Memory Research Research Articles

PSII-8 Analysis of maternal influence on phenotypic ultrasound measurements of weaned Angus calves

Abstract Ultrasound carcass data can be used to accurately estimate the body composition of beef cattle in comparison with a body composition score. Literature regarding the analysis of phenotypic carcass data has focused predominately on yearling or mature cattle with limited measurements on weaned calves. Therefore, the influence of the milking ability of the dam on body composition traits measured via carcass ultrasound is unknown. The objective of this study was to estimate correlations between the maternal influence of the dam on the phenotypic ultrasound measurements of the calf. To quantify maternal influence, the expected progeny difference (EPD) for milk (MILK) of the dam was correlated to three ultrasound measurements of the calf: backfat thickness (BFAT), ribeye area (REA), and intramuscular fat (IMF). Ultrasound measurements were collected 1 wk after weaning on 104 purebred Angus heifer calves from the Iowa State University McNay Memorial Research and Demonstration Farm located outside Chariton, Iowa. The average age and body weight for heifers were 187 d and 195 kg, respectively. The milk EPD of the dam was correlated to the ultrasound measurements taken on the calves. For each trait, Pearson’s correlations were calculated between the ultrasound traits of the calf to the dam’s milk EPD using R Statistical Software version 4.3.1. A small positive correlation was identified between MILK and REA (r = 0.28, P = 0.004). This suggests a weak phenotypic relationship between MILK and REA for weaned heifers. The correlation between MILK to BFAT and IMF was 0.10 (P = 0.318) and -0.05 (P = 0.619), respectively. These correlations were not significantly different from zero. This suggests the potential for milk production of the dam has little association with BFAT and IMF for weaned heifers. Although further research is needed, the results from this study indicate little to no relationship between milk EPD of the dam on ultrasound measures of the calf for BFAT, REA, and IMF.

Trends in typhoid fever during the COVID-19 pandemic in Pakistan.

Pakistan has been experiencing an extensively drug-resistant (XDR) outbreak of typhoid for some years. We sought to evaluate how the COVID-19 pandemic impacted typhoid epidemiology in Pakistan, from the beginning of the pandemic in 2020 through the end of 2022, and the reduction of COVID-19 cases. We compared national public COVID-19 data with retrospectively obtained patient data of confirmed S. Typhi isolates between January 2019 and December 2022 from Shaukat Khanum Memorial Cancer Hospital and Research Centre and the hospital's extended network of laboratory collection centers across Pakistan. We observed that during the early onset of the COVID-19 pandemic and COVID-19 peaks, typhoid positivity generally decreased. This suggests that restrictions and non-pharmaceutical interventions that limited social interactions and promoted good sanitation and hygiene practices had a positive secondary effect on typhoid. This led to an overall yearly decrease in typhoid positivity between 2019 to 2021. However, the percentage of S. Typhi cases isolated that were ceftriaxone-resistant continued to increase, suggesting the continued dominance of XDR typhoid in Pakistan. In 2022, with the alleviation of pandemic restrictions, we observed increased typhoid positivity and COVID-19 and typhoid positivity started to follow similar trends. Given the continued presence of COVID-19 along with XDR typhoid in Pakistan, it will be imperative to use differential testing to ensure that the epidemiology of each reported is accurate, the spread of each it contained, and that antibiotics are not misused. The use of approved vaccinations will lessen the burden of both diseases.

Use of an adaptive sensory environment in patients with autism spectrum disorder (ASD) in the perioperative environment: a parallel, randomized controlled trial

