Global distribution and definitive host range of Echinococcus species and genotypes: A systematic review.

Echinococcus species (spp.) are regarded as neglected cestodes causing several potential zoonoses of global public health. This systematic review critically appraises the worldwide distribution of Echinococcus spp. and genotypes (Echinococcus spp.: recognized species in the genus; genotypes: variants identified within E. granulosus sensu lato.) in definitive hosts. We analyzed 82 studies from major databases, comprising 24 individual host species, including canids, felids, and a hyenid species. Canids, particularly dogs, were the most studied group among the host species, with E. granulosus sensu stricto (G1-G3) being the most frequently reported. E. granulosus s.s. was distributed across five major continents, while other Echinococcus spp. and genotypes exhibited an uneven continental distribution. The highest overlap of species existed among Asia, Europe, and Africa. Among the reported host species, 4.2 % were endangered (e.g. Lycaon pictus), 12.5 % species were vulnerable (e.g. Panthera leo, Panthera pardus, and Acinonyx jubatus), and 4.2 % were near threatened (e.g. Speothos venaticus). Overall, our review highlights the significance of canids, particularly dogs, as the core focus of scientific investigations, with E. granulosus s.s. being the most widely distributed species across five major continents, emphasizing the urgent need for continued research and public health efforts.

Thriving among Pakistani physicians: A qualitative study.

OBJECTIVE: Burnout among physicians negatively impacts the quality of patient care and provider's mental health. While many studies have evaluated burnout, factors associated with physician thriving are not well-defined. This study involved a qualitative exploration of thriving and career satisfaction among physicians in Pakistan. METHODS: A snowball sampling technique was used to recruit participants who completed a measure of job satisfaction, life satisfaction, and burnout between December 2022 and February 2023. Semi-structured interviews were conducted to explore factors associated with burnout and thriving. Participants were physicians working in public and private hospitals in North Punjab. RESULTS: Twenty-four physicians were interviewed. Six themes emerged that might help to explain factors involved in thriving: patient's affirmation, serving humanity, social support, spiritual connection, occupational prestige, and activities outside of work. Two themes were identified as challenges to thriving: excessive workload and lack of resources. CONCLUSION: Improving the well-being of primary care practitioners requires a multi-modal approach, which includes cultivating intrinsic virtues, such as resilience and spiritual resources, as well as improving social support and the workplace environment.

Genetic diversity and population structure of Echinococcus multilocularis: An in-silico global analysis.

Objective: Alveolar echinococcosis is caused by Echinococcus multilocularis, a parasite of zoonotic significance with a wide range of intermediate and final hosts, and the parasite survives successfully in diversified conditions. Plentiful studies have been done to study the genetic structure of the population of the parasite and the level of intimate kinship using mitochondrial (mt) DNA. The present study was conducted to investigate the population structure, genetic variation, and phylogenetic relationship of various isolates of E. multiocularis submitted to GenBank worldwide. Sequences of mt genes (mt-cytochrome c oxidase (cox1), mt-NADH dehydrogenase (nad1)) of E. multilocularis were analyzed to achieve the set goals. Materials and Methods: A total of 275 and 124 gene sequences of mt-cox1 and mt-nad1 belonging to E. multilocularis, respectively, were retrieved from the National Center for Biotechnology Information GenBank. The retrieved sequences were subjected to alignment with respective reference sequences using MEGA software. The PopArt software was used to establish median-joining networks, while DnaSp was used to calculate neutrality and diversity indices. MrBayes software was used to investigate the phylogenetic association between haplotypes based on Bayesian phylogeny. Results: Approximately 13 and 20 distinctive haplotypes of nad1 and cox1 genes, respectively, were observed in the present study. In both of the mt genes, diversity indices indicated low haplotype (mt-cox1 = 0.140; mt-nad1 = 0.374) and nucleotide (mt-cox1 = 0.00111; mt-nad1 = 0.00287) diversities. The values of Tajima's D and Fu Fs for a population of both of the genes under study were found to be negative. Conclusion: This study is a maiden attempt to provide insights into the population structure and genetic variation of E. multilocularis on a global scale. However, it is suggested that to better understand the population structure and genetic diversity of E. multilocularis, more geographical locations and amplifications of full-length gene sequences should be considered, which could be helpful in widening the insights into the genetic diversity of E. multilocularis.

