An Unusual Presentation of Superior Mesenteric Venous Occlusion in Mild COVID-19.

SARS-CoV-2, an etiological agent of COVID-19, has been reported to inflict remarkably diverse manifestations in different subjects across the globe. Though patients with COVID-19 predominantly have fever, respiratory and constitutional symptoms, atypical presentations are becoming increasingly evident. COVID-19 may predispose to both venous and arterial thromboembolism due to excessive inflammation, hypoxia, immobilization, and diffuse intravascular coagulation in moderate to severe symptomatic cases. In this case report, we are reporting thromboembolic complications of COVID-19 in a mild symptomatic subject incidentally diagnosed with mesenteric venous occlusion with no abdominal symptoms. Early recognition of the abdominal symptoms, diagnosis, initiation of anticoagulants, and timely surgical intervention may improvise the outcome in a patient with COVID-19 infection-induced mesenteric thrombosis. Superior mesenteric artery and venous thrombosis may lead to subsequent ischemia necessitating emergency laparotomy. Thus, the usage of low-dose anticoagulants in all the patients of COVID-19 irrespective of the categorization into mild, moderate, and severe COVID-19 disease should be considered.

Evaluation of Clinical, Hormonal and Ultrasound Parameters of Male Reproductive System in Leprosy: A Cross-Sectional Study.

Background and Objectives: Testicular involvement in leprosy is neglected as it is insidious and silent, although it can have an impact on quality of life. Our study aimed at evaluating and estimating the frequency of the hormonal, radiological and clinical parameters in these patients. Materials and Methods: A cross-sectional study was conducted including 31 male leprosy patients attending our OPD. After detailed clinical assessment, patients were subjected to ultrasonological with Doppler examination of the scrotum and hormonal evaluation by ELISA technique for serum follicle-stimulating hormone (FSH), luteinising hormone (LH) and total testosterone. Results: Thirty-one patients were included with ages ranging from 19 to 54 with a mean of 34 years. Decreased libido (19.3%) was significantly observed in the abnormal FSH (P < 0.01) and testosterone (P < 0.01) groups. The majority of the clinical findings such as erectile dysfunction, infertility and altered pubic hair pattern were seen in the lepromatous spectrum. Six (19.6%) patients had increased LH and FSH. Twenty-three (74%) had testicular atrophy (<12 ml) as assessed by USG. There was a significant association between the bilateral decreased testicular volumes (TVs) and FSH (P = 0.016 on the left and P < 0.01 on the right). Four of 31 patients had altered testicular echo texture of which two belong to the BL spectrum. The increase in the resistive index (RI) corresponded significantly to the decreased TV (P < 0.01) albeit on the left side only. Conclusion: A sizeable proportion (74%) of the study sample had testicular atrophy. The significant association between increased RI and testicular atrophy, especially in patients with infertility, emphasises the ancillary role of Doppler indices in methodical diagnosis. Risk factors noted in the study include increased bacillary index, delayed initiation of treatment and recurrent ENL. Early detection, early initiation of MDT and specific therapies such as testosterone replacement can help improve the quality of life.

Dung beetles prefer used land over natural greenspace in urban landscape.

Urbanization drives land-use and patterns of biodiversity. Yet, very little is known about how biodiversity of structurally different habitats is responded to urbanization. We surveyed coprophagous dung beetles and their ecological functional groups-tunnellers, dwellers, and rollers-in shaded natural semi-evergreen forests of sacred groves and the neighbouring relatively open home gardens of sites that represent three levels of urbanization to address the following questions: (1) Do sacred groves have higher abundance, richness, and diversity of dung beetles than home gardens? (2) Is urbanization a key driver of dung beetle abundance, richness, diversity, and community? (3) Is dung beetle assemblage of sacred groves immune to urbanization? and (4) Which ecological functional groups of dung beetles are affected by urbanization? We hypothesized that the sacred groves have a distinct community, resulting in higher abundance, richness, and diversity of dung beetles than home gardens, and the dung beetle assemblage of sacred groves may be immune to urbanization. We sampled the beetles during wet and dry periods using cow dung as a bait. Against our predictions, dung beetle abundance, richness, and diversity were higher in used lands than sacred groves, particularly in urban landscapes. The two habitats had distinct compositions of dung beetles. Tunnellers and rollers were affected by urbanization, but not dwellers. Heliophilic and synanthropic species characterized by smaller species dominated overall catches in the used lands of urban areas. Results downplay sacred grove as a potential refuge for dung beetles and suggest that the biodiversity of native forests may be affected more by urbanization than the manipulated anthropogenic habitats.

Urban tropical forest islets as hotspots of ants in general and invasive ants in particular.

Urbanization is a crucial driver of environmental and biodiversity change. It is suggested that urbanization favours generalist and invasive species and might harm specialists of natural and semi-natural habitats. In this study, we examined how an urbanization gradient and environmental gradients in the habitat area, habitat diversity, elevation, and proportion of built-up area influenced the abundance and richness of ants within tropical forest islet habitat in south India. We used abundance (proportional trap incidence) of overall ants, native ants, invasive ants, and Anoplolepis gracilipes-a globally notorious invasive ant of possible south Asian origin-and rarefied richness as the response variables. We found that native ant abundance was greater and A. gracilipes abundance was lesser in less-urbanized landscape compared to moderately-urbanized and highly-urbanized landscape. The richness of ants and abundance of overall and invasive ants were unaffected by the urbanization. We also found that none of the measured environmental gradients but habitat diversity influenced abundance of overall ants, native ants, overall invasive ants, and richness of ants; however, A. gracilipes abundance was negatively correlated with habitat diversity. Ant species composition of less-urbanized landscape was distinct from that of higher urbanization levels. The richness and abundance of native ants and abundance of non-A. gracilipes invasive ants decreased with the abundance of A. gracilipes. Because the forest islets of all three urbanization levels supported similar richness of native ants, the urbanization seems not to have an adverse effect for the native ants of native forest islets. The increasing population of A. gracilipes in urban green islets, however, is a concern. Future studies might investigate its effect on other invertebrates of epigeal and soil strata.

Sentiment Analysis of Image with Text Caption using Deep Learning Techniques.

People are actively expressing their views and opinions via the use of visual pictures and text captions on social media platforms, rather than just publishing them in plain text as a consequence of technical improvements in this field. With the advent of visual media such as images, videos, and GIFs, research on the subject of sentiment analysis has expanded to encompass the study of social interaction and opinion prediction via the use of visuals. Researchers have focused their efforts on understanding social interaction and opinion prediction via the use of images, such as photographs, films, and animated GIFs (graphics interchange formats). The results of various individual studies have resulted in important advancements being achieved in the disciplines of text sentiment analysis and image sentiment analysis. It is recommended that future studies investigate the combination of picture sentiment analysis and text captions in more depth, and further research is necessary for this field. An intermodal analysis technique known as deep learning-based intermodal (DLBI) analysis is discussed in this suggested study, which may be used to show the link between words and pictures in a variety of scenarios. It is feasible to gather opinion information in numerical vector form by using the VGG network. Afterward, the information is transformed into a mapping procedure. It is necessary to predict future views based on the information vectors that have been obtained thus far, and this is accomplished through the use of active deep learning. A series of simulation tests are being conducted to put the proposed mode of operation to the test. When we look at the findings of this research, it is possible to infer that the model outperforms and delivers a better solution with more accuracy and precision, as well as reduced latency and an error rate, when compared to the alternative model (the choice).

Cloud-Based IoE Enabled an Urban Flooding Surveillance System.

A flood is defined as a surplus of water or sludge on parched soil, and a flood has originated through the runoff of water inside the water route from the various water sources like canals, etc. Intense rainfall, deforestation, urbanization, deprived water and sewerage administration, and lack of concentration toward the environment of the hydrological scheme have been the causes of urban flooding. In addition, there is a deficiency in flood assessment due to the impediment in getting data on floods to the control room from the flood-affected area. To diminish the possessions due to flooding, there ought to be an immediate move of captured statistics as of the hectic region en route to the observation room with no further wait for a completely fledged technique in the wireless settings data from the Internet of Things (IoT). The Internet of Everything (IoE) is a concept that extends the Internet of Things. In view of the fact that the wireless nodes are changeable in their environment, those effects lead to unsteadiness and uncertainty in information distribution. Therefore, there is a requirement for flood-predictable region data that may be exaggerated between the source and the control room. In the past, there were a lot of techniques set up and put into practice intended for keeping an eye on the flood spots. However, one of the biggest challenges is to have data sharing without delay and loss of data among source and destination nodes. In addition to that, the video quality also needs to be taken into consideration at the same time in receipt, as it is a tough task to determine and preplan the flood happenings completely from the normal disaster that makes scientific complicatedness more than the information being received in a wireless ad-hoc environment using IoT-based sensors. Considering all the abovementioned reasons, the proposed work comprises of three folded goals, namely, the design of a mobile ad-hoc flooding environment, the development of an urban flood high definition video surveillance system using IoT-based sensors, and experimental work on simulation.

Does Global Surgery Interest Influence the Choice of Surgical Residency Program?

OBJECTIVE: Medical students actively seek global health opportunities. Surgical residents also show great enthusiasm for international missions, rotations and global surgery. Unfortunately, only 18% to 34% of all surgery residency programs offer such international opportunities. We surveyed fourth year medical students applying for surgery residency to determine if international surgery opportunities offered by a program would influence their match rank list. DESIGN: A 20 question survey was given to interviewees at our surgery residency program. Survey was optional and anonymous. We queried prior volunteerism, interest in global surgery and importance of international opportunities offered during residency. SETTING: Hackensack University Medical Center, Hackensack New Jersey PARTICIPANTS: All candidates interviewing for general surgery residency at Hackensack University Medical Center from October 2019 to January 2020. RESULTS: A total of 97 fourth year medical students interviewed, with a 66% response rate to the survey. Mean age was 27 years. 92% of students had volunteered during college and/or medical school. 41% of students had volunteered internationally. Majority of students were interested in a surgery residency program offering international opportunity. 78% of students planned to volunteer internationally after residency, and two-thirds planned to include global surgery in future career. Half of the students reported they would rank a residency program higher if it offered an international opportunity. Students who were immigrants were significantly more likely to rank a program higher in the match if an international opportunity was offered, compared to students born in the US (p < 0.05). CONCLUSIONS: There is great interest in global surgery and international volunteer opportunities amongst fourth year medical students who apply for surgery residency. The majority of applicants have prior volunteer experience either locally or abroad. Majority of students plan to volunteer internationally after residency and are interested in academic global surgery careers. Students will rank surgery residency programs that offer international opportunities higher in the match.

Spatiotemporal effects on dung beetle activities in island forests-home garden matrix in a tropical village landscape.

Insects in seasonal tropics experience a wide range of temperatures along seasons, habitats, and a day. Therefore, the thermal tolerance of the insects can be a major driver for their habitat preference, temporal patterns of activity, and formation of communities. We examined the dung beetle communities of eleven pairs of neighboring open (home gardens) and closed habitats (sacred groves) during dry and wet seasons and diel periods (day and night) to understand the dung beetle activities along a spatiotemporal gradient constituted by the sacred groves-home garden matrix on a tropical village landscape. We tested the following hypotheses: (i) closed habitats have greater activities of dung beetles over open habitats; (ii) the diurnal communities of dung beetles are different from the nocturnal communities; and (iii) the diurnal-nocturnal activities of dung beetles could be predicted by the habitat and season. We considered abundance, richness, total biomass, and Shannon diversity of overall beetles, abundance of different functional groups, and species composition in communities as the quantitative measures in the predictive statistical models. In total, 2727 dung beetles belonging to 38 species, ten genera, and three functional groups were collected. The open habitat supported more number of dung beetles (N = 2318) than the closed habitat (N = 409). The diurnal communities were different from nocturnal communities, particularly in open habitat, where the temperature was different between day and night. The dominant species of the diurnal communities of open habitat hardly used the closed habitat in any context including dry-wet seasons, but the nocturnal communities of the open habitat were closer to the communities of closed habitat. The diel period and habitat predicted the abundance activity of functional groups; season was a poor predictor of dung beetle activities. Given that the species composition has turned over across habitats, and the closed habitat supported remarkably lesser number of beetles than the open habitats, the closed habitat is unlikely to be a thermal refuge for the open habitat species in village landscapes that have island forests, such as sacred groves, and home gardens form a matrix.

Extracorporeal Membrane Oxygenation Support After Heart Transplantation in Children-Outcomes of a Single Center Cohort.

OBJECTIVES: Extracorporeal membrane oxygenation is used for postcardiotomy low cardiac output but is less established following heart transplantation. We characterized outcomes for children supported with extracorporeal membrane oxygenation after heart transplantation. DESIGN: Single-center retrospective study. SETTING: Large pediatric cardiac referral center. PATIENTS: All patients who received heart transplantation and were cannulated to extracorporeal membrane oxygenation between 1995 and 2016. INTERVENTIONS: Primary outcome measure was mortality 12 months postextracorporeal membrane oxygenation. Patient characteristics were analyzed for association with outcome according to early graft failure (extracorporeal membrane oxygenation ≤ 7 d after heart transplantation), or late graft failure. MEASUREMENTS AND MAIN RESULTS: There were 246 heart transplants during the study period and 50 extracorporeal membrane oxygenation runs in 44 patients. Median time from transplant to extracorporeal membrane oxygenation was 1 day (range, 0-11.7 yr), with early graft failure in 28 patients (median 1, range 0-2 d) and 22 extracorporeal membrane oxygenation runs in 20 late graft failure patients (median, 0.8 yr; range, 8 d to 11.7 yr), including four patients with prior extracorporeal membrane oxygenation for early graft failure. Twenty-six patients (59%) survived to hospital discharge, and survival 12 months postextracorporeal membrane oxygenation was 24 patients (55%), lower in those with late graft failure (40% