Passage Of Blood Research Articles

Pulmonary Shunt in Critical Care: A Comprehensive Review of Pathophysiology, Diagnosis, and Management Strategies.

Pulmonary shunt, an abnormal passage of blood through the pulmonary circulation without adequate gas exchange, poses significant challenges in critical care. This comprehensive review explores the pathophysiology, diagnostic approaches, and management strategies associated with pulmonary shunt. Pulmonary shunts are classified into anatomical and physiological types, each with distinct mechanisms and implications for gas exchange. Anatomical shunts result from structural heart defects, while physiological shunts arise from ventilation-perfusion (V/Q) mismatches. Both conditions can significantly impair oxygenation and contribute to multi-organ dysfunction. This review delves into various diagnostic modalities, including clinical assessment, imaging techniques such as chest X-ray and CT scans, and advanced diagnostic methods such as V/Q scanning and echocardiography. Challenges in diagnosing pulmonary shunt are discussed, emphasizing the limitations of current tools and the need for accurate differentiation of shunt types. Management strategies are examined, covering pharmacological interventions, non-pharmacological treatments such as mechanical ventilation and prone positioning, and surgical options. Emerging therapies and innovations in treatment are also highlighted. Special considerations are given to different patient populations, including pediatric and elderly patients and those with multiple comorbidities. This review concludes with an analysis of the prognosis and outcomes associated with pulmonary shunt, focusing on short-term and long-term impacts on survival and quality of life. This review aims to enhance understanding and guide effective management practices for pulmonary shunt in critical care settings by synthesizing current knowledge and identifying areas for further research.

Application of Differential Equation in the Design of Dialysis Machine

In this work, I have discussed the application of differential equations in the design of a dialyzer machine. A dialyzer is a device through which blood flows from the patient's body into the machine. A substance called dialysate flows through the machine in the opposite direction to the blood. This aids in separating waste materials with the help of a semipermeable membrane attached to the machine. This membrane possesses minute pores that allow the passage of waste matter, which has much smaller molecules than the blood cells, but restrict the passage of blood itself. The design of the dialyzer machine concerns the flow rate of the waste material through the membrane. This flow-rate is determined by the differences in concentration of waste material on either side of the membrane, where, the flow occurs from high concentration to low concentration.

Navigating Complex Cardiovascular Pathologies: A Case Report on Aortic Arch Replacement in a Middle-Aged Male with Stanford A De Bakery I Aortic Dissection

Background: Aorta dissection is characterized by the presence of an intimal tear, which permits the passage of blood through the tear and into the aorta media. This process leads to the separation of the intimal and the formation of a dissection flap, representing the true lumen and a newly formed false lumens. The incidence of aortic dissection varies between 0.2% and 0.8%. Management of acute aortic standford A aortic dissection primarily involves invasive surgical procedures. Case presentation: A middle-aged male patient, aged 40, who possesses risk factors including uncontrolled hypertension and obesity, arrived to the emergency room with symptoms of chest pain. He described the pain as tearing in nature and said that it radiated towards the abdominal. The examination findings included a blood pressure reading of 255/143, a widened mediastinum and cardiomegaly observed on the chest X-ray, a slight elevation in Hs-Troponin levels, and the presence of sinus rhythm with left ventricular hypertrophy. He underwent CT scan, which demonstrated the presence of an aortic dissection extending from the ascending to descending aorta, with no associated damage to the aortic valve from echocardiography. He was diagnosed with Standford A DeBakey I Aortic dissection and underwent preference replacement of the aortic arch and elephant trunk implantation instead of Bentall procedure. Conclusion: The surgical and perioperative methods employed may differ based on the specific clinical presentation and the nature of the aortic disease. Because there was no involvement of the aortic valve, we performed total aortic arch replacement and elephant trunk procedure over the Bentall procedure. Keyword: Aortic Dissection, Dissection Flap, Total Aortic Arch Replacement.