Patients with autism spectrum disorders (ASD) experience higher rates of perioperative anxiety and are likely to receive premedication. Little is known about nonpharmaceutical interventions which may decrease anxiety. This study aims to evaluate the use of an adaptive sensory environment (ASE) to reduce ASD patient anxiety during the perioperative process. Our feasibility study (ClinicalTrials.govNCT04994613) enrolled 60 patients in two parallel groups randomized to a control (no ASE) or intervention group (ASE). We included all surgical patients aged three to twelve years, with a formal diagnosis of ASD, Asperger's Syndrome, or pervasive developmental disorder not otherwise specified. Preoperative behaviors were recorded by an unblinded nurse utilizing the validated Modified Yale Preoperative Anxiety Scale (mYPAS). The difference in score on the mYPAS was the primary outcome, and an intention-to-treat analysis was employed. A generalized estimating equations model was used to compare mYPAS scores controlling for significant independent variables. 58 patients were analyzed after 1:1 randomization of 30 patients to each group. Groups were balanced except the median number of intraoperative pain medications was significantly lower in the ASE group (1 vs. 3, p=0.012). Mean (SD) age for all patients was 7.2 (2.9) years, range 2.6-12.7. 72.4% (42/58) were White and all were Non-Hispanic or Latino. 74% were Male (21/30 ASE and 22/28 Control) and 26% were Female (9/30 ASE and 6/28 Control). No differences were found in mYPAS scores between groups at three time periods (43.5 vs. 42, p=0.88, 47.8 vs. 48.4, p=0.76, and 36.4 vs. 43.8, p=0.15, ASE vs. control group, respectively). The ASE group had a significant within-group decrease in mYPAS scores from nursing intake to transition (p=0.030). An ASE did not significantly reduce perioperative anxiety. However, the promising results deserve further investigation. Dayton Children's Hospital Foundation Robert C. Cohn Memorial Research Grant.

Assessing the relationship of prospective, retrospective, and everyday memory with cognitive failure among Bangladeshi adults

Memory has a profound impact on every aspect of who we are. The present study explored the extent to which deficits in everyday memory (EM), prospective memory (PM), and retrospective memory (RM) serve as predictive indicators of cognitive failure (CF) in the context of the Bangladeshi population, as well as to identify differences for the variables across various age cohorts and genders. A total of 352 participants took part in the cross-sectional survey of PM, RM, EM, CF, and the demographic questionnaire package. The main goal of this study was accomplished by the findings, which showed a positive link between CF and EM, PM, and RM. Additionally, the results show that while deficiencies in RM have a somewhat smaller correlation with CF, lapses in EM and PM primarily serve as predictive indications of CF. The results of the current study reveal a recurrent pattern of memory recall and cognitive failure, where men are doing generally better than those of women. A noteworthy finding was the superior performance of middle-aged adults in comparison to their younger counterparts. Hence the majority of memory research is conducted on Western or European people, therefore the current study and its findings can serve as a strong starting point for determining the reasons, nature, and direction of the correlations between memory types and cognitive failures. Dhaka Univ. J. Biol. Sci. 33(1): 133-142, 2024 (January)

Retrieving autobiographical memories in autobiographical contexts: are age-related differences in narrated episodic specificity present outside of the laboratory?

The Autobiographical Interview, a method for evaluating detailed memory of real-world events, reliably detects differences in episodic specificity at retrieval between young and older adults in the laboratory. Whether this age-associated reduction in episodic specificity for autobiographical event retrieval is present outside of the laboratory remains poorly understood. We used a videoconference format to administer the Autobiographical Interview to cognitively unimpaired older adults (N = 49, M = 69.5, SD = 5.94) and young adults (N = 54, M = 22.5, SD = 4.19) who were in their homes at the time of retrieval. Relative to young adults, older adults showed reduced episodic specificity in their home environment, as reflected by fewer episodic or "internal" details (t (101) = 3.23, p = 0.009) and more "external" details (i.e., semantic, language-based details) (t (101) = 3.60, p = 0.003). These findings, along with detail subtype profiles in the narratives, bolster the ecological validity of the Autobiographical Interview and add promise to the use of virtual cognitive testing to improve the accessibility, participant diversity, scalability, and ecological validity of memory research.

