VER-Net: a hybrid transfer learning model for lung cancer detection using CT scan images.

BACKGROUND: Lung cancer is the second most common cancer worldwide, with over two million new cases per year. Early identification would allow healthcare practitioners to handle it more effectively. The advancement of computer-aided detection systems significantly impacted clinical analysis and decision-making on human disease. Towards this, machine learning and deep learning techniques are successfully being applied. Due to several advantages, transfer learning has become popular for disease detection based on image data. METHODS: In this work, we build a novel transfer learning model (VER-Net) by stacking three different transfer learning models to detect lung cancer using lung CT scan images. The model is trained to map the CT scan images with four lung cancer classes. Various measures, such as image preprocessing, data augmentation, and hyperparameter tuning, are taken to improve the efficacy of VER-Net. All the models are trained and evaluated using multiclass classifications chest CT images. RESULTS: The experimental results confirm that VER-Net outperformed the other eight transfer learning models compared with. VER-Net scored 91%, 92%, 91%, and 91.3% when tested for accuracy, precision, recall, and F1-score, respectively. Compared to the state-of-the-art, VER-Net has better accuracy. CONCLUSION: VER-Net is not only effectively used for lung cancer detection but may also be useful for other diseases for which CT scan images are available.

Evaluation of Antioxidant and Anti-Inflammatory Activities, and Metabolite Profiling of Selected Medicinal Plants of Nepal.

This study aimed to evaluate the antioxidant, antiarthritic, and anti-inflammatory properties of extracts from the leaves of twelve different medicinal plants in Nepal. We then evaluated the total phenolic, flavonoid, and tannin contents of the extract using in-vitro assays and characterized it using GC-MS analysis. Results revealed that most of the leaf extracts contained phenolic compounds, flavonoids, tannins, alkaloids, and saponins. Few plants also showed the presence of glycosides, phytate, and vitamin C. Among the studied plants, Neolamarckia cadamba exhibited the highest total phenolic and tannin contents, as 241.53 ± 0.20 µg of gallic acid equivalent/mg and 74.48 ± 1.081 µg of tannic acid equivalent/mg, respectively. Ipomoea batatas exhibited the highest total flavonoid content, as 53.051 ± 1.11 µg of quercetin equivalent/mg. Moreover, Raphanus sativus demonstrated significant ferrous ion chelating, 2,2-diphenyl-1-picrylhydrazyl, hydrogen peroxide scavenging, and total antioxidant activities with IC50 value of 4.76 ± 0.68 µg/mL, 5.84 ± 0.14 µg/mL, 6.89 ± 0.16 µg/mL, and 8.99 ± 0.20 µg/mL, respectively. Similarly, Colocasia esculenta and Cicer arietinum exhibited the highest hydroxyl radical and nitric oxide scavenging activities, measuring IC50 value of 7.22 ± 0.56 µg/mL and 9.06 ± 0.10 µg/mL, respectively. Among all the extracts, Amorphophallus paeoniifolius displayed significant human red blood cell (HRBC) membrane stabilization activity (IC50 = 6.22 ± 0.78 µg/mL). Furthermore, Raphanus sativus, Chenopodium album, Cicer arietinum, and Murraya koenigii exhibited the highest inhibitory activities against protein denaturation with bovine serum albumin, antiarthritic, lipoxygenase inhibitory, and proteinase inhibitory, measuring IC50 of 7.48 ± 0.48 µg/mL, 9.44 ± 1.62 µg/mL, 14.67 ± 1.94 µg/mL, and 28.57 ± 2.39 µg/mL, respectively. In conclusion, this study demonstrated the twelve leaf extracts' significant antioxidant, antiarthritic, and anti-inflammatory activities.

Molecular Advances to Combat Different Biotic and Abiotic Stresses in Linseed (Linum usitatissimum L.): A Comprehensive Review.