Acute mercury poisoning complicated by gastrointestinal bleeding

Mercury poisoning is a rare but potentially serious condition that can result from environmental exposure to elemental mercury. We present a case of a 22-year-young male who presented to the emergency department (ED) with symptoms of mercury poisoning after his family members brought home a vial of elemental mercury. The patient experienced nausea, anxiety, abdominal pain, diarrhea, and fever. Despite normal initial laboratory tests and imaging studies, a presumptive diagnosis of mercury poisoning was made based on the patient's history of exposure and clinical presentation. Although his hospital stay was complicated by passage of blood in stool, possibly lower GI bleed, but treatment with N-acetylcysteine (NAC) was initiated empirically, leading to resolution of symptoms and a favorable outcome. This case highlights the importance of considering mercury poisoning in patients with appropriate exposure history and the effectiveness of NAC in the treatment of acute mercury poisoning. Public education on the hazards of mercury and the importance of prompt recognition and treatment are essential in preventing severe complications associated with mercury exposure.

Iatrogenic high-flow femoral AV-fistula – A clinical case

Arteriovenous fistula (AVF) was first described in medicine by William Hunter in 1757, followed by the first surgical attempt at its correction in 1837 by Breschet, who attempted to eliminate the fistula by ligation of the proximal artery. As minimally invasive procedures and the wide variety of endovascular devices have increased, so have post-procedural complications. Post-procedural arteriovenous fistula in the inguinal region is a relatively rare complication, which in its evolution could lead to congestive heart failure and changes in tissue perfusion of the lower limb due to the direct passage of blood from the arterial to the venous system.

Partial Exchange Transfusion in the Management of a Preterm Neonate with Severe Anaemia from Acute Foetomaternal Haemorrhage: A Case Report

Foetomaternal Haemorrhage (FMH) refers to the passage of foetal blood into the maternal circulation. FMH is rarely diagnosed antenatally as clinical findings are subtle and non specific. Massive FMH is suspected when foetal movements are decreased, and Cardiotocographic (CTG) findings are abnormal with decreased heart rate variability, saw-tooth or a sinusoidal pattern. Massive FMH can lead to foetal demise, stillbirth, hydrops, or the birth of a severely anaemic infant with hypovolaemic shock. A 35-week pregnant woman presented with decreased foetal movements, and an emergency caesarean section was performed due to late deceleration on the cardiotocograph. The baby was very pale at birth and in shock. The Kleihauer-Betke (KB) test performed on the mother’s blood shortly after delivery showed 2.7% foetal red cells, suggesting 135 cc of FMH. The clinical features and outcome of FMH depend on the gestational age, volume, and rapidity of FMH, as well as, whether it is acute or chronic. Packed cell transfusion is recommended, but in babies with severe anaemia and cardiac failure, partial exchange transfusion is performed. The baby was managed with a fluid bolus, inotropic support, respiratory support, and partial exchange transfusion, resulting in a successful outcome. A high index of suspicion enables the obstetrician to undertake diagnostic tests, cordocentesis, plan for intrauterine transfusion or delivery, and alert the neonatal team for a better outcome.

Rivaroxaban versus Low Molecular Weight Heparin in Treatment of Acute Deep Vein Thrombosis

Abstract Objectives The purpose of this study is to examine the use of low molecular weight heparin, warfarin, and rivaroxban in the treatment of acute deep vein thrombosis. Background A blood clot stops the passage of blood via vein, usually in the legs, causing deep vein thrombosis (DVT). Clots can detach and obstruct blood flow to the pulmonary, which can be deadly (pulmonary embolism (PE). Methodology This prospective study included 250 Patients with acute deep vein thrombosis 20 patients died (9 died due to Pulmonary embolism 1 died due to bleeding – 10 died due to myocardial infarction, stroke and cardiac aresst) during study, 30 patients lack of follow up. 100 Patients are subjected to low molecular weight heparin followed by warfarin and the other 100 subjected to rivaroxban. During the period of the study from Mars 2017 to July 2019 at emergency department in Menofia university. Results The total number of Patient selected for the tests was 200 Patient. The main age was 39 and the Minimum of age was 20 year and the maximum age are 55 year. the disruption of sex are not show any concentration in any groups, the mean BMI in Warfarin Group and Rivaroxban Group are the same with no significant, the age groups shows no statistically significant of data. Conclusion According to this study Warfarin need long term monitoring, Rivaroxaban does not require laboratory surveillance, which makes treatment easier, and there are no medication or dietary interactions with Rivaroxaban.