Deep learning-based cervical lesion segmentation in colposcopic images

Artificial intelligence assisted cancer detection has changed the ream of diagnosis precision. This study aims to propose a segmentation network using artificial intelligence for accurately segmenting the cervix region and acetowhite lesions in cervigram images, addressing the shortage of skilled colposcopists and streamlining the training process. A computational approach is employed to develop and train a deep learning model specifically tailored for cervix region and acetowhite lesion segmentation in cervigram images. A dataset acquired in collaboration with KIDWAI memorial cancer research institute is used for building the model. Cervigram images are collected for training and validation, and a deep learning architecture is constructed and trained using annotated datasets. The segmentation network based on efficientnet architecture and atrous spatial pyramid pooling is designed to accurately identify and delineate the target regions, with performance evaluation conducted using precision, accuracy, recall, dice score, and specificity metrics. The proposed segmentation network achieves a precision of 0.7387±0.1541, accuracy of 0.9291, recall of 0.7912±0.1439, dice score of 0.7431±0.1506, and specificity of 0.9589±0.0131, indicating its reliability and robustness in segmenting cervix regions and acetowhite lesions in cervigram images. This research demonstrates the feasibility and effectiveness of using artificial intelligence-based computational models for cervix region and acetowhite lesion segmentation in cervigram images. It provides a foundation for further investigations into classifying cervix malignancy using AI techniques, potentially enhancing early detection and treatment of cervical cancer while addressing the shortage of skilled professionals in the field

A Deeper Depth of Response After Salvage Therapy Improves Outcomes of Autologous Stem Cell Transplantation in Relapsed Lymphoma and the Feasibility of Non-controlled Rate Freezing of Peripheral Blood Stem Cells.

Background High-dose chemotherapy followed by autologous stem cell transplantation is considered a standard treatment approach for patients with relapsed Hodgkin's lymphoma (HL) and non-Hodgkin lymphoma (NHL). The goal of autologous stem cell transplant in relapsed lymphoma is to achieve long-term disease control, i.e., cure, in contrast to disorders like multiple myeloma, where it only prolongs the duration of remission, progression-free survival, and improves the quality of life. Published outcomes of high-dose therapy and ASCT and the impact of different factors affecting survival in low- to middle-income countries are very limited. Our study analyzed all the autologous stem cell transplants performed in our center over a six-year period to ascertain engraftment, responses, outcomes, and variables that may have impacted transplant outcomes. Methods We conducted a retrospective study including 76 patients from January 2015 to December 2020. Data were retrieved from electronic medical records at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. Results Out of a total of 82 autologous transplant patients, 76 were eligible for the study, out of which 50 (66%) had HLand 26 (34%) had NHL. The median age was 29 years (range 18-53) and 29 years (range 20-45) for HL and NHL, respectively. The male-to-female ratio was 5:2 and 4:1 for HL and NHL, respectively. The majority had advanced-stage disease, 85% in HL and 75% in NHL. The minimum cell dose infused was 2.5 million CD34+ cells/kg. Median days to platelets and ANC engraftment were 14 and 11 days, respectively. The 30-day transplant-related mortality was 8.9% and 7.4% in HL and NHL, respectively. The 100-day mortality was 15.2% and 11% in HL and NHL, respectively. The two-year disease-free survival (DFS) and overall survival (OS) were 83% and 83%, respectively, in HL patients. The two-year DFS and OS were 78% and 85%, respectively, in NHL patients. Conclusion High-dose therapy and autologous stem cell transplantation in low- to middle-income countries are limited to relatively younger patients, potentially curative conditions such as lymphoma, and predominantly after achieving a complete response to salvage therapy due to limited resources. Due to these factors, our study shows excellent response rates and survival outcomes compared to internationally published data. Engraftment was also excellent and comparable to published data despite the non-controlled rate freezing of peripheral blood stem cells.

Demographic characteristics and short-term outcomes of laparoscopic colon cancer surgeries at a newly developed cancer center in Peshawar, Pakistan.