Non-Contact Measurement of Cardiopulmonary Activity Using Software Defined Radios.

Vital signs are important indicators to evaluate the health status of patients. Channel state information (CSI) can sense the displacement of the chest wall caused by cardiorespiratory activity in a non-contact manner. Due to the influence of clutter, DC components, and respiratory harmonics, it is difficult to detect reliable heartbeat signals. To address this problem, this paper proposes a robust and novel method for simultaneously extracting breath and heartbeat signals using software defined radios (SDR). Specifically, we model and analyze the signal and propose singular value decomposition (SVD)-based clutter suppression method to enhance the vital sign signals. The DC is estimated and compensated by the circle fitting method. Then, the heartbeat signal and respiratory signal are obtained by the modified variational modal decomposition (VMD). The experimental results demonstrate that the proposed method can accurately separate the respiratory signal and the heartbeat signal from the filtered signal. The Bland-Altman analysis shows that the proposed system is in good agreement with the medical sensors. In addition, the proposed system can accurately measure the heart rate variability (HRV) within 0.5m. In summary, our system can be used as a preferred contactless alternative to traditional contact medical sensors, which can provide advanced patient-centered healthcare solutions.

The Chest Pain That Never Went Away: A Case of Complex Cardiopulmonary Pathologies in a 64-Year-Old Caucasian Male.

Chest pain is a common and complex symptom that can arise from various etiologies, ranging from benign musculoskeletal conditions to life-threatening cardiovascular events. It is a hallmark symptom of myocardial infarction, angina, and other ischemic heart diseases, necessitating prompt and thorough evaluation. Ongoing chest pain post-procedures and medication administration presents a diagnostic challenge, as it may be indicative of an exacerbation of underlying conditions. We present the case of a 64-year-old Caucasian male who initially presented with severe and persistent chest pain suggestive of an anterior wall ST-elevation myocardial infarction (STEMI). He had a history of coronary artery disease and had recently undergone cardiac catheterization. Despite prompt administration of nitroglycerin and aspirin, the patient's symptoms persisted, prompting emergent percutaneous coronary intervention (PCI). Subsequent to PCI, ongoing chest discomfort persisted, prompting further investigation, which revealed a concurrent lung mass and nodules on imaging. Additional interventions, including repeated PCI procedures and thoracentesis, were undertaken. Unfortunately, the patient's clinical course rapidly deteriorated, culminating in cardiac arrest and unsuccessful resuscitative efforts. This case highlights the complexities inherent in managing intricate cardiovascular conditions and emphasizes the critical importance of maintaining vigilance for concomitant pathologies.

Optimization of biodiesel yield from waste cooking oil and sesame oil using RSM and ANN techniques.

In the era of global energy crises and the pressing concern of fossil fuel depletion, the quest for sustainable alternatives has become paramount. The current study aims to optimize biodiesel extraction from a combination of waste cooking oil (WCO) and sesame seed oil (SSO) through response surface methodology (RSM) and artificial neural network (ANN). The cold flow properties of biodiesel produced from WCO are a major obstacle to the commercial use of biodiesel. On the other hand, SSO possesses better oxidation stability and cold flow properties. A mixture of waste cooking oil (i.e. 70 % by volume) and sesame seed oil (i.e. 30 % by volume) has been prepared for biodiesel production via a microwave-assisted transesterification process. For biodiesel yield optimization, the interaction among the operating parameters is developed by RSM, whereas biodiesel yield is predicted by ANN. The operating parameters include reaction speed, RPM (100-600 rpm), reaction time (1-5 min), methanol to oil ratio (8:1-12:1 v/v), and catalyst concentration (0.1-2 % w/w). The highest biodiesel yield of 94 % is found at a reaction speed of 350 rpm, reaction time of 3 min, catalyst concentration of 1.05 w/w, and methanol to oil ratio of 10:1. Furthermore, it is discovered that when estimating biodiesel production rate depending on reaction constraints, ANN shows lower comparative error compared to RSM. The results show that ANN outperforms RSM in terms of percentage improvement when it comes to biodiesel production prediction.

Effects of betaine supplementation on dry matter intake, milk characteristics, plasma non-esterified fatty acids, and beta-hydroxybutyric acid in dairy cattle: a meta-analysis.