The usefulness of flexible sigmoidoscopy in bleeding per rectum during pregnancy: an observational study

Introduction: Bleeding per rectum is not an infrequent complaint during pregnancy, which may require endoscopic evaluation and treatment. Flexible sigmoidoscopy is a relatively simple, quick procedure. The current study was aimed to assess the usefulness of flexible sigmoidoscopy in bleeding per rectum during pregnancy from a single tertiary care centre. Methods: A single centre retrospective study was carried out. Randomly selected 1000 medical records of the pregnant mothers who were referred as out patients and hospitalized from 2012 to 2022 were retrieved. All patients had the passage of fresh blood as their chief complaint. All of them had not undergone any prior diagnostic workup for their presentation. All had undergone flexible sigmoidoscopies and patients with significant additional bowel symptoms underwent colonoscopy following sigmoidoscopy. Endoscopic findings were recorded in a computer based database. Ethical approval was obtained from the Ethical Review Committee of Nawaloka Hospitals of Sri Lanka. No conflict of interest. Results: A total of 48 pregnant women had undergone lower GI endoscopies. The mean age of the patients was 25.3 ± 6.5 years. Twenty-four patients (50%) were primigravida. Majority was in the second trimester of pregnancy 89.5% (43/48). The mean (±SD) gestational age at the time of procedure was 18(±2) weeks. All had undergone sigmoidoscopy, and an additional colonoscopy were done in 2 patients. Bleeding per rectum was the main indication. All flexible sigmoidoscopies were done without sedation. Wiliest, the colonoscopies were performed under conscious sedation. Majority of the pregnant mothers found to have haemorrhoids followed by anal fissures (46/48; 95.8%). Ulcerative colitis and a sigmoidal cancer were found in two patients (4.2%). None had an immediate post procedure-related complication. Conclusion: Flexible sigmoidoscopy is useful and safe to be performed in pregnancy with clinically significant bleeding per rectum. It has a good diagnostic yield. Further prospective multicentre research studies are strongly recommended.

Next Generation Sequencing in Vitellointestinal Duct Adenoma: Existence of Adenoma-Carcinoma Sequence or too Early to Predict?

Patent vitello-intestinal duct with adenoma is rare presentation. We report a case of a 1-month-old boy presenting with intermittent passage of stool and blood from the umbilicus since birth. On local examination polypoidal mass measuring 1×1 cm was seen protruding from umbilicus with faecal discharge. Ultrasound was performed which revealed a tubular hyperechoic structure, extending from umbilicus to part of small intestine measuring 30 ×30 mm and clinical diagnosis of patent vitello-intestinal duct was given, exploratory laparotomy, excision with umbilicoplasty done, and send for histopathological examination. On histopathological examination, patent vitello-intestinal duct adenoma was rendered and next generation sequencing (NGS) was performed revealing somatic mutation of KRAS (NM_033360.4; c.38G>A; p.Gly12Asp). To our knowledge, this is the first report of the adenoma in patent vitello-intestinal duct with NGS analysis. This case emphasizes the importance of thorough microscopic examination of resected patent vitello-intestinal duct and mutational analysis of the early lesions.

Abstract WP53: The Assessment Of Brain Water Content At Posttraumatic Ischemia: Ct Perfusion Study