In Pakistan, colon cancer ranks fourth in incidence, exhibiting survival rates of 90% to 14%, contingent on TNM staging and early detection. This research focuses on the demographic involvement and short-term outcomes of elective colon cancer resections at a newly established tertiary care cancer center utilizing laparoscopic procedures. A retrospective analysis of elective laparoscopic colorectal resections at Shaukat Khanum Memorial Cancer Institute and Research Centre, Peshawar, from April 2021 to February 2022 was conducted. Out of 157 cases, 79 had colon cancer. Criteria included patients >18 years old with positive biopsies; consent non-providers were excluded. Statistical analysis employed descriptive statistics and cross-tabulations using SPSS-22. The study encompassed biopsy-confirmed colon cancers in patients >18 years. 157 colorectal cases were performed, including 79 colon cancers. The sample comprised 61 males (77.2%) and 18 females (22.7%), mean age 42 years. Most patients (33%) were in the 36-45 age group. Majority were from KPK (69.6%), followed by Afghanistan (24%). Tumors were predominantly in the ascending colon (30.3%). Most were moderately differentiated (70.8%). Mean lymph node yield was 19.0, with 1.2% requiring open laparotomy. Post-discharge, one readmission occurred within 30 days. Mortality within 90 days was 2%, attributed to aspiration pneumonia and chemotherapy-related effects. Elective laparoscopic colonic surgery exhibits safety and efficacy in treating colon cancer. The study provides evidence of minimal morbidity and mortality, low readmission rates, and absence of anastomotic leaks. Hence, elective laparoscopic colonic surgery should be favored due to fewer post-operative complications and superior short-term outcomes. Larger studies on colon cancer are imperative for enhanced healthcare delivery.

Rodent maze studies: from following simple rules to complex map learning.

More than 100years since the first maze designed for rodent research, researchers now have the choice of a variety of mazes that come in many different shapes and sizes. Still old designs get modified and new designs are introduced to fit new research questions. Yet, which maze is the most optimal to use or which training paradigm should be applied, remains up for debate. In this review, we not only provide a historical overview of maze designs and usages in rodent learning and memory research, but also discuss the possible navigational strategies the animals can use to solve each maze. Furthermore, we summarize the different phases of learning that take place when a maze is used as the experimental task. At last, we delve into how training and maze design can affect what the rodents are actually learning in a spatial task.

Collaborative encoding with a new categorization task: a contribution to collaborative memory research

Collaborative memory research has focused primarily on the effects of collaboration at recall with collaboration during encoding receiving less attention. In the present study, collaboration was investigated both at encoding and at retrieval to determine its effects and possible interactions. The aim was to clarify whether the collaborative inhibition effect depended on whether the encoding was with the same or with a different partner. A total of 320 participants (160 Italian and 160 Spanish undergraduate students) were administered a modified version of the collaborative memory paradigm with a new categorization task of verbal affective stimuli at encoding. Specifically, they were asked to classify 90 printed words into 6 categories, so as to have 15 words in each category and then did two recall tasks. Participants were assigned to one of five possible conditions according to encoding (collaborative, individual) and recall (collaborative with the same partner, with another partner, and individual). Results show a collaborative encoding deficit and the classic collaborative inhibition effect independently of whether the encoding was collaborative or individual and even in a collaborative recall group that showed a degree of recall output organization comparable to that of the individual recall group. These results are not wholly consistent with a retrieval disruption explanation and are discussed according to divided attention during collaborative recall and how it may contribute to the collaborative inhibition effect.

The Impact of Digital Technologies on Memory and Memory Studies

With the widespread integration of smartphones, computers, and the internet, information access and processing have undergone significant changes. This paper investigates both positive and negative implications, acknowledging the extension of cognitive capacities through easy access to vast databases and external memory aids while also addressing concerns about diminished memory consolidation and reliance on shallow encoding strategies. Examining the interdisciplinary field of memory studies, the study also highlights collaborative efforts among scholars in psychology, neuroscience, sociology, and information science to comprehend the impact of digital technologies on memory, and emphasizes the challenges and future directions in memory research, including issues like digital amnesia, information overload, and privacy concerns. Overall, the paper underscores the need for understanding the relationship between human memory and digital tools, enabling the development of strategies to enhance memory, counteract potential adverse effects, and promote a balanced utilization of digital resources in memory-related tasks.