Betaine supplementation in dairy cattle has gained attention due to its potential benefits to production and health as a methyl donor, which can play a crucial role in the metabolism of dairy cows. The objective of the current meta-analysis was to quantify the effects of betaine supplementation on milk production, composition, beta-hydroxybutyric acid (BHBA), and non-esterified fatty acids (NEFA). A systematic literature search was carried out, all relevant studies were retrieved, and the meta-analysis was carried out. The mean difference (MD) for dry matter intake (DMI) using the random-effects model was 0.499 kg/day (P < 0.0001). The subgroup analysis indicated that supplementing betaine in heat-stressed cows increased DMI by 0.584 kg/day (P < 0.001), while in cows not exposed to heat stress, DMI was increased by 0.381 kg/day (P = 0.007). The energy-corrected milk (ECM) increased by 1.36 kg/day (P < 0.0001). The milk fat yield was significantly increased in betaine-supplemented cows (MD = 0.040 kg/day, 95% CI = 0.015 to 0.065). The milk protein yield (kg/day) (MD = 0.014, P = 0.138) was increased (MD = 0.035, P = 0.0005) by betaine supplementation. The lactose yield (kg/day) was also significantly higher (MD = 0.055, P = 0.020) in betaine-supplemented cows. The standardized mean difference (SMD) for NEFA (SMD = -0.447, 95% CI = -1.029 to 0.135, P = 0.114) and BHBA (SMD = -0.130, 95% CI = -0.491 to 0.234). In conclusion, the findings from this meta-analysis suggest that betaine supplementation positively influences DMI, ECM, milk fat yield, milk lactose yield, and milk protein yield. Subgroup analysis further indicated that the positive effects on DMI are greater in heat-stressed cows compared to those not exposed to heat stress. The analysis did not find significant effects on the levels of NEFA or BHBA, suggesting that betaine supplementation may not directly influence these metabolic parameters.

Three layered sparse dictionary learning algorithm for enhancing the subject wise segregation of brain networks.

Independent component analysis (ICA) and dictionary learning (DL) are the most successful blind source separation (BSS) methods for functional magnetic resonance imaging (fMRI) data analysis. However, ICA to higher and DL to lower extent may suffer from performance degradation by the presence of anomalous observations in the recovered time courses (TCs) and high overlaps among spatial maps (SMs). This paper addressed both problems using a novel three-layered sparse DL (TLSDL) algorithm that incorporated prior information in the dictionary update process and recovered full-rank outlier-free TCs from highly corrupted measurements. The associated sequential DL model involved factorizing each subject's data into a multi-subject (MS) dictionary and MS sparse code while imposing a low-rank and a sparse matrix decomposition restriction on the dictionary matrix. It is derived by solving three layers of feature extraction and component estimation. The first and second layers captured brain regions with low and moderate spatial overlaps, respectively. The third layer that segregated regions with significant spatial overlaps solved a sequence of vector decomposition problems using the proximal alternating linearized minimization (PALM) method and solved a decomposition restriction using the alternating directions method (ALM). It learned outlier-free dynamics that integrate spatiotemporal diversities across brains and external information. It differs from existing DL methods owing to its unique optimization model, which incorporates prior knowledge, subject-wise/multi-subject representation matrices, and outlier handling. The TLSDL algorithm was compared with existing dictionary learning algorithms using experimental and synthetic fMRI datasets to verify its performance. Overall, the mean correlation value was found to be 26 % higher for the TLSDL than for the state-of-the-art subject-wise sequential DL (swsDL) technique.

Food temperature altered macronutrients induced changes in satiety hormones; glucagon - like peptide -1 and cholecystokinin and their correlation with subjective satiety.

BACKGROUND: The benefits of dietary macronutrients for weight management depend on the integrity of gut hormones. The role of food temperature in the release of satiety hormones and satiety needs elucidation. We aimed to determine the impact of different food temperatures with varying macronutrient compositions on satiety-related gut hormones glucagon-like peptide-1 (GLP-1) and cholecystokinin (CCK) and find the correlation of satiety hormones with appetite scores and remainder-day food (energy) intake. MATERIALS AND METHODS: Thirteen healthy participants (eight males and five females) aged 25-35 years with body mass index 18.5-24.9 kg/m2 with no medical illnesses or eating disorders consumed three compositions of meals (high carbohydrate, high fat, and high protein meals) each at three temperatures (cold, warm, and hot) in a randomized, double-blinded, controlled crossover design. Plasma concentrations of peptide hormones were determined at 0, 30, and 240 minutes by enzyme-linked immunosorbent assay, and 24-hours food recall was used for remainder-day food intake (remainder energy). Data were analyzed using SPSS version 27.0. The change in plasma levels of gut hormones with time was assessed using Friedman test; Kruskal-Wallis test was employed to compare GLP-1 and CCK hormonal levels across nine meals. RESULTS: A comparison of the three meals at the three temperatures (total of nine groups), showed that the GLP-1 and CCK plasma concentrations were significantly different (P < 0.001). GLP-1 and CCK responses increased more after hot meals than cold meals. Overall, high-fat meals had more effective gut hormone secretions. The area under the curve was increased for GLP-1 in high-fat meals and for CCK in hot meals. The peptide hormones (GLP-1 and CCK) were positively correlated with satiety scores and inversely with remainder food intake. CONCLUSION: The temperature of food was found to be an effective stimulus for the regulation of CCK and GLP-1 secretion. Hot food temperature increased satiety hormones (CCK and GLP-1), independent of food macronutrient composition.

MCNN_MC: Computational Prediction of Mitochondrial Carriers and Investigation of Bongkrekic Acid Toxicity Using Protein Language Models and Convolutional Neural Networks.

Mitochondrial carriers (MCs) are essential proteins that transport metabolites across mitochondrial membranes and play a critical role in cellular metabolism. ADP/ATP (adenosine diphosphate/adenosine triphosphate) is one of the most important carriers as it contributes to cellular energy production and is susceptible to the powerful toxin bongkrekic acid. This toxin has claimed several lives; for example, a recent foodborne outbreak in Taipei, Taiwan, has caused four deaths and sickened 30 people. The issue of bongkrekic acid poisoning has been a long-standing problem in Indonesia, with reports as early as 1895 detailing numerous deaths from contaminated coconut fermented cakes. In bioinformatics, significant advances have been made in understanding biological processes through computational methods; however, no established computational method has been developed for identifying mitochondrial carriers. We propose a computational bioinformatics approach for predicting MCs from a broader class of secondary active transporters with a focus on the ADP/ATP carrier and its interaction with bongkrekic acid. The proposed model combines protein language models (PLMs) with multiwindow scanning convolutional neural networks (mCNNs). While PLM embeddings capture contextual information within proteins, mCNN scans multiple windows to identify potential binding sites and extract local features. Our results show 96.66% sensitivity, 95.76% specificity, 96.12% accuracy, 91.83% Matthews correlation coefficient (MCC), 94.63% F1-Score, and 98.55% area under the curve (AUC). The results demonstrate the effectiveness of the proposed approach in predicting MCs and elucidating their functions, particularly in the context of bongkrekic acid toxicity. This study presents a valuable approach for identifying novel mitochondrial complexes, characterizing their functional roles, and understanding mitochondrial toxicology mechanisms. Our findings, that utilize computational methods to improve our understanding of cellular processes and drug-target interactions, contribute to the development of therapeutic strategies for mitochondrial disorders, reducing the devastating effects of bongkrekic acid poisoning.

Quality of life of pediatric patients with craniopharyngioma: A retrospective series from a low-middle-income country with more than 4 years follow-up.

Background: Craniopharyngiomas (CPs) are rare, low-grade tumors characterized by a range of debilitating symptoms. Most of the existing literature reports postoperative outcomes of the different treatment modalities of childhood CP. However, few studies have reported the impact of these different treatment methods on the quality of life (QoL) of survivors of childhood CP. Therefore, we aim to assess the correlation between different surgical modalities on the QoL of patients with childhood CP from a lower-middle-income country. Methods: Twenty-nine survivors who underwent treatment for CP were included in the study. The selected patients had either been managed with complete resection, debulking, or placement of an Ommaya reservoir. QoL was assessed by the pediatric quality of life (PedsQL) questionnaire. The effect of the different treatment modalities on the QoL was assessed. Results: Mean follow-up was 4.4 ± 2.19 years. The type of surgery was significantly related to the mean PedsQL scores for the total score as well as each of the individual domain scores (P < 0.001). Complete resection of the tumor resulted in the lowest mean (standard deviation) PedsQL total score of 56.6 ± 7.12 compared to the Ommaya reservoir with biopsy (83.3 ± 5.69) and debulking (93.8 ± 3.37) (P < 0.001). Conclusion: There was a significant effect of the type of surgical treatment on the QoL of the survivors of childhood CP. It is important to consider the long-term outcomes in addition to immediate postoperative outcomes when deciding on a treatment strategy while managing children with CP.

The Risk of Infection-Caused Mortality in Gastric Adenocarcinoma: A Population-Based Study.

Background: Gastric adenocarcinoma (GAC) is a deadly tumor. Postoperative complications, including infections, worsen its prognosis and may affect overall survival. Little is known about perioperative complications as well as modifiable and non-modifiable risk factors. Early detection and treatment of these risk factors may affect overall survival and mortality. Methods: We extracted GAC patient's data from the Surveillance, Epidemiology, and End Results (SEER) database and analyzed using Pearson's Chi-square, Cox regression, Kaplan-Meier, and binary regression methods in SPSS. Results: At the time of analysis, 59,580 GAC patients were identified, of which 854 died of infection. Overall, mean survival in months was better for younger patients, age < 50 years vs. ≥ 50 years (60.45 vs. 56.75), and in females vs. males (65.23 vs. 53.24). The multivariate analysis showed that the risk of infectious mortality was higher in patients with age ≥ 50 years (hazard ratio (HR): 3.137; 95% confidence interval (CI): 2.178 - 4.517), not treated with chemotherapy (HR: 1.669; 95% CI: 1.356 - 2.056), or surgery (HR: 1.412; 95% CI:1.132 - 1.761) and unstaged patients (HR: 1.699; 95% CI: 1.278 - 2.258). In contrast, the mortality risk was lower in females (HR: 0.658; 95% CI: 0.561 - 0.773) and married patients (HR: 0.627; 95% CI: 0.506 - 0.778). The probability of infection was higher in older patients (odds ratio (OR) of 2.094 in ≥ 50 years), other races in comparison to Whites and Blacks (OR: 1.226), lesser curvature, not other specified (NOS) as a primary site (OR: 1.325), and patients not receiving chemotherapy (OR: 1.258). Conclusion: Older, unmarried males with GAC who are not treated with chemotherapy or surgery are at a higher risk for infection-caused mortality and should be given special attention while receiving treatment.

Bayesian-Edge system for classification and segmentation of skin lesions in Internet of Medical Things.

BACKGROUND: Skin diseases are severe diseases. Identification of these severe diseases depends upon the abstraction of atypical skin regions. The segmentation of these skin diseases is essential to rheumatologists in risk impost and for valuable and vital decision-making. Skin lesion segmentation from images is a crucial step toward achieving this goal-timely exposure of malignancy in psoriasis expressively intensifies the persistence ratio. Defies occur when people presume skin diseases they have without accurately and precisely incepted. However, analyzing malignancy at runtime is a big challenge due to the truncated distinction of the visual similarity between malignance and non-malignance lesions. However, images' different shapes, contrast, and vibrations make skin lesion segmentation challenging. Recently, various researchers have explored the applicability of deep learning models to skin lesion segmentation. MATERIALS AND METHODS: This paper introduces a skin lesions segmentation model that integrates two intelligent methodologies: Bayesian inference and edge intelligence. In the segmentation model, we deal with edge intelligence to utilize the texture features for the segmentation of skin lesions. In contrast, Bayesian inference enhances skin lesion segmentation's accuracy and efficiency. RESULTS: We analyze our work along several dimensions, including input data (datasets, preprocessing, and synthetic data generation), model design (architecture, modules), and evaluation aspects (data annotation requirements and segmentation performance). We discuss these dimensions from seminal works and a systematic viewpoint and examine how these dimensions have influenced current trends. CONCLUSION: We summarize our work with previously used techniques in a comprehensive table to facilitate comparisons. Our experimental results show that Bayesian-Edge networks can boost the diagnostic performance of skin lesions by up to 87.80% without incurring additional parameters of heavy computation.

Compatibility and performance study of electrohydrodynamic printing using zinc oxide inkjet ink.