Background: The influence of cerebral edema and secondary insults on the clinical outcome of traumatic brain injury (TBI) is well known. The studies of the brain water homeostasis dynamics at TBI remain rare, which determines the relevance of our work. The purpose is to study the changes in brain water homeostasis after TBI of varying severity compared to the cerebral microcirculation parameters. Materials: This non-randomized retrospective single-center study complies with the Helsinki Declaration. One hundred twenty-eight patients with posttraumatic ischemia (PCI) after moderate-to-severe TBI in the middle cerebral artery territory who presented between July 2015 and February 2022 to our hospital were included. PCI was determined using perfusion computed tomography (CT), and brain edema was determined using net water uptake (NWU) on baseline CT images. The patients were divided according to Marshall’s classification. Multivariate linear regression models were performed to analyze data. Results: NWU in PCI zones was significantly higher than in non-ischemic zones (8.1% versus 4.2%; P <0.001). In the multivariable regression analysis, the mean transit time increase was significantly and independently associated with higher NWU ( R 2 = 0,089, P <0.01). In the PCI zone, cerebral blood flow (CBF), volume (CBV), and time to peak (TTP) were not significantly associated with NWU values ( P >0.05). No significant differences existed between the NWU values in PCI foci in different Marshall groups ( P =0.308). Conclusion: The Marshall classification does not seem to be able to predict the progression of posttraumatic ischemia. The blood passage delay through the cerebral microvascular bed was significantly accompanied by brain tissue water uptake increase in the PCI focus.

On Net Water Uptake in Posttraumatic Ischemia Foci.

The influence of cerebral edema and resultant secondary complications on the clinical outcome of traumatic brain injury (TBI) is well known. Clinical studies of brain water homeostasis dynamics in TBI are limited, which determines the relevance of our work. The purpose is to study changes in brain water homeostasis after TBI of varying severity compared to corresponding cerebral microcirculation parameters. This non-randomized retrospective single-center study complies with the Helsinki Declaration for patient's studies. The study included 128 patients with posttraumatic ischemia (PCI) after moderate-to-severe TBI in the middle cerebral artery territory who were admitted to the hospital between July 2015 and February 2022. PCI was evaluated by perfusion computed tomography (CT), and brain edema was determined using net water uptake (NWU) on baseline CT images. The patients were allocated according to Marshall's classification. Multivariate linear regression models were performed to analyze data. NWU in PCI areas were significantly higher than in patients with its absence (8.1% vs. 4.2%, accordingly; p<0.001). In the multivariable regression analysis, the mean transit time increase was significantly and independently associated with higher NWU (R2=0.089, p<0.01). In the PCI zone, cerebral blood flow, cerebral blood volume, and time to peak were not significantly associated with NWU values (p>0.05). No significant differences were observed between the NWU values in PCI foci in different Marshall groups (p=0.308). Marshall's classification does not predict the progression of posttraumatic ischemia. The blood passage delays through the cerebral microvascular bed is associated with brain tissue water content increase in the PCI focus.

Negative alactic base excess is reversed by hemoperfusion in septic patients

Introduction: Gattinoni et al. have recently introduced a new parameter: the “alactic base excess” (ABE). ABE is equivalent to the number of strong acids, other than lactate, which are present in the plasma in abnormal concentrations, negative ABE being associated with higher mortality in sepsis. Hemoperfusion (HPF) is an extracorporeal procedure that involves the passage of blood through an adsorption cartridge, where solutes are removed by direct binding to the sorbent material. Then, it was decided to explore the influence of HPF on negative ABE value in sepsis. Materials and methods: Basal values of ABE, standard base excess (SBE), and lactate (mean, standard deviation [SD]) were obtained. The difference between these parameter values before and after four sessions of HPF (HA330) (delta value) was evaluated. Student’s t-test and Wilcoxon test were applied. Results: From 32 patients (age: 57±13) suffering from respiratory insufficiency secondary to COVID-19 who were treated with HPF in the critical care unit of Clinica de la Mujer, Bogotá (Colombia), 6 patients presented with metabolic acidosis with negative ABE value (‒2.7±1) with negative SBE (‒4.7±1) and high lactate serum value (2±0.7 mmol/L). Delta ABE, SBE, and lactate were: 7.7 (p = 0.005), 6.1 (p = 0.003), and 1.6 (p = NS), respectively. Thus, negative ABE was significantly reversed by HPF, since SBE value turned positive without significant change in lactate. Conclusion: Negative alactic parameter was significantly reversed by HPF in septic patients. It is necessary to carry out evaluations in larger groups to estimate their impact on clinical outcomes.