Flax, or linseed, is considered a "superfood", which means that it is a food with diverse health benefits and potentially useful bioactive ingredients. It is a multi-purpose crop that is prized for its seed oil, fibre, nutraceutical, and probiotic qualities. It is suited to various habitats and agro-ecological conditions. Numerous abiotic and biotic stressors that can either have a direct or indirect impact on plant health are experienced by flax plants as a result of changing environmental circumstances. Research on the impact of various stresses and their possible ameliorators is prompted by such expectations. By inducing the loss of specific alleles and using a limited number of selected varieties, modern breeding techniques have decreased the overall genetic variability required for climate-smart agriculture. However, gene banks have well-managed collectionns of landraces, wild linseed accessions, and auxiliary Linum species that serve as an important source of novel alleles. In the past, flax-breeding techniques were prioritised, preserving high yield with other essential traits. Applications of molecular markers in modern breeding have made it easy to identify quantitative trait loci (QTLs) for various agronomic characteristics. The genetic diversity of linseed species and the evaluation of their tolerance to abiotic stresses, including drought, salinity, heavy metal tolerance, and temperature, as well as resistance to biotic stress factors, viz., rust, wilt, powdery mildew, and alternaria blight, despite addressing various morphotypes and the value of linseed as a supplement, are the primary topics of this review.

Genome Editing and Improvement of Abiotic Stress Tolerance in Crop Plants.

Genome editing aims to revolutionise plant breeding and could assist in safeguarding the global food supply. The inclusion of a 12-40 bp recognition site makes mega nucleases the first tools utilized for genome editing and first generation gene-editing tools. Zinc finger nucleases (ZFNs) are the second gene-editing technique, and because they create double-stranded breaks, they are more dependable and effective. ZFNs were the original designed nuclease-based approach of genome editing. The Cys2-His2 zinc finger domain's discovery made this technique possible. Clustered regularly interspaced short palindromic repeats (CRISPR) are utilized to improve genetics, boost biomass production, increase nutrient usage efficiency, and develop disease resistance. Plant genomes can be effectively modified using genome-editing technologies to enhance characteristics without introducing foreign DNA into the genome. Next-generation plant breeding will soon be defined by these exact breeding methods. There is abroad promise that genome-edited crops will be essential in the years to come for improving the sustainability and climate-change resilience of food systems. This method also has great potential for enhancing crops' resistance to various abiotic stressors. In this review paper, we summarize the most recent findings about the mechanism of abiotic stress response in crop plants and the use of the CRISPR/Cas mediated gene-editing systems to improve tolerance to stresses including drought, salinity, cold, heat, and heavy metals.

Shear bond strengths of bur or Er:YAG laser prepared dentine to composite resin with or without low-level laser conditioning: an in vitro study.

This study aims to compare the different modes of cavity preparation while evaluating the effect of low-level laser therapy (LLLT) on dentine before bonding in terms of shear bond strength between composite resin and dentine. Fifty human molar teeth were mounted on acrylic blocks and dentine specimen were prepared after which they were randomized into four equal groups. Cavity preparation mode differed in respective groups. After etching, bonding; composite resin was placed and polymerized on the prepared dentine surfaces. The specimens were kept in an environment simulating oral cavity and then shear tested in a universal testing machine. The failure surfaces of the specimen teeth were subjected to SEM micrographic evaluation. The cavity prepared with diamond abrasive points had a higher shearing load at failure that was statistically significantly different from the ones prepared with laser. That with diamond abrasive points followed by LLLT of the cavity surface with Nd:YAG laser had a higher bond strength than the ones prepared with just Er:YAG laser and there was no statistically significant difference between these and the ones prepared with diamond abrasive points alone. SEM analysis of the failure mode in bur-cut dentine showed the presence of a hybrid layer at the interface. Surface conditioning of the same with Nd:YAG laser before etching suggested a recrystallisation of dentine due to the heat produced. Cavity preparation with Er:YAG laser leads to reduced shear bond strength to adhesive restorative materials when compared with that using burs and high-speed handpiece.