The demand for modern electronics and semiconductors has increased throughout the years, which has enabled the innovation and exploration of solution-processed deposition. Solution-based processes have gained a lot of interest due to the low-cost fabrication and the large fabrication areas without the need for high-vacuum equipment. In this study, we utilized the ZnO ink for inkjet printer ink to fabricate a thin film via Electrohydrodynamic printing. Three different ink solutions were prepared for experimentation. The EHD printing technique demonstrated the ink's compatibility with and without the modifications. The outcomes of the EHD printed materials were comparable with the spin-coated thin films. The EHD-printed films demonstrated better results in comparison to spin-coated films. Ra and Rq of the EHD film measured at 3.651 nm and 4.973 nm, respectively. It improved the absorbance up to two-fold at 360 nm wavelength and electrical conductivity up to 40% compared to the spin-coated films. Furthermore, the optimization of the printing parameters can lead to the improved morphology and thickness of the EHD thin films.

Budesonide Versus Mesalamine in Microscopic Colitis: A Comparative Meta-analysis of Randomized Controlled Trials.

BACKGROUND: Microscopic colitis (MC) is an inflammatory bowel disease of autoimmune origin that causes chronic watery diarrhea. Medications, including budesonide, mesalamine, loperamide, cholestyramine, and bismuth subsalicylate, are first-line therapies. Meanwhile, azathioprine, 6-mercaptopurine, and methotrexate are indicated for refractory MC. OBJECTIVE: We aim to assess the efficacy and safety of budesonide compared with mesalamine for induction of remission in MC patients. METHODS: We searched the Cochrane Library, Scopus, Web of Science, and PubMed for relevant clinical trials comparing either mesalamine or budesonide with a control group. We included the following outcomes: clinical remission (3 or fewer stools/day), daily stool weight, daily stool frequency, number of patients with clinical response <50% in the disease activity, and daily stool consistency. Safety end points included: any adverse event, serious adverse events, any adverse event-related discontinuation, abdominal discomfort, constipation, flatulence, nausea, dizziness, headache, bronchitis, nasopharyngitis, and depression. We conducted a meta-analysis model using the generic inverse variance method and performed a subgroup analysis based on the intervention administered. RESULTS: Nineteen randomized clinical trials were included. We found that after 6 weeks of follow-up, budesonide is associated with increased clinical remission rates compared with mesalamine [RR=2.46 (2.27, 2.67), and RR=2.24 (1.95, 2.57), respectively]. However, the test of subgroup difference revealed that the difference is not significant (P=0.25). After 8 weeks of follow-up, budesonide showed significantly higher clinical remission rates than mesalamine RR=2.29 (2.14, 2.45), and RR=1.7 (1.41, 2.05), respectively (P=0.003). Regarding the daily stool weight, patients in the budesonide group showed nonsignificant less stool weight [MD=-351.62 (-534.25, -168.99)] compared with mesalamine [MD=-104.3 (-372.34, 163.74)], P=0.14. However, daily stool frequency was significantly less in the budesonide group compared with mesalamine (P<0.001). Budesonide is associated with a significantly lower incidence of adverse events compared with mesalamine (P=0.002). Analysis of other safety endpoints was not significant between both groups. CONCLUSIONS: Budesonide was found to be better than mesalamine in MC patients in terms of clinical remission rate, especially after 8 weeks of follow-up. Budesonide also showed less incidence of adverse events. There is an urgent need for randomized, double-blinded clinical trials to provide direct and reliable evidence.

Histopathological features of idiopathic portal hypertension: A systematic review and meta-analysis.

BACKGROUND: Portal hypertension (PH) is a clinically significant entity that could present with life-threatening gastrointestinal bleeding. Cirrhosis is the most common cause of PH, with well-documented histopathology and etiology. However, in idiopathic portal hypertension (IPH), no single histopathologic finding is associated with PH. Our systematic review aims to identify and summarize the prevalence of the common histological findings of IPH. METHODS: We systematically searched PubMed, Cochrane CENTRAL, Web of Science, and Scopus till 1ST March 2022 for studies describing the histopathological features of IPH. Data were extracted from eligible studies and pooled as events rate and 95% confidence interval (CI) using binary random-effects model by open meta-analyst software. RESULTS: We included 23 retrospective studies with a total sample size of 813 patients. The overall incidence of nodular regenerative hyperplasia was 38.6%, 59.8% for portal fibrosis, 51.3% for periportal fibrosis, 39.3% for perisinusoidal fibrosis, 89.8% for portal vein sclerosis, 42.2% for portal inflammation, 53.3% for mega-sinusoids, 39.5% for thickening of portal vein branches, 93.8% for narrowing of portal veins, 53.3% for hepatic veins/venous outflow obstruction, 51.4% for aberrant portal/periportal vessels, 42.4% for shunt vessel, 50.9% for ductular proliferation, and 16.3% for steatosis. CONCLUSION: Due to the relatively non-pathognomonic and non-specific nature of IPH, a combination of different histological features such as the portal and periportal fibrosis, portal vein sclerosis, mega-sinusoids, narrowing of portal veins, hepatic venous outflow obstruction, aberrant portal or periportal vessels, and ductular proliferation may be of value in diagnosing IPH as the incidence rate of these features was at approximately 50%.

Atypical haemolytic uremic syndrome in a patient with severe Babesiosis.

Babesiosis is a tick-borne parasitic infection that can result in various haematological complications. This case report discusses a patient with severe Babesiosis complicated by an unorthodox presentation of Babesiosis-associated haemolytic uremic syndrome. Discussed here is the patient's clinical course and the management strategies employed, with an emphasis on early recognition and treatment of renal failure in the context of severe Babesiosis. Haematologic manifestations of Babesia are common and the severity of disease is dependent on parasite load. While treatment options such as red blood cell exchange have been proposed for severe cases, their impact on clinical outcomes is limited and they may not be readily available in resource-limited settings. Traditional management using antimicrobials has been proposed but there is limited discussion about managing unique presentations such as renal failure in Babesiosis. Hence, understanding the pathophysiology, early recognition and aggressive treatment strategies can optimise clinical outcomes and reduce mortality.

Negative Pressure Wound Therapy in Pharyngocutaneous Fistula.

Pharyngocutaneous fistula (PCF) is an abnormal connection between the pharynx and skin that can occur after laryngectomy surgery. It can have a significant negative impact on patient recovery, delaying wound healing, requiring prolonged nil-per-oral (NPO) status, and reducing quality of life. Traditionally, the management of PCF has relied on conservative measures or surgical intervention. However, negative pressure wound therapy (NPWT) offers a promising alternative approach. This case study involves three patients who underwent laryngectomy and developed postoperative PCF. All patients received NPWT with a modified suction catheter and low negative pressure (20-40 mmHg). With NPWT, all patients achieved complete wound closure, with healing times ranging from two weeks to six weeks. This suggests that NPWT may significantly accelerate PCF healing compared to traditional methods. However, maintaining an airtight dressing on the neck region can be challenging. This study highlights the potential of NPWT for faster PCF closure after laryngectomy. Further research is needed to optimize NPWT application techniques, explore the impact on long-term outcomes, and establish guidelines for broader clinical use.

Efficacy and Safety of Rivaroxaban Versus Enoxaparin in Prevention of Recurrence of Venous Thrombo-Embolism Events in Cancer Patients: A Meta-Analysis.

OBJECTIVE: To examine the effectiveness of rivaroxaban compared to enoxaparin in patients diagnosed with cancer and venous thromboembolism. METHODS: A search of Pub Med, Scopus, and Google Scholar, from inception through April 2023 was conducted. Articles comparing rivaroxaban with enoxaparin in patients with cancer and VTE/PE/DVT were included. Review Manager Version 5.2 was utilised for the analysis of the following outcomes; VTE, PE, DVT, major bleeding, and mortality. RESULTS: A total of 8 articles and 2276 patients were included in the final analysis. Pooled analysis showed that rivaroxaban had a statistically insignificant reduced association with VTE occurrence (RR:0.83, 95% CI:0.58-1.18, P:0.3) as well as a statically insignificant reduction in major bleeding (RR:0.79, 95% CI:0.53-1.18, P:0.25). Analysis showcased that there was an insignificant reduction of mortality rivaroxaban as compared to enoxaparin (RR:0.74, 95% CI: 0.46-1.20, P:0.23). CONCLUSION: Rivaroxaban can serve as a viable alternative to enoxaparin, with no appreciable drawbacks, for preventing and managing VTE in patients with malignancy.