Performance optimization for an optimal operating condition for a shell and heat exchanger using a multi-objective genetic algorithm approach.

In this study, shell and heat exchangers are optimized using an integrated optimization framework. In this research, A structured Design of Experiments (DOE) comprising 16 trials was first conducted to systematically determine the essential parameters, including mass flow rates (mh, mc), temperatures (T1, t1, T2, t2), and heat transfer coefficients (€, TR, U). By identifying the first four principal components, PCA was able to determine 87.7% of the variance, thereby reducing the dimensionality of the problem. Performance-related aspects of the system are the focus of this approach. Key outcomes (€, TR, U) were predicted by 99% R-squared using the RSM models. Multiple factors, such as the mass flow rate and inlet temperature, were considered during the design process. The maximizing efficiency, thermal resistance, and utility were achieved by considering these factors. By using genetic algorithms, Pareto front solutions that meet the requirements of decision-makers can be found. The combination of the shell and tube heat exchangers produced better results than expected. Engineering and designers can gain practical insight into the mass flow rate, temperature, and key responses (€, TR, U) if they quantify improvements in these factors. Despite the importance of this study, it has several potential limitations, including specific experimental conditions and the need to validate it in other situations as well. Future research could investigate other factors that influence system performance. A holistic optimization framework can improve the design and engineering of heat exchangers in the future. As a result of the study, a foundation for innovative advancements in the field has been laid with tangible improvements. The study exceeded expectations by optimizing shell and heat exchanger systems using an integrated approach, thereby contributing significantly to the advancement of the field.

An automatic diagnostic model for the detection and classification of cardiovascular diseases based on swarm intelligence technique.

Globally, cardiovascular diseases (CVDs) rank among the leading causes of mortality. One out of every three deaths is attributed to cardiovascular disease, according to new World Heart Federation research. Cardiovascular disease can be caused by a number of factors, including stress, alcohol, smoking, a poor diet, inactivity, and other medical disorders like high blood pressure or diabetes. In contrast, for the vast majority of heart disorders, early diagnosis of associated ailments results in permanent recovery. Using newly developed data analysis technology, examining a patient's medical record could aid in the early detection of cardiovascular disease. Recent work has employed machine learning algorithms to predict cardiovascular illness on clinical datasets. However, because of their enormous dimension and class imbalance, clinical datasets present serious issues. An inventive model is offered in this work for addressing these problems. An efficient decision support system, also known as an assistive system, is proposed in this paper for the diagnosis and classification of cardiovascular disorders. It makes use of an optimisation technique and a deep learning classifier. The efficacy of traditional techniques for predicting cardiovascular disease using medical data is anticipated to advance with the combination of the two methodologies. Deep learning systems can reduce mortality rates by predicting cardiovascular illness based on clinical data and the patient's severity level. For an adequate sample size of synthesized samples, the optimisation process chooses the right parameters to yield the best prediction from an enhanced classifier. The 99.58% accuracy was obtained by the proposed method. Also, PSNR, sensitivity, specificity, and other metrics were calculated in this work and compared with systems that are currently in use.

Machine learning-based assessment and simulation of land use modification effects on seasonal and annual land surface temperature variations.

Rapid urban sprawl adversely impacts the local climate and the ecosystem components. Islamabad, one of South Asia's green and environment-friendly capitals, has experienced major Land Use Land Cover (LULC) changes over the past three decades consequently, elevating the seasonal and annual Land Surface Temperature (LST) in planned and unplanned urban areas. The focus of this study was to quantify the fluctuations in LULC and LST in planned and unplanned urban areas using Landsat data and Machine Learning algorithms involving the Support Vector Machine (SVM) over the 1990-2020 data period. Moreover, hybrid Cellular Automata-Markov (CA-Markov) and Artificial Neural Network (ANN) models were employed to project the future changes in LULC and annual LST, respectively, for the years 2035 and 2050. The findings of the study reveal a distinct difference in seasonal and annual LST in planned and unplanned areas. Results showed an increase of ∼22 % in the built-up area but vegetation and bare soil decreased by ∼10 % and ∼12 %, respectively. Built-up land showed a maximum annual mean LST followed by bare-soil and vegetative surfaces. Seasonal analysis showed that summer months experience the highest LST, followed by spring, autumn and winter. Future projections revealed that the built-up areas (∼27 % in 2020) are likely to increase to ∼37 % and ∼50 %, and the areas under the highest annual mean LST class i.e., ≥28 °C are likely to increase to ∼19 % and ∼21 % in planned, and ∼38 % and ∼42 % in unplanned urban areas for the years 2035 and 2050, respectively. Planned areas have better temperature control with urban green spaces, and controlled infrastructure. The Capital Development Authority of Islamabad may be advised to control the expansion of built-up areas, grow urban forests, and thus mitigate the possible Urban Heat Island (UHI) effect.

Plant-Based Nutraceutical Formulation Modulates the Human Gut Microbiota and Ferulic Acid Esterase Activity During In Vitro Fermentation.

Oxidative stress is an imbalance between free reactive oxygen species and antioxidant defences leading to neurological and other chronic disorders. The interaction between food and gut microbiota and their metabolites significantly reduces oxidative stress and influences host physiology and metabolism. This process mainly involves enzymes that hydrolyse complex polysaccharides and produce metabolites. Ferulic acid esterases (FAE) one of the most important enzymes of the gut microbiome, release ferulic acid from feruloylated sugar ester conjugates, that occur naturally in grains, fruits, and vegetables. FA is crucial in combating oxidative stress resulted from free radical formation. This study investigated the effect of two plant-based nutraceutical formulations, cereal-millet-based (PC1) and fruit-vegetable-based (PC2), on gut microbiota and the production of FAE, short chain fatty acids (SCFA) and other small metabolites in in vitro fermentation using human faecal samples. After in vitro fermentation, both nutraceutical formulations increased the abundance of Bifidobacterium, Lactobacillus, Prevotella, Feacalibacteria, and Clostridium leptum. Furthermore, they induced the production of FAE, xylanase and pectinase enzymes, SCFA and other small metabolites, resulting in increased antioxidation activity of the fermentate. PC1 stimulated FAE and xylanase production more effectively. These results demonstrated a positive correlation between the feruloylated nutraceutical formulation and the production of FAE and other accessory enzymes, suggesting that PC1 and PC2 stimulate the proliferation of the FAE-producing microbial consortium of the gut microbiome and therefore, increase FA and SCFA concentration. From this study it is evident that FA-rich plant-based formulation can be used as a prophylactic nutraceutical supplement to alleviate oxidative stress by modulating the gut microbiota.

Cancer Stem Cells and Treatment of Cancer: An Update and Future Perspectives.

Cancer stem cells (CSCs) play an essential role in tumour progression and metastasis. These cells have the unique ability to self-renew and differentiate into specific tissue cell types. Their capacity for self-renewal enables CSCs to persist over time, thereby contributing to cancer relapse and therapy resistance. Therefore, targeting CSCs has emerged as a promising cancer treatment strategy. CSCs exhibit differentiation, self-renewal, and plasticity, and they contribute to multiple aspects of malignant tumours, such as recurrence, metastasis, heterogeneity, multidrug resistance, and radiation resistance. While conventional treatments predominantly target cancer cells that are not CSCs, CSCs frequently survive, resulting in tumour recurrence and relapse. This article concentrates on the development of novel therapeutic strategies that combine conventional treatments with CSC inhibitors to eradicate cancer cells and CSCs, thereby treating cancer and preventing its recurrence. However, the diversity of CSCs poses a significant obstacle to the development of CSC-targeted therapies, necessitating extensive research for a better understanding and exploration of therapeutic approaches. Future development of CSC-targeted therapies will rely heavily on overcoming this obstacle.

Conservation tillage practices affect soil microbial diversity and composition in experimental fields.