Documentation of Menstrual Concerns in Patients with Inherited Bleeding Disorders

Introduction: Inherited bleeding disorders (IBD) such as von Willebrand disease (VWD) and clotting factor deficiencies may be associated with heavy menstrual bleeding (HMB) in patients with a uterus. Identification of HMB and development of an adequate management plan is fundamental to the care of these patients. However, the frequency with which hematologists discuss, document, and recommend treatment or gynecologic (GYN) consultation in women with IBD has not been well described. In this retrospective review, our aim was to assess the frequency and breadth of documented discussions about menstrual concerns in women with IBD during initial consultative visits with a hematologist. Methods: We performed a retrospective chart review of women ages 18 to 50 with a confirmed diagnosis of VWD, hemophilia A or hemophilia B seen for an initial consultative visit at the Penn Comprehensive Hemophilia and Thrombosis Program (PCHP) between January 2017 and July 2022. We collected information regarding patient demographics and laboratory values related to the bleeding disorder diagnosis and the frequency of documentation of menstrual periods in general, as well as specific rates of discussion of concerns related to HMB (passage of clots, amount of flow), documentation of management recommendations (oral contraceptive, IUD, adjunctive antifibrinolytic agents) and/or referral to GYN. Results: Forty-two patients were included in the analysis including 39 (92.8%) with VWD, 2 (4.8%) with hemophilia A, and 1 (2.4%) with hemophilia B). Thirty-eight of 42 patients (90.5%) had a documented discussion regarding menstrual periods at the time of the initial consultative visit. Thirty-four of the 38 (89.5%) who had a documented discussion about menstruation subjectively reported having "heavy menstrual bleeding" (sHMB), although the quantity was not documented in any case with a verified tool such as the PBAC. Nineteen of 38 (50%) patients had a documented discussion regarding the amount of menstrual blood flow. Ten (52.6%) had documentation of the number of pads/tampons/products used per day. Three (15.8%) had documented menses duration (number of period days). Six (31.6%) had documentation both of period duration and the number of pads/tampons used per day. Male hematologists documented amount of flow in 41.7% of patient visits, while female hematologists did so for 53.3% of visits. Twelve of 38 (31.6%) patients had a documented discussion regarding passage of clots during their periods. Five (41.7%) had a description only of clot presence, 4 (33.3%) of clot frequency and presence and 2 (16.7%) of clot size and presence; 1 (8.3%) reported no clot passage. Male hematologists documented the presence of clots for 33.3% of visits, while female hematologists did so 26.7% of visits. There was a documented discussion of treatment options in 29 of 34 patients reporting sHMB (85.3%). Treatment options included either those in use at the time of the initial consult visit or those recommended during the initial visit in patients who reported inadequate control of sHMB with prior treatments. Treatments discussed included: 15 oral contraceptives (51.7%), 8 IUD (27.6%), 2 subdermal implant (Nexplanon) (6.9%), 1 Depo Provera (3.4%), 1 contraceptive patch (3.4%), and 2 who reported not having any response to hormonal contraception and were treated with antifibrinolytic therapy alone (6.9%). There was a documented discussion of referral to GYN in 14 of 34 (41.2%) of patients who reported sHMB. Conclusions: In this retrospective study, we found that hematologists often document menstrual bleeding concerns in female patients with IBD, but do not consistently document specific components of sHMB such as amount of menstrual blood flow and/or passage of clots. Documentation rates were similar for hematologists of both sexes. Standardized templates for evaluation of HMB (both subjectively reported and formally assessed) may improve documentation rates in the future. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Application of the three-step method of mydriasis with prone position followed by anterior chamber paracentesis in post-vitrectomy vitreous hemorrhage.

Application of the three-step method of mydriasis with prone position followed by anterior chamber paracentesis in post-vitrectomy vitreous hemorrhage.

Invigorating chronic wound healing by nanocomposites composed with bioactive materials: a comprehensive review.

Wound healing research has revealed a plethora of data regarding various techniques for treating diverse types of wounds. It is well known that chronic wounds heal slowly and are vulnerable to infection. Also, there are numerous factors like destitute blood passage, undetermined inflammation, angiogenesis, neuropathy, and cell multiplication which overhang chronic wound healing. To eliminate the speculative features of chronic wounds, we made a consecutive survey on specific categories of biomaterials like bioglass, bioactive glass, bioceramics, biopolymers, and biocompatible metal oxide nanoparticles. In particular, the bioglass or bioactive glass which is a silica matrix composed of sodium, calcium, phosphorous, etc., is used for bone-bonding ability and easily dissolved in vivo conditions to repair damaged and wounded tissues with their peculiar physiochemical (surface area, porous nature, structural formation, mechanical stability) and biological properties (biocompatible, cytocompatible, osteoinductive, angiogenesis, hemostatic, antibacterial, and anti-inflammation). Furthermore, based on the existing literature studies, we summarized the healing of diabetes wound tendency by bioactive composite materials and offer detailed information on the method, techniques, and future technologies for wound healing.

S2611 It Is so Complicated: Pancreatico-Spleno-Colonic Fistula Presenting as Gastrointestinal Bleeding

Introduction: Gastrointestinal bleeding is common in clinical practice with variable etiology, we present a rare case of pancreatic pseudocyst complicated by spleno-colonic fistula manifesting with brisk hematochezia. Case Description/Methods: A 50-year-old male with no significant past medical history presented with fever and acute encephalopathy. He subsequently had a prolonged and complicated hospital course with a new diagnosis of Human immunodeficiency virus/Acquired immunodeficiency syndrome, disseminated tuberculosis, and chronic pancreatitis with a pancreatic pseudocyst. During hospitalization, the patient suddenly developed passage of bright red blood per rectum over 48 hours with down-trending hemoglobin. Hemoglobin initially dropped from 9.6 g/dL to 5.0 g/dl (Normal: 12-16 g/dL) and he required multiple units of packed red cell, platelets, and fresh frozen plasma transfusion. The patient underwent a tagged Red blood cell scan with radiolabelled 28.4 mCi of Tc-99 m. Red blood cell tagged Tc 99 m gastrointestinal bleeding scan showed large brisk pooling of the radiotracer in the splenic flexure consistent with significant active hemorrhage in the region of the splenic flexure. There was a retrograde flow of the tracer into the transverse colon and antegrade flow into the descending colon. Retrospective evaluation of the prior CT tomography scans of the abdomen demonstrated possible communication between the pancreatic tail cyst, the spleen as well as the splenic flexure which was the likely source of the GI bleed. The patient had a total of 35 units of packed red blood cells transfused, 8 units of platelets, and 7 units of fresh frozen plasma during his hospital course. The patient failed multiple attempts at Interventional radiology arterial embolization and due to multiple co-morbidities, he was not a candidate for surgical intervention. He later died after 6 months of hospitalization (Figure 1). Discussion: There have been reported cases of pancreatico-colonic fistula and spleno-colonic fistula, arising from pancreatic pseudocysts and pseudoaneurysms associated with trauma, pancreatitis, and Crohn’s disease. Pancreatico-spleno-colonic fistula is a rare and complex entity usually presenting with massive gastrointestinal bleeding. The findings of acute or chronic pancreatitis and pseudocyst with gastrointestinal bleeding should raise the suspicion of possible pancreatico-colonic fistula. Prompt imaging is key to accurate diagnosis and management.Figure 1.: Tc-99 m RBC tagged showing radiotracer in the splenic flexure, transverse colon and the descending colon. Non-contrast (A) and contrast enhanced axial (B, C) and coronal (D, E) computerized tomographic scan of the abdomen showing cystic mass at the tail of pancreas (blue arrow) communicating with the spleen and splenic flexure of the colon(red arrow).

Effects of L-arginine on impaired blood fluidity after high-intensity exercise: An in vitro evaluation.

Exercise-induced impairment of blood fluidity is considered to be associated with thrombosis development. However, the effects of L-arginine on blood fluidity after exercise remain unclear. We investigated the mechanisms of impaired blood fluidity after high-intensity exercise, and examined whether L-arginine improves exercise-induced blood fluidity impairment in vitro. Ten healthy male participants performed 15 minutes of ergometer exercise at 70% of their peak oxygen uptake levels. Blood samples were obtained before and after exercise. L-arginine and NG-monomethyl-L-arginine acetate (L-NMMA)-a nitric oxide (NO) synthase inhibitor-were added to the post-exercise blood samples. Using Kikuchi's microchannel method, we measured the blood passage time, percentage of obstructed microchannels, and the number of adherent white blood cells (WBCs) on the microchannel terrace. Exercise increased the hematocrit levels. The blood passage times, percentage of obstructed microchannels, and the number of adherent WBCs on the microchannel terrace increased after exercise; however, they decreased in a dose-dependent manner after the addition of L-arginine. L-NMMA inhibited the L-arginine-induced decrease in blood passage time. High-intensity exercise impairs blood fluidity by inducing hemoconcentration along with increasing platelet aggregation and WBC adhesion. The L-arginine-NO pathway improves blood fluidity impairment after high-intensity exercise in vitro.

758 Unique Case of Recurrent Non-Neutropenic Typhlitis

Abstract Tacrolimus is an important component of the immunosuppressive regime used after solid organ transplantation. It is known to predispose patients to typhlitis also known as neutropenic enterocolitis, which presents with the characteristic triad of abdominal pain, fever, and neutropenia. A 66-year-old lady was referred with vomiting, abdominal pain, and passage of blood per ileostomy. The patient had an extensive medical history including a panproctocolectomy for Crohn's disease, cholecystectomy and a liver transplant. Her immunosuppressive regime included prednisolone, azathioprine, and tacrolimus. Based on her presentation, a presumptive diagnosis of ischemic bowel was made, and non-contrast (due to AKI) CT scan demonstrated evidence of intramural gas with marked mesenteric and portal venous gas. The decision was made to proceed to laparotomy, the findings of which included dense adhesions but with normal healthy small bowel. After several investigations, it was concluded that her symptoms were caused by typhlitis secondary to her tacrolimus therapy. In 2020, the patient presented with similar symptoms. She was able to undergo a contrast-enhanced CT scan during this episode as she had presented early with preserved renal function. Her radiological findings were similar to the previous episode. However, owing to her known past history, she was managed conservatively. To the authors knowledge, no similar cases have been reported so far, which makes this case unique and makes a strong motion for the clinicians to maintain a high suspicion for typhlitis inmmunocompromised patients, even in absence of classical feature of neutropenia

Exosomes in the visual system: New avenues in ocular diseases.

Exosomes are a subgroup of membrane-bound extracellular vesicles secreted by all cell types and present virtually in all biological fluids. The composition of exosomes in the same cell type varies in healthy and disease conditions. Hence, exosomes research is a prime focus area for clinical research in cancer and numerous age-related metabolic syndromes. Functions of exosomes include crucial cell-to-cell communication that mediates complex cellular processes, such as antigen presentation, stem cell differentiation, and angiogenesis. However, very few studies reported the presence and role of exosomes in normal physiological and pathological conditions of specialized ocular tissues of the eye and ocular cancers. The eye being a protected sense organ with unique connectivity with the rest of the body through the blood and natural passages, we believe that the role of exosomes in ocular tissues will significantly improve our understanding of ocular diseases and their interactions with the rest of the body. We present a review that highlights the existence and function of exosomes in various ocular tissues, their role in the progression of some of the neoplastic and non-neoplastic conditions of the eyes.

Stroke Analysis Using 10 ML Comparison

Abstract: An illness known as a stroke damages the brain by rupturing the blood arteries in the brain. It can also happen when the passage of blood and other functioning of the brain is disrupted. The biggest cause of death and disability worldwide, according to the WHO, is stroke. The majority of research has been done on heart attack predictions, but very little research has been done on brain stroke risk. Considering this, numerous ML models are created to estimate the risk of a brain stroke. This work uses Ten ML Models such as Gaussian Naive Bayes, Bernoulli Naive Bayes, Gradient Boosting Classifier, Stochastic Gradient Descent, KNN, SVM, Decision Tree, Random Forest, Logistic Regression and MLP Classifier Classification. To analyze a wide range of physiological parameters and for precise prediction, The KNN algorithm, which had an accuracy of almost 94 percent, accomplished this task the best.