2/ angiogenesis associated to tissue repair after deep mechanical wounding. These studies establish a solid physiologically relevant model for further investigation of skin cell interactions and in vitro wound healing.

Neurodevelopmental profiles of 14 individuals with phosphomannomutase deficiency (PMM2-CDG).

PMM2-CDG (formerly CDG-1a), the most common type of congenital disorders of glycosylation, is inherited in an autosomal recessive pattern. PMM2-CDG frequently presents in infancy with multisystemic clinical involvement, and it has been diagnosed in over 1000 people worldwide. There have been few natural history studies reporting neurodevelopmental characterization of PMM2-CDG. Thus, a prospective study was conducted that included neurodevelopmental assessments as part of deep phenotyping. This study, Clinical and Basic Investigations into Known and Suspected Congenital Disorders of Glycosylation (NCT02089789), included 14 participants (8 males and 6 females ages 2-33 years) with a confirmed molecular diagnosis of PMM2-CDG. Clinical features of PMM2-CDG in this cohort were neurodevelopmental disorders, faltering growth, hypotonia, cerebellar atrophy, peripheral neuropathy, movement disorders, ophthalmological abnormalities, and auditory function differences. All PMM2-CDG participants met criteria for intellectual disability (or global developmental delay if younger than age 5). The majority never attained certain gross motor and language milestones. Only two participants were ambulatory, and almost all were considered minimally verbal. Overall, individuals with PMM2-CDG present with a complex neurodevelopmental profile characterized by intellectual disability and multisystemic presentations. This systematic quantification of the neurodevelopmental profile of PMM2-CDG expands our understanding of the range in impairments associated with PMM2-CDG and will help guide management strategies.

Investigation of Basicity on Compressive Strength and Oxidation Induration Mechanism of Vanadium–Titanium Magnetite Pellets

Currently, the typical charge structure for blast furnace smelting of vanadium–titanium magnetite (VTM) is the addition of acidic pellets, high‐basicity sinters, and lumps. To increase the percentage of pellets entering the blast furnace, it is necessary to transfer the basicity burden to the pellets. In this study, the effect of basicity on the phase transition and oxidation hardening mechanism of VTM pellets is investigated. In the results, it is indicated that when the preheating temperature is 950 °C, the preheating time is 15 min, the roasting temperature is 1260 °C, and the roasting time is 15 min, with the basicity (CaO/SiO2) increasing from 0.08 to 1.3, the compressive strength of pellets shows a trend of “increasing first and then decreasing,” with the highest value reaching 3159 N pellet−1 at basicity of 0.5. As the basicity increases, calcium ferrate can be generated by CaO in the liquid phase with Fe2O3 in addition to silicate with SiO2, which will increase the amount of the liquid phase. With the increase of basicity, the oxide‐bonded induration is gradually weakened, and the slag‐bonded induration is gradually enhanced. A moderate amount of liquid phase can play the role of bonding and filling, thereby improving compressive strength.