Introduction: Conservation tillage is a widely used technique worldwide, but the effects of conservation tillage on bacterial community structure are poorly understood. We explored proportional alterations in the bacterial community under different tillage treatments. Methodology: Hence, this study utilized high-throughput sequencing technique to investigate the structure and assembly processes of microbial communities in different tillage treatments. Results and discussion: Tillage treatments included tillage no-straw retention (CntWt), no-tillage with straw retention (CntWntS), tillage with straw retention (CntWtS), no-tillage and no-straw retention (CntWnt). The influence of tillage practices on soil bacterial communities was investigated using Illumina MiSeq sequencing. Different tillage methods and straw retention systems significantly influenced soil parameters such as total potassium and pH were not affected by tillage practices, while straw retention significantly affected soil parameters including nitrogen content, available phosphorus and available potassium. Straw retention decreased bacterial diversity while increased bacterial richness. The effect of straw retention and tillage on bacterial communities was greater than with no tillage. Phylogenetic ß-diversity analysis showed that deterministic homogeneous selection processes were dominated, while stochastic processes were more pronounced in tillage without straw retention. Ecological network analysis showed that microbial community correlation was increased in CntWntS and CntWnt. Straw retention treatment significantly increased the relative abundance of bacterial taxa Proteobacteria, Bacteroidetes, and OD1, while Nitrospirae, Actinobacteria, and Verrucomicrobia significantly decreased. Conclusion: The conservation tillage practices significantly affect soil properties, bacterial composition, and assembly processes; however, further studies are required to investigate the impact of different crops, tillage practices and physiological characteristics on bacterial community structure and functions.

Ghost ileostomy release down: our initial experience

Background: Many publications describe the advantages of the creation of ghost ileostomy (GI) to prevent the need for formal covering ileostomy in more than 80% of carcinoma rectum patients. However, none of the papers describes exactly how to ultimately remove the GI in these 80% of patients in whom it doesn't need formal maturation. Aim: To describe and evaluate the ghost ileostomy release down (GIRD) technique in terms of feasibility, complications, hospital stay, procedure time etc. in patients with low anterior resection/ultra-low anterior resection (LAR/uLAR) with GI for carcinoma rectum. Method: The present was a prospective cohort study of patients with restorative colorectal resections with GI for carcinoma rectum, Postoperatively the patients were studied with respect to ease and feasibility of the release down of GI and its complications. The data was collected, analyzed and inference drawn. Results: A total of 26 patients needed the GIRD and were included in the final statistical analysis of the study. The procedure was done between 7th to 16th postoperative days (POD) and was successful in all patients without the need of any additional surgical procedure. None of the patients required any local anesthetic injection or any extra analgesics. The average time taken for procedure was 5-minutes and none of the patients had any significant difficulty in GI release. There were no immediate postprocedure complications. Conclusion: The GIRD technique is a simple, safe, and quick procedure done around the 10th POD that can easily be performed by the bedside of patient without the need of any anesthesia or additional analgesics. (AU)

The Prevalence of Blood Borne Diseases in Blood Donors of Peshawar, Khyber Pakhtunkhwa, Pakistan.

BACKGROUND: The goal of the study was to investigate the burden of transfusion- transmitted infections (TTIs) hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), syphilis, and malarial parasite (MP) in ABO Blood Groups and Rh Type System among voluntarily blood donors in Khyber Pakhtunkhwa (KPK), Pakistan. It is a retrospective single center cross sectional study. This study was conducted from June 2020 to September 2021 (16 months) at the frontier foundation thalassemia center Peshawar KPK. Donors were physically healthy and fit for donation. Donors with physical disabilities and/or having co-morbid conditions were excluded from the report. METHODS: All the samples were screened for anti-HIV, anti-HCV, HBsAg, Syphilis, and Malarial Parasite via ELISA kit and Immune Chromatographic Technique (ICT), respectively. A total of 6311 blood donations were evaluated. The majority of the donations (92%) were from (VNRBD) voluntary non-remunerated blood donation, while only 8% came from replacement donors. RESULTS: Amongst 6311 blood donations, 1.50 % (n = 95) were infected at least with one pathogen, HBV positive cases were 0.855 % (n = 54), HCV positive cases were 0.316% (n = 20), syphilis positive were 0.30% (n = 19) and MP positive cases were only 0.031% (n = 2). HBV, HCV, syphilis and malaria infections rates were found to be low as compared to the previous data published, while no case was reported for HIV. The study also revealed the distribution pattern of the aforementioned pathogens in blood groups and the Rh type system of the reactive samples. CONCLUSION: The lower reported in our study indicates the awareness among the people of Peshawar about TTIs and their precautions. The prevalence rate that we are reporting is less than previously published articles in the same domain.