Breeding and Genomic Approaches towards Development of Fusarium Wilt Resistance in Chickpea.

Chickpea is an important leguminous crop with potential to provide dietary proteins to both humans and animals. It also ameliorates soil nitrogen through biological nitrogen fixation. The crop is affected by an array of biotic and abiotic factors. Among different biotic stresses, a major fungal disease called Fusarium wilt, caused by Fusarium oxysporum f. sp. ciceris (FOC), is responsible for low productivity in chickpea. To date, eight pathogenic races of FOC (race 0, 1A, and 1B/C, 2-6) have been reported worldwide. The development of resistant cultivars using different conventional breeding methods is very time consuming and depends upon the environment. Modern technologies can improve conventional methods to solve these major constraints. Understanding the molecular response of chickpea to Fusarium wilt can help to provide effective management strategies. The identification of molecular markers closely linked to genes/QTLs has provided great potential for chickpea improvement programs. Moreover, omics approaches, including transcriptomics, metabolomics, and proteomics give scientists a vast viewpoint of functional genomics. In this review, we will discuss the integration of all available strategies and provide comprehensive knowledge about chickpea plant defense against Fusarium wilt.

Bilateral symmetry and anatomical root variations of mandibular second molars in North Indian populations using cone beam computed tomography.

Background: To evaluate bilateral symmetry and anatomical variations of root morphology of permanent mandibular second molar using systematic evaluation of CBCT scans. Material and Methods: This cross-sectional study involved the mandible which were imaged using serial axial cone-beam computed tomography (CBCT) from 680 North Indian patients who visited dental hospital for various reasons unrelated to the study. CBCT Records with presence of bilateral fully erupted permanent mandibular second molars with fully formed apexes were selected. Results: Bilaterally present two root and three canal configurations were most consistently seen (75.88 % and 59.11 %, respectively). The occurrence of two roots with two canals and four canals was 15.14% and 1.61% respectively. Mandibular second molar present with one extra root, radix entomolaris with three canals and four canals was 0.44% and 3.53% while radix paramolaris present with three canals and four canals 1.32% and 1.03% respectively. The occurrence of C-shaped root bilaterally with C shaped canal was 15.88% whereas the presence of one fused root bilaterally was 0.44%. The presence of four roots bilaterally with four canals was identified in only one CBCT scanned image (0.14%). The frequency distribution of root morphology on bilateral symmetrical analysis revealed 98.58 % bilateral symmetry. Conclusions: In 402 CBCT scans, bilateral presence of two roots with three canals was the most typical root structure seen in mandibular second molars (59.11%). A rare variation found was the presence of four roots occurring bilaterally, seen in only 1 CBCT scan. Bilateral symmetrical analysis of root morphology revealed 98.58 % bilateral symmetry. Key words:Anatomic root variations, mandibular second molar, Cone Beam Computed Tomography scans, bilateral symmetry.

Tenofovir-based first-line regimen in newly diagnosed HIV-patients: An experience from a Tertiary Care Hospital in India.

Introduction: India has a huge burden of HIV/AIDS infection. Tenofovir-based first-line therapy is the preferred treatment for newly diagnosed cases of HIV infection. Materials and Methods: The present prospective study was done among newly diagnosed cases of HIV infection. The patients were followed up for 6 months from the day of enrollment. Sociodemographic parameters, CD4 counts, and adverse drug reactions (ADRs) were analyzed at baseline and after 6 months. Bivariate and multivariate logistic regression was performed with the occurrence of ADRs as outcome variable. Results: In this study, 67 patients were enrolled with a mean age of 32.75 (±14.39) years. Mean CD4 count at the start of treatment was 241.5/mm3. The mean difference in CD4 count was 383.05/mm3 (standard deviation = 274.9). Dizziness, tingling, numbness of extremities, and muscle cramps were the most common adverse effects. On multivariate logistic regression, the occurrence of ADRs was seen to be significantly higher only in illiterate patients. Conclusion: The present study highlights the importance of long-term follow-up of the patients on antiretroviral therapy. Adequate monitoring of the treatment parameters is of utmost importance.