Sleep and spatial memory: Mechanisms, relationships, applications, and potential

More and more attention is being paid to the study of sleep and memory because of the immense potential the field has to offer, with the majority of studies focusing on episodic and procedural memory. However, another type of declarative memory spatial memory is relatively lesser-known. This review discusses the scientific community's current understanding of spatial memory and its relationship with sleep using both animal and human studies as examples, exploring, in particular, existing knowledge on spatial memory, whether sleep can affect spatial memory, the nature of such a relationship, and cellular mechanisms. The discussion then moves onto some potential applications of recent findings, including actions that researchers have already taken to better incorporate the enhancing properties of sleep on spatial memory into solutions for clinical problems. The review also points out future directions for research, considering the uncertainties in sleep and memory research and the significance of investigating such topics.

Distinct neural signatures underlying information maintenance and manipulation in working memory.

Previous working memory research has demonstrated robust stimulus representations during memory maintenance in both voltage and alpha-band activity in electroencephalography. However, the exact functions of these 2 neural signatures have remained controversial. Here we systematically investigated their respective contributions to memory manipulation. Human participants either maintained a previously seen spatial location, or manipulated the location following a mental rotation cue over a delay. Using multivariate decoding, we observed robust location representations in low-frequency voltage and alpha-band oscillatory activity with distinct spatiotemporal dynamics: location representations were most evident in posterior channels in alpha-band activity, but were most prominent in the more anterior, central channels in voltage signals. Moreover, the temporal emergence of manipulated representation in central voltage preceded that in posterior alpha-band activity, suggesting that voltage might carry stimulus-specific source signals originated internally from anterior cortex, whereas alpha-band activity might reflect feedback signals in posterior cortex received from higher-order cortex. Lastly, while location representations in both signals were coded in a low-dimensional neural subspace, location representation in central voltage was higher-dimensional and underwent a representational transformation that exclusively predicted memory behavior. Together, these results highlight the crucial role of central voltage in working memory, and support functional distinctions between voltage and alpha-band activity.

Community Outreach and Engagement in Cancer Research Through a Biobank Clinic at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Pakistan.

Cancer's increasing prevalence across the globe emphasizes the urgency for continued research, prevention, and accessible healthcare to mitigate its impact on individuals and communities. While there have been significant advances made towards controlling cancermorbidity and mortality in recent decades, Pakistan continues to experience a markedly elevated burden of the disease. With this study, we aim to raise awareness about biobank research within the cancer patient community, fostering participation and collaboration to advance the fight against cancer through vital research contributions. In October 2022, we initiated the biobank clinic at Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC). Here, patients underwent screening and received invitations to voluntarily participate in biobank research. During these interactions, we engaged patients in discussions about the significance of biobank research, addressed their concerns, and encouraged their participation in advancing our research endeavors. Two-sample independent t-tests were performed to compare the mean number of participants in pre-clinic and post-clinic cohorts. This research involved a total of 958 participants, with 312 participants enrolled before the clinic and 646 participants enrolled after the clinic. We have observed a noticeable increase in the participation of cancer patients in our research endeavors since the inception of the biobank clinic (p-value<0.001). Over an 11-month time frame, we scheduled appointments for 759 patients, and out of those, 656 patients availed themselves to visit the clinic. Impressively, we achieved the enrollment of 646 patients into the clinic, reflecting an exceptional consent rate of 98.47% for their active involvement in our research initiatives. This underscores our commitment to conducting comprehensive discussions and providing thorough explanations regarding the ethical and procedural aspects of our research. Biobank clinic plays a pivotal role in raising cancer awareness and fostering research participation, especially in regions with limited healthcare infrastructure and lower literacy rates. It emerges as a community-engagement model that aligns research with local needs, ensuring its relevance and benefit to the population.

Effectiveness of Ceftazidime-Avibactam in Gram-Negative Nosocomial Pneumonia: A Real-World Study in India.

The incidences of nosocomial pneumonia in intensive care units (ICUs) in India have been reported to range from 9% to 58% and are associated with a mortality rate of 30-70%. Ceftazidime-avibactam has activity against OXA-48-like carbapenem-resistant Enterobacterales (CRE) and has a safer adverse effect profile as compared to the nephrotoxic colistin. The current study aimed to assess the effectiveness and usage pattern of ceftazidime-avibactam in gram-negative hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) in real-world settings in India. Electronic medical records of hospitalized patients in three prominent medical centers in India (Fortis Memorial Research Centre, Gurugram, S L Raheja Hospital, Mumbai, and Fortis Hospital, Anandapur, Kolkata)with nosocomial pneumonia and documented gram-negative Klebsiella pneumoniae (KP)-confirmed infection were collected. This study assessed the effectiveness, usage pattern of ceftazidime-avibactam, and clinical and microbiological cure rates. Among the 116 patients included, 78.45% (91/116) showed clinical cure. Microbiological cure was observed in nine out of 13 (69.23%) patients. In the subset analysis, a clinical cure rate of 84.85% (28/33) and microbiological recovery rate of 62.50% (5/8) were observed when ceftazidime-avibactam was initiated within 72 hours of diagnosis. Ceftazidime-avibactam was administered for a mean (±SD) duration of 7.79 ± 4.43 days, with improvement in signs and symptoms reported among 91.38% (106/116). Ceftazidime-avibactam showed a susceptibility of 56% (28/56) in the study. The current study showed a better clinical and microbiological cure rate with a safer tolerability profile of ceftazidime-avibactam in carbapenem-resistant KP nosocomial pneumonia and VAP. This study has further demonstrated that ceftazidime-avibactam may be used as one of the viable treatment choices in carbapenem-resistant KP with favorable clinical outcomes.

Comparison of semantic and phonological false memories in short- and long-term tests.

The Deese-Roediger-McDermott (DRM) paradigm has been at the centre of false memory research. Whereas most work with this paradigm has examined memory at the long term and with semantically associated lists, the present study examines phonological and semantic false memories at both short- and long-term delays. In two experiments, participants studied short lists containing six (Experiment 1) or four (Experiment 2) items, either semantically or phonologically related to the same non-studied critical items (CI). Following each list, participants completed 36 trials of an immediate recognition task (short-term memory [STM]-only condition) only or they also completed a surprise recognition test after a 1-min delay after all 36 STM trials (STM + long-term memory [LTM] condition). In STM, false alarms were higher in phonological lists, whereas after the delay, false alarms were higher in semantic lists, reflecting differential sensitivity to the type of association as a function of delay. A third experiment examined LTM performance after controlling for prior testing and yielded highly similar results. Both the activation-monitoring framework (AMF) and fuzzy-trace theory (FTT) can explain the majority of the findings, with some remaining issues. These results confirm that information from the knowledge base (LTM) does influence accuracy in an STM task, albeit less so than perceptual level similarity.

A243 BONE MINERAL DENSITY AND DIETARY BONE NUTRIENTS DIFFER IN PATIENTS WITH CROHN'S DISEASE STRICTURES

Abstract Background Crohn’s disease (CD) phenotypes include inflammatory (non-stricture) and stricture behaviours. Strictures are bowel narrowing’s that may lead to obstructions and subsequent dietary restrictions to prevent blockages. Bone mineral density (BMD) in CD is affected by many factors including corticosteroid use, CD itself, but also dietary changes. Clinical gold standard for measuring BMD is by dual x-ray absorptiometry (DXA) scans. High-resolution peripheral quantitative computed tomography (HR-pQCT), a more precise imaging modality assesses volumetric BMD, bone geometry and bone microarchitecture. We aim to compare dietary intake, and bone quality in both stricture and non-stricture CD. Aims To identify nutritional patterns, bone quality differences and deficiencies between two subtypes of CD; including energy intake, dietary components and/or micronutrients Methods Individuals (≥55 years old) with ileal CD strictures (fixed, angulated bowel or thickened bowel with pre-stenotic dilation on diagnostic imaging), or inflammatory CD were prospectively recruited. Patients with short gut, celiac disease, dysphagia history were excluded. All patients completed DXA hip and spine scans and HR-pQCT radius and tibia scans. Dietary assessment questionnaires (Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24), and Diet History Questionnaire III for food frequency over the past year were completed. Results 56 (27 inflammatory (48% female, mean age 64.2, BMI 28.7, 16 years CD duration) and 29 strictures (45% female, mean age 65.9, BMI 27.3, 25 years CD duration, 15 (51.7%) prior bowel resection) were included. 31/56 (55.4%) patients were on biologics and 11 (19.5%) had past corticosteroid exposure. DXA-based BMD for stricture versus non-stricture CD patients was not significantly different at the hip or spine. However, HR-pQCT-based radial total BMD (p=0.03), cortical thickness (p=0.01) and cortical area (p=0.04) were lower in stricture than non-stricture patients.11 (7 stricture, 4 inflammatory) patients with past steroids consumed more dairy (p=0.01), vitamin D (p = 0.04), and calcium (p=0.03) than other CD patients. Stricture patients had significantly less consumption of vitamin K (p=0.001), vegetables (p=0.02), calcium (p=0.03), and dairy (p=0.03). Conclusions Patients with CD strictures have lower BMD and cortical bone quality at the radius than those without strictures. Patients with CD strictures also consume significantly less vitamin K, calcium, and dairy, all vital dietary components to prevent OP, compared to non-stricture patients. Overall, the skeletal fracture risk is likely much greater in CD patients with strictures than without, due to greater inherent bone fragility, and less consumption of key nutrition building blocks of bones. Funding Agencies Koopmans Memorial Research Fund

Preventive analgesia with oral tramadol and pregabalin for post-operative pain in breast surgical patients

Background &amp; objective: Preventive analgesia is implied before the actual surgical insult occurs and it is aimed to reduce the neuro-humoral changes associated with surgical induced pain. Different methods have been used by the anesthesiologists for this purpose. We studied the effect of pre-emptive oral tramadol 50 mg and pregabalin 100 mg on post-operative pain, the requirement of rescue analgesics and the stay in post-anesthesia care unit (PACU) in breast cancer surgery patients. Methodology: A randomized double blinded, placebo-controlled trial, was conducted in the Department of Anesthesia, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore (Pakistan) after ethical approval by the hospital Scientific Review Committee and Institutional Review Board. Atotal of 30 patients, undergoing breast cancer surgery, were enrolled and randomly divided into two groups. Group A (study group) patients were given tramadol 50 mg and pregabalin 100 mg orally, and Group B (control group) received two soda mint tablets orally 30 min prior to induction of anesthesia. Standard monitoring was done and routine general anesthesia was administered with intubation. After recovery, Visual Analog Scale (VAS) scores and time to rescue analgesia, total morphine consumption, were recorded. Data was analyzed using SPSS v.20. P &lt; 0.05 was considered significant. Results: The mean ages in Group A and B were 36.67 ± 9.50 y and 41.80 ± 12.43 y (P = 0.236). The differences in intra-operative morphine and rescue morphine use in both groups were not significant (P = 0.139 and 0.293, The rescue analgesic use and VAS scores in PACU were significantly different in both groups (P = 0.005 and P = 0.022, respectively). Total PACU stay in Group A was 79.33 ± 26.31 min and in Group B was 96.67 ± 34.98 min (P = 0.281). Tramadol use in the ward was not statistically equivalent (P = 0.300). Mean post-operative rescue morphine was 0.2 ± 0.775 mg/kg in control group as compared to placebo group was 1.4 ± 1.682 mg/kg, which was statistically significant (P = 0.02). VAS scores in PACU in both groups showed statistically differences, e.g., 1.33 ± 1.1 vs 2.70 ± 1.60 (P = 0.01). PACU stay time was also higher in the control group. Conclusion: The use of pre-emptive analgesia with oral tramadol 50 mg and pregabalin 100 mg 30 min before the surgery can reduce the requirement of peri operative opioid use, achieve better pain control and early recovery. Abbreviations: BMI- Basal Metabolic Rate; PACU- Post-Anesthesia Care Unit; PONV- Postoperative Nausea and Vomiting; VAS- Visual Analog Scale Key words: Analgesia, Preventive; Cancer Surgery; Opioids; Post-Anesthesia Care Unit; Pregabalin; Tramadol Citation: Usman A, Mehdi SR, Khan AA. Preventive analgesia with oral tramadol and pregabalin for post-operative pain in breast surgical patients. Anaesth. pain intensive care 2024;28(1):81−84; DOI: 10.35975/apic.v28i1.2374 Received: November 17, 2021; Reviewed: September 24, 2022; Accepted: July 06, 2023

Hypofractionated versus conventional fractionation external beam radiotherapy in intermediate and high risk localized prostate cancer

BackgroundProstate cancer is the second most common malignancy in men, and its incidence is increasing which is attributed to increased screening programs. The treatment options of intermediate and high risk prostate cancer include radical prostatectomy, radiotherapy and androgen deprivation therapy. Hypofractionated radiotherapy is becoming more popular lately due to better understanding of the radiobiology of prostate cancer and favorable logistics.ObjectiveTo compare the toxicity and efficacy of hypofractionated versus conventional fractionation external beam radiotherapy in patients with intermediate and high risk localized prostate cancer treated in Shaukat Khanum Memorial Hospital and Research Center, Lahore (SKMCH & RC).MethodologyWe retrospectively conducted this study on histopathologically confirmed 114 patients with prostate adenocarcinoma who underwent treatment from January 2013 till December 2018. These patients were treated with radical radiotherapy along with hormonal therapy as per indication. Data was collected from electronic hospital system and analyzed by SPSS version 23.Results114 patients were selected according to the inclusion criteria. Mean age was 68 years (61–75). 88% of patients had stage III-IVA disease at the time of diagnosis. Mean PSA and GS was 33 ± 39 SD and 7 ± 0.9 SD respectively. 89% (n = 102) received radiotherapy with 69% of patients receiving dose of 60 Gy in 20 fractions. Among patients who received hypofractionated dose, 86% (n = 61) of them were categorized as high risk and 14% (n = 10) were intermediate risk, whereas among conventional group 90% (n = 28) were high risk patients and 10% (n = 3) were of intermediate risk. In hypofractionated dose group, 14% (n = 10) developed grade 2 proctitis and 8% (n = 6) developed grade 2 cystitis, in contrast to conventional dose group in which only 3 patients (5%) developed grade 2 GI toxicity and 2 patients (2.9%) had grade 2 GU toxicity. However, these toxicities and their grade were clinically insignificant when compared with the dose groups (p = 0.11). 5 year overall survival for hypofractionated radiotherapy versus conventional dose was 100% and 90% respectively with 95% Cl and p value of 0.3 (clinically insignificant), whereas 5 year disease free survival was 100% and 75% for hypofractionation versus conventional EBRT respectively with 95% CI and p value of 0.04 (clinically significant).ConclusionHypofractionated radiotherapy in patients with intermediate and high risk localized prostate cancer has better disease free survival at the expense of higher risk for proctitis and cystitis but no difference in overall survival as compared to conventional dose of radiation.

Toward interpretable and generalized mitosis detection in digital pathology using deep learning.

The mitotic activity index is an important prognostic factor in the diagnosis of cancer. The task of mitosis detection is difficult as the nuclei are microscopic in size and partially labeled, and there are many more non-mitotic nuclei compared to mitotic ones. In this paper, we highlight the challenges of current mitosis detection pipelines and propose a method to tackle these challenges. Our proposed methodology is inspired from recent research on deep learning and an extensive analysis on the dataset and training pipeline. We first used the MiDoG'22 dataset for training, validation, and testing. We then tested the methodology without fine-tuning on the TUPAC'16 dataset and on a real-time case from Shaukat Khanum Memorial Cancer Hospital and Research Centre. Our methodology has shown promising results both quantitatively and qualitatively. Quantitatively, our methodology achieved an F1-score of 0.87 on the MiDoG'22 dataset and an F1-score of 0.83 on the TUPAC dataset. Qualitatively, our methodology is generalizable and interpretable across various datasets and clinical settings. In this paper, we highlight the challenges of current mitosis detection pipelines and propose a method that can accurately predict mitotic nuclei. We illustrate the accuracy, generalizability, and interpretability of our approach across various datasets and clinical settings. Our methodology can speed up the adoption of computer-aided digital pathology in clinical settings.