A featureless approach for object detection and tracking in dynamic environments.

One of the challenging problems in mobile robotics is mapping a dynamic environment for navigating robots. In order to disambiguate multiple moving obstacles, state-of-art techniques often solve some form of dynamic SLAM (Simultaneous Localization and Mapping) problem. Unfortunately, their higher computational complexity press the need for simpler and more efficient approaches suitable for real-time embedded systems. In this paper, we present a ROS-based efficient algorithm for constructing dynamic maps, which exploits the spatial-temporal locality for detecting and tracking moving objects without relying on prior knowledge of their geometrical features. A two-prong contribution of this work is as follows: first, an efficient scheme for decoding sensory data into an estimated time-varying object boundary that ultimately decides its orientation and trajectory based on the iteratively updated robot Field of View (FoV); second, lower time-complexity of updating the dynamic environment through manipulating spatial-temporal locality available in the object motion profile. Unlike existing approaches, the snapshots of the environment remain constant in the number of moving objects. We validate the efficacy of our algorithm on both V-Rep simulations and real-life experiments with a wide array of dynamic environments. We show that the algorithm accurately detects and tracks objects with a high probability as long as sensor noise is low and the speed of moving objects remains within acceptable limits.

Predictors of pathological complete response following neoadjuvant chemoradiotherapy for rectal cancer.

Background: Neoadjuvant chemoradiotherapy (NACRT) is an established treatment option for locally advanced rectal cancer (LARC). Patients achieving pathological complete response (pCR) following NACRT have better oncological outcomes and may be subjected to wait and watch policy as well. The aim of this study was to identify predictors of pCR in LARC following NACRT. Materials and Methods: A retrospective analysis of a prospectively maintained colorectal cancer database from January 2018 to December 2019 was undertaken. A total of 129 patients of LARC who were subjected to conventional long course NACRT, followed by surgery were included in the study. Pathological response to NACRT was assessed using Mandard grading system and response was categorized as pCR or not-pCR. Correlation between various clinico pathological parameters and pCR was determined using univariate and multivariate logistic regression analysis. Results: Mean age of patients was 53.79 ± 1.303 years. Complete pathological response (Mandard Gr 1) was achieved in 24/129 (18.6%) patients. Age of patients more than 60 years (P = 0.011; odds ratio [OR] 3.194, 95% confidence interval [CI] 1.274-8.011), interval between last dose of NACRT and surgery >8 weeks (P = 0.004; OR 4.833, 95% CI 1.874-12.467), well-differentiated tumors (P < 0.0001; OR 32.00, 95% CI 10.14-100.97) and node-negative disease (P = 0.003; OR 111.0, 95% CI 2.51-48.03) proved to be strong predictors of pCR. Conclusion: Older age, longer interval between NACRT and surgery, node-negative disease and favorable tumor grade help in achieving better pCR rates. Awareness of these variables can be valuable in counseling patients regarding prognosis and treatment options.

Association Of Adiponectin With Total Leukocyte Count In Patients Of Coronary Artery Disease.

Background: Hypoadiponectinemia and raised total leukocyte count have been associated with coronary artery disease. The aim of this study was to investigate association of serum adiponectin levels with total leukocyte count in patients of coronary artery disease belonging to Khyber Pakhtunkhwa. Method: This cross-sectional/analytical study consisted of two groups. Group A contained 100 patients of coronary artery disease while group B contained 100 healthy controls. Consent of the study subjects was obtained, their history was recorded and fasting blood samples were analyzed for serum adiponectin level, total leukocyte count (TLC), serum lipid profile which included serum total cholesterol (T-C), triglyceride level (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Adiponectin level was determined with ELIZA method, TLC was estimated on automated haematology analyzer and lipid profile was determined using enzymatic colorimetric method. SPSS version 21 was used to analyze the data. Results: Subjects with coronary artery disease when compared to healthy subjects showed significantly high level of total leukocyte count (9.26±1.488 vs. 6.37±4.052) and low level of serum adiponectin (4.3±0.80 vs. 9.6±3.69). Moreover, serum lipid profile showed low HDL-C (30.04±9.1 vs. 43.64±7.3) and rose triglyceride (220.1±67.7 vs. 181.86±41.4), total cholesterol (229.3±37.01 vs. 189.4±32.7), and LDL-C (153.78±38.53 vs. 109.16±33.91) levels. Significant negative association of adiponectin with TLC (r -0.826 with p<0.01) was observed in the study subjects. Conclusion: We observed elevated level of total leukocyte count and reduced level of adiponectin in subjects with coronary artery disease. Moreover, hypoadiponectinemia correlated negatively with TLC levels.