Molecular Breeding and Drought Tolerance in Chickpea.

Cicer arietinum L. is the third greatest widely planted imperative pulse crop worldwide, and it belongs to the Leguminosae family. Drought is the utmost common abiotic factor on plants, distressing their water status and limiting their growth and development. Chickpea genotypes have the natural ability to fight drought stress using certain strategies viz., escape, avoidance and tolerance. Assorted breeding methods, including hybridization, mutation, and marker-aided breeding, genome sequencing along with omics approaches, could be used to improve the chickpea germplasm lines(s) against drought stress. Root features, for instance depth and root biomass, have been recognized as the greatest beneficial morphological factors for managing terminal drought tolerance in the chickpea. Marker-aided selection, for example, is a genomics-assisted breeding (GAB) strategy that can considerably increase crop breeding accuracy and competence. These breeding technologies, notably marker-assisted breeding, omics, and plant physiology knowledge, underlined the importance of chickpea breeding and can be used in future crop improvement programmes to generate drought-tolerant cultivars(s).

Comparative evaluation of different irrigating and irrigant activation system in removal of gutta-percha/sealer during retreatment: An in vitro Micro-CT study.

Background: The aim of the study was to compare the efficacy of different irrigation and irrigant activation system used as an adjuvant to retreatment rotary files in removal of gutta-percha and sealer from endodontic retreatment using Micro-CT. Method: 64 extracted permanent maxillary central incisor teeth with single canal, were collected and decoronated to standard length of 16 mm. Instrumentation was done using rotary files and obturation was performed using GuttaCore and AH plus sealer. After setting of sealer, initial removal of filling material was performed using ProTaper universal retreatment files (D1, D2, D3). All 64 sample were randomised into four groups (n = 16) Group1: Endodontic syringe irrigation, Group 2: Passive Ultasonic Irrigation (PUI), Group 3: EndoActivator, and Group 4: EndoVac. Micro-CT scanning was performed after obturation, initial removal of filling material by retreatment file and after using experimental protocols of each group, and volume of remaining filling material was calculated using Dolphin software. Statistical analysis performed with one-way ANOVA followed by Tukey's post hoc. Results: A significant reduction in the volume of residual obturation material were found between each group. PUI was superior to the sonic (EndoActivator), negative pressure irrigation technique (EndoVac) and positive pressure irrigation at the coronal, middle third and apical third of the root canal. However, none of the supplementary techniques were able to completely remove the residual obturation material. Conclusion: PUI and EndoActivator were found better in remaining filling material removal, demonstrating clinically useful as supplementary technique in removing remaining obturation material during endodontic retreatment.

Comparative evaluation of remineralizing effect of fluoride and nonfluoride agents on artificially induced caries using different advanced imaging techniques.

Aim: The aim of the study is to evaluate and compare the in-vitro remineralization efficacy of remineralizing agents, i.e., fluoride-free toothpaste, fluoride toothpaste, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), CPP-amorphous calcium fluoride phosphate (CPP ACFP), and silver diamine fluoride (SDF) paste on dentine over time. Methodology: Seventy-five extracted human permanent molars were selected. The buccal section of these samples was shaped into a slab. Artificial caries was induced by dipping the samples into the demineralizing solution (pH 4.5) for 21 days. They were then divided into five groups (n = 15). Each experimental group underwent one of the following treatments: Group 1 - Fluoride-free toothpaste (negative control), Group 2 - Fluoride toothpaste (positive control), Group 3 - CPP-ACP, Group 4 - CPP-Amorphous Calcium fluoride Phosphate and Group 5 - SDF. Postremineralizing treatment, Scanning electron microscope, Energy dispersive X-ray and Quantitative light induced fluorescence imaging were carried out to analyze the remineralizing efficacy. The data obtained was then subjected to statistical analysis using ANOVA and Paired t-tests. Results: It was seen that SDF showed highest remineralization efficacy followed by CPP-amorphous calcium fluoride phosphate, CPP-ACP, fluoride toothpaste and fluoride-free toothpaste. The difference in mean value among the groups was statistically significant (P < 0.001). Conclusion: SDF showed the highest remineralizing potential in scanning electron microscopy and energy dispersive X-ray, followed by CPP-ACFP, CPP-ACP, Fluoride toothpaste, and Fluoride-free toothpaste. Quantitative light fluorescence analysis showed more fluorescence changes in the CPP-ACFP followed by CPP-ACP, Fluoride toothpaste, and Fluoride-free toothpaste.

Intranasal drug delivery of sumatriptan succinate-loaded polymeric solid lipid nanoparticles for brain targeting.

Migraine is a frequent neurological condition characterized by throbbing headaches, nausea, photophobia, and phonophobia, among other symptoms. Sumatriptan belongs to a BCS class III, which exhibits poor oral bioavailability and several side-effects. The objective of the present study was to develop solid lipid nanoparticles (SLNPs) of sumatriptan succinate for brain targeting by nasal route. Solvent injection method was used to increase the entrapment efficiency of hydrophilic drug. Thus, formulation was optimized by central composite design with minimum particle size, optimized zeta potential, and maximum entrapment efficiency, which was found to be 133.4 nm, -17.7 mV, and 75.5%, respectively. Optimized batch was further evaluated for surface morphology, Fourier-transform infrared spectroscopy, in vitro release, permeation across nasal mucosa, and histopathology. It was seen that most of the particles were spherical in shape as confirmed by scanning electron microscopy and transmission electron microscopy. The release of drug through the lipid showed initial burst release followed by sustained release up to 12 h. The ex vivo diffusion study using goat nasal mucosa at pH 6.8 revealed that SLNPs permeation across nasal mucosa was quick, which was sufficient for brain targeting. Histopathology studies further revealed integrity of nasal mucosa after treatment with SLNPs. The investigation indicated that hydrophilic drug, sumatriptan succinate can be successfully entrapped in SLNPs to target brain via nasal delivery, and thus it could be an effective approach for nose-to-brain delivery.

Cross-covariance based affinity for graphs.

The accuracy of graph based learning techniques relies on the underlying topological structure and affinity between data points, which are assumed to lie on a smooth Riemannian manifold. However, the assumption of local linearity in a neighborhood does not always hold true. Hence, the Euclidean distance based affinity that determines the graph edges may fail to represent the true connectivity strength between data points. Moreover, the affinity between data points is influenced by the distribution of the data around them and must be considered in the affinity measure. In this paper, we propose two techniques, C C G A L and C C G A N that use cross-covariance based graph affinity (CCGA) to represent the relation between data points in a local region. C C G A L also explores the additional connectivity between data points which share a common local neighborhood. C C G A N considers the influence of respective neighborhoods of the two immediately connected data points, which further enhance the affinity measure. Experimental results of manifold learning on synthetic datasets show that CCGA is able to represent the affinity measure between data points more accurately. This results in better low dimensional representation. Manifold regularization experiments on standard image dataset further indicate that the proposed CCGA based affinity is able to accurately identify and include the influence of the data points and its common neighborhood that increase the classification accuracy. The proposed method outperforms the existing state-of-the-art manifold regularization methods by a significant margin.

Deep convection-driven vortex formation on Jupiter and Saturn.

The surfaces of Jupiter and Saturn have magnificent vortical storms that help shape the dynamic nature of their atmospheres. Land- and space-based observational campaigns have established several properties of these vortices, with some being similar between the two planets, while others are different. Shallow-water hydrodynamics, where the vortices are treated as shallow weather-layer phenomenon, is commonly evoked for explaining their formation and properties. Here, we report novel formation mechanisms for vortices where the primary driving mechanism is the deep planetary convection occurring in these planets. Using three-dimensional simulations of turbulent convection in rotating spherical shells, we propose two ideas: (i) Rotating turbulent convection generates deep axially aligned cyclones and anticyclones; (ii) a deep planetary dynamo acts to promote additional anticyclones, some as large as Jupiter's Great Red Spot, in an overlying atmospheric layer. We use these ideas to interpret several observational properties of vortices on Jupiter and Saturn.

A randomized controlled trial of endodontic treatment using ultrasonic irrigation and laser activated irrigation to evaluate healing in chronic apical periodontitis.

BACKGROUND: Aim of this trial was to evaluate the combined clinical and radiographic success rate of endodontic treatment using passive ultrasonic irrigation (PUI) and laser activated irrigation (LAI) as compared to conventional syringe irrigation. MATERIAL AND METHODS: Permanent incisors and single rooted premolars were assessed for eligibility and 69 patients were randomly divided into three treatment groups (n=23) by allocation concealment method and irrigation was performed in accordance with the allocated group. Teeth were evaluated clinically and radiographically with CBCT after 6 months and 12 months of the treatment. RESULTS: A significant difference was observed in the radiographic healing rates among three groups (χ2=12.29, p=0.05). On comparing the final outcome among the three groups (n=19), it was found that 2 (10.5%) cases of group I(Conventional Syringe irrigation), 7 (36.8%) cases of group II (Passive ultrasonic irrigation) and 8 (42.1%) cases of group III(Laser activated irrigation) were healed while under healing category 13 (68.4%) cases of group I, 12 (63.2%) cases of group II and 11 (57.9%) of group III were observed whereas 4 (21.1%) cases were categorised as diseased in group I only. CONCLUSIONS: LAI and PUI can increase the predictability of the endodontic treatment success in cases of chronic apical periodontitis. Key words:Cone-beam computed tomography, CBCT-PAI, Irrigation, LASER, Radiographic healing, Root canal treatment, Ultrasonic.

"Effect of local application of simvastatin in bone regeneration of peri-apical defects-a clinico-radiographic study.

OBJECTIVE: The present study evaluates and compares the effectiveness of Simvastatin (SIM), Hydroxyapatite (HA), and platelet-rich fibrin (PRF) in bone regeneration of periapical defects. MATERIAL& METHOD: Thirty-nine patients were selected and randomized into three groups, Group 1: HA (n = 13), Group 2: PRF (n = 13), Group 3: SIM (n = 13). After completion of RCT and apicoectomy, the grafts were placed locally in the defect and sutured. RESULTS: At the end of twelve months, postoperative symptoms and radiographic analysis assessed the outcome of the treatment. CONCLUSION: Intragroup analysis of CBCT- Periapical Index (PAI) scores at 6th and 12th month revealed a significant change in the SIM group (p = 0.018 and 0.001 respectively), compared to PRF (p = 0.026 and 0.001 respectively) and HA (p = 0.053 and 0.039 respectively). Intergroup analysis of change in the level of CBCT-PAI score was highly significant (p = 0.003).SIM caused a more considerable change in the level of CBCT-PAI score compared to other groups, thereby indicating a faster rate of bone regeneration.

Comparative evaluation of neodymium-doped yttrium aluminum garnet laser with nanocrystalline hydroxyapatite dentifrices and herbal dentifrices in the treatment of dentinal hypersensitivity.