Association Of C-Reactive Protein With Hyperlipidemia In Patients With Polycystic Ovarian Syndrome In Khyber Pakhtunkhwa.

BACKGROUND: It has been unknown whether there exist any relations of C-Reactive Protein (CRP) level with hyperlipidaemia in polycystic ovarian syndromes patients. To determine Association of CRP with Hyperlipidaemia in patients with polycystic ovarian syndrome. METHODS: This was a cross sectional descriptive study conducted among 50 each polycystic ovarian syndrome and normal women. After taking a written consent from participants predesigned questionnaire was filled including information regarding demography and medical history. A 3 to 5 ml blood was taken from patients and controls and transferred to laboratory for determination of CRP level and lipid profile. The test results were collected, compiled, entered and analyzed using SPSS Version 20 for determination of any kind of association of CRP with Hyperlipidaemia in patients with polycystic ovarian syndrome. RESULTS: The mean age of study participants was 29.72±4.00 for cases and 29.04±3.99 for control. The cases and control were with the same age range, however there was a significant difference p=0.00 in BMI of the cases and control. There was no significant association observed between CRP and lipid profile parameters among polycystic ovarian syndrome patients. CONCLUSIONS: There exist no association between increasing CRP level and hyperlipidaemia in polycystic ovarian syndrome patients however CRP and lipid profile parameters showed high values among these patients.

A Case of Heterotopic Gastric Tissue in Duodenal Bulb: An Interesting Endoscopic Finding.

Gastric heterotopia (GH) is a rare, congenital condition where gastric tissue is found outside of its normal location in the gastric mucosa. It is usually benign and can be found throughout the gastrointestinal (GI) tract. In the duodenum, it is usually seen as multiple polyps, specifically in the duodenal bulb. Here, we discuss the case of a 67-year-old male patient who presented with hematemesis, melena, and abdominal pain. Esophagogastroduodenoscopy (EGD) and biopsy revealed a mass consisting of heterotopic gastric mucosa along with an esophageal ulcer. In this article, we will discuss the literature related to the clinical presentation, diagnosis, and management of GH.

A Case of Gastric Outlet Obstruction Secondary to Parastomal Stomach Herniation.

Parastomal hernia (PH) is an abnormal herniation of tissue or intra-abdominal organ through the fascial defect created at the ostomy site. It is a common complication of stoma creation and usually contains bowel, intra-abdominal fat, or omentum. Herniation of a fixed organ like the stomach is very rare and can lead to significant morbidity and mortality. Here, we present a case of an 83-year-old female with a history of sigmoidectomy and subsequent development of parastomal hernia who presented with abdominal pain, nausea, and vomiting and was found to have stomach herniation into the parastomal hernia sac. She was managed conservatively with intravenous (IV) fluids, electrolyte replacement, and decompression with a nasogastric (NG) tube. In this article, we have discussed the incidence, clinical presentation, diagnosis, and management of gastric involvement in the parastomal hernia that can help clinicians identify and treat it early at the time of presentation.

WITHDRAWN: Original Antigenic Sin in COVID-19: Hoskins Effect and Vaccine

The article has been withdrawn at the request of the authors.Bentham Science apologizes to the readers of the journal for any inconvenience this may have caused.The Bentham Editorial Policy on Article Withdrawal can be found at https://benthamscience.com/editorial-policies-main.php. Bentham Science Disclaimer: It is a condition of publication that manuscripts submitted to this journal have not been published and will not be simultaneously submitted or published elsewhere. Furthermore, any data, illustration, structure or table that has been published elsewhere must be reported, and copyright permission for reproduction must be obtained. Plagiarism is strictly forbidden, and by submitting the article for publication the authors agree that the publishers have the legal right to take appropriate action against the authors, if plagiarism or fabricated information is discovered. By submitting a manuscript the authors agree that the copyright of their article is transferred to the publishers if and when the article is accepted for publication.

Trends and projections of land use land cover and land surface temperature using an integrated weighted evidence-cellular automata (WE-CA) model.

Land use land cover (LULC) change has become a major concern for biodiversity, ecosystem alteration, and modifying the climatic pattern especially land surface temperature (LST). The present study assessed past and predicted future LULC and LST change in the Swabi District of Pakistan. LULC maps were generated from satellite data for years 1987, 2002, and 2017 using supervised classification. Mean LST and its areal change were estimated for different LULC classes from thermal bands of satellite images. LULC and LST were projected for the year 2047 using the integrated weighted evidence-cellular automata (WE-CA) model and a regression equation developed in this study, respectively. LULC change revealed an increase of > 5% in the built-up while a decrease in the agricultural area by ~ 9%. There was an increase of ~ 63% area in the LST class ≥ 27 °C which may create urban heat island (UHI). Simulation results indicated that the built-up area will further be increased by ~ 3% until 2047. Area associated with LST class > 30 °C indicated a further increase of ~ 38% till 2047 with reference to year 2017. Findings of this study suggested proper utilization of LULC in order to mitigate the creation of UHIs associated with urbanization and built-up areas.

A Short Review on Key Role of Plants and their Extracts in Boosting up Immune Response to Combat COVID-19.

In the wake of the recent global pandemic of COVID-19, there has been increasing concern among the general public to improve their immune system. The causative agent of COVID-19 is SARS CoV-2, similar to its relative viruses SARS Cov-1 and MERS. Although vaccines have been developed now and are in public use, still the role of a healthy immune system is crucial as new strains of the virus are being discovered and along with emergence of new strains, short and long term side effects of vaccine cannot be excluded. Plants have been used in herbal medicines and many chemicals since ancient times and extracts in them are found to boost the immune system. Therefore, a consciously maintained diet consisting of plant-based immunity boosters is the need of the hour. Plants are known to provide many chemicals, natural therapeutics and vitamins which naturally enhance our immune system. Recently, vaccination research is also being carried out in transgenic plants. In this review, main focus has been put on highlighting some of the key players within the Kingdom Plantae, which, when taken up in regular diet, can significantly boost our immune system capacity and thus helps the human body to combat this deadly virus more efficiently.

Transanal minimal invasive surgery (TAMIS): safety and feasibility for the resection of benign and malignant lesions of the rectum.

OBJECTIVES: Radical surgery for rectal tumours has high morbidity. Local excision of such tumours can be achieved without compromising oncologic safety. However tumours that are not accessible to local excision can be approached using Transanal Minimal Invasive Surgery (TAMIS). The aim of our study was to assess feasibility of TAMIS procedure in terms of complications, operating time, resection margin positivity, hospital stay and local recurrence rate. MATERIAL AND METHODS: Forty eight patients with benign adenomas or early stage adenocarcinoma, within 4 to 12 cm from anal verge who were subjected to TAMIS over a period of 3 years were included in the study. Short and long term outcomes were assessed. RESULTS: TAMIS was performed for 36 benign adenomas and 12 adenocarcinomas, which were located at an average distance of 6.2 cm from anal verge. The mean operating time was 72 minutes. There were no intraoperative complications.1 (2.08%) patient suffered post operative bleeding, which was managed conservatively. 2 (4.16%) patients developed acute urinary retention who required indwelling catheterisation. Resection margin was positive in 3 (6.25%) benign cases. Average hospital stay was 2.7 days. Local recurrence occurred in 2 (4.16%) villous adenoma patients (after 11 and 13 months), whereas in malignant patients there was no recurrence at a follow up period ranging between 12 to 36 months. CONCLUSION: TAMIS is a safe and feasible procedure for benign tumours and early rectal cancers, located in low and middle rectum.

Role of covering Ileostomy in causation of anastomotic strictures in low anterior resections for rectum carcinoma / O papel da ileostomia de proteção como causa das estenoses anastomóticas nas ressecções anteriores de reto

Abstract Background Colorectal resection anastomosis is the commonest cause of rectal strictures. Anastomotic site ischemia, incomplete doughnuts from stapled anastomosis and pelvic infection, are some of the risk factors that play a role in the development of postoperative rectal strictures. However, the role of diverting stoma in the development of rectal strictures has not been studied extensively. Objectives To study the difference in the occurrence of anastomotic strictures (AS) in patients submitted to low anterior resection (LAR) with covering ileostomy (CI), and to LAR without CI for carcinoma rectum. Methods This was a prospective, comparative case control study carried out at a tertiary care referral center. Low anterior resection with covering ileostomy was performed in patients with rectum carcinoma in the study group, while LAR without covering ileostomy was performed in the control group. The study group had 29 patients, while the control group had 33 patients with rectum carcinoma. Results During themean follow-up period of 9.1months, 8 (28%) patients in the study group and 2 (6%) patients in the control group developed AS (p =0.019). Out of these 8 patients with AS in the study group, 50% had Grade-I AS, 25% had Grade-II AS, while 25% of the patients had Grade-III (severe) AS. However, both patients who developed AS in the control group had a mild type (Grade I) of AS. Conclusion Covering ileostomy increases the chances of AS formation after LAR for rectum carcinoma. Also, the SKIMS Clinical Grading of Rectal Strictures is a simple and

Resumo Introdução A anastomose de ressecção colorretal é a causa mais comum de estenoses retais. A isquemia do local da anastomose, donuts (anéis) incompletos de anastomose grampeada e infecção pélvica são alguns dos fatores de risco que desempenham um papel no desenvolvimento de estenoses retais pós-operatórias. No entanto, o papel do estoma de desvio no desenvolvimento de estenoses retais não foi estudado extensivamente. Objetivos Estudar a diferença na ocorrência de estenoses anastomóticas (EA) em pacientes submetidos à ressecção anterior baixa (LAR) com ileostomia de proteção e a LAR sem ileostomia de proteção para carcinoma de reto. Métodos Este foi um estudo prospectivo e comparativo de caso-controle realizado em um centro de referência de atenção terciária. A ressecção anterior baixa com ileostomia de proteção foi realizada em pacientes com carcinoma de reto no grupo de estudo, enquanto LAR sem ileostomia de proteção foi realizada no grupo controle. O grupo de estudo tinha 29 pacientes, enquanto o grupo controle tinha 33 pacientes com carcinoma de reto. Resultados Durante o período de acompanhamento médio de 9, 1 meses, 8 (28%) pacientes no grupo de estudo e 2 (6%) pacientes no grupo controle desenvolveram EA (p=0,019). Destes 8 pacientes com EA no grupo de estudo, 50% tinham EA de Grau I, 25% tinhamEA de Grau II, enquanto 25% dos pacientes tinham EA de Grau III (grave). No entanto, ambos os pacientes que desenvolveram EA no grupo de controle tinham um tipo leve (Grau I) de EA. Conclusão A ileostomia de proteção aumenta as chances de formação de AS após LAR para carcinoma de reto. Além disso, o SKIMS Clinical Grading of Rectal Strictures é uma ferramenta simples e útil disponível para cada cirurgião para graduar, classificar e monitorar as estenoses retais pós-operatórias.

Urine My Heart: A Case of Aerococcal Endocarditis.

An elderly woman with previously known valvular disease presented to the emergency department due to altered mental status. In addition to obtaining an infectious work-up, a bedside echocardiogram was performed and revealed right heart strain prompting a formal echocardiogram evaluation and treatment for a possible pulmonary embolism. Initial laboratory work returned with blood and urine cultures positive for Aerococcus urinae. A transthoracic echocardiogram further revealed new aortic regurgitation. Given this, a transesophageal echocardiogram was completed, confirming new aortic insufficiency as well as findings of infective endocarditis. She did not undergo surgical intervention; however, she was discharged with a plan to continue intravenous antibiotics for six weeks. Although typically seen in genitourinary infections, A. urinae is a rare cause of infective endocarditis and is increasingly identified due to improved speciation techniques. We describe a unique presentation of invasive A. urinae infection to increase awareness and further research on a less commonly encountered bacteria that may present as a urinary tract infection and has the potential to cause invasive disease.