BACKGROUND: The aim of this study was to compare and evaluate the efficacy of neodymium-doped yttrium aluminum garnet laser with and without herbal and nanohydroxyapatite dentifrices in management of dentinal hypersensitivity (DH). MATERIALS AND METHODS: A total of 180 patients who responded to air-blast test and cold-water test using verbal rating scale (VRS) were included in this study. The patients were randomly assigned to six groups (n = 30): control group (CG), scaling and root planning (SRP) + nanocrystalline hydroxyapatite dentifrices, SRP + nanocrystalline hydroxyapatite dentifrices + laser, SRP + herbal dentifrices, SRP + herbal dentifrices + laser, and SRP + laser. Each group was evaluated at baseline, 1 week, 1 month, and 6 months. In every visit of each patient, their clinical examination was done. RESULTS: Among all groups', repeated ANOVA measures and Kruskal-Wallis test was performed in which laser groups showed maximum reduction in DH in all indices while the CG showed minimum reduction in DH. The VRS values showed maximum reduction in SRP + nanocrystalline hydroxyapatite dentifrices + laser group with mean of 0.3 ± 0.5 and minimum reduction in CG with mean of 3.0 ± 0.5 (P < 0.001). CONCLUSION: Among all the groups, SRP + Nanocrystalline hydroxyapatite + Laser can be an effective treatment modality for DH.

A study of adherence to antiretroviral therapy in a tertiary care hospital at Allahabad, India.

INTRODUCTION: India has a large proportion of the global HIV-infected patients. Antiretroviral therapy (ART) is the cornerstone of HIV treatment. Antiretroviral drugs are highly toxic and lead to diverse adverse drug reactions (ADRs). Adherence to medications plays a prominent role in success of the therapy. This prospective study was done to study the adherence and analyze its associated factors. METHODOLOGY: The present study was conducted at ART Centre, Swarup Rani Hospital, Allahabad, Uttar Pradesh, India. Selection of the patients was done based on systematic random sampling method. Baseline enrollment was done over 2 months and follow-up was done monthly over 6 months. Information regarding sociodemographic profile, ART regimen, occurrence of ADRs, adherence to ART and factors affecting adherence was collected. Bivariate logistic regression was done to analyze the association of selected variables with adherence. RESULTS: This study enrolled 163 participants among which 152 participants completed the study. During the study period, 94 participants reported the occurrence of at least one ADR. Nonadherence to ART therapy was seen in 31.6% of patients. The most common reason was forgetting to take the medicine (21.8%) followed by occurrence of ADRs (18.3%). No statistically significant association of nonadherence was found with the selected variables. CONCLUSION: Comprehensive research to assess nonadherence to ART therapy is the need of the hour. Policy formulations ought to be made to assess and promote effective adherence to enhance the longevity and quality of life of people living with HIV/AIDS. Concerted efforts by government and intersectoral collaboration are further needed to sustain promotive measures.

Blumgart's technique of pancreaticojejunostomy: Analysis of safety and outcomes.

BACKGROUND: Blumgart's pancreaticojejunostomy (PJ) has been described with low pancreatic leak rates. This study aimed to evaluate our experience with this technique regarding the pancreatic leak and other perioperative outcomes. METHODS: We performed a single-center retrospective analysis of a cohort of 81 patients who underwent pancreaticoduodenectomy in our department from January 2011 to February 2018. The primary endpoint was the occurrence of a clinically relevant postoperative pancreatic fistula (CR-POPF) and analysis of its risk factors. RESULTS: The CR-POPF rate was 12.3%. Fistula risk score (FRS) was the only significant risk factor for the occurrence of overall POPF in multivariate analysis. However, none of the other factors including FRS was found to be significantly associated with CR-POPF risk. A strong positive correlation was found between the CR-POPF and the incidence of delayed gastric emptying, post-pancreatectomy hemorrhage and increased length of hospital stay. CONCLUSION: Blumgart's technique is a safe technique of pancreatico-enteric anastomosis with low rates of CR-POPF. CR-POPF with this technique is independent of most of the preoperative and intraoperative factors. Therefore, this technique can be used for all types of the pancreas with consistently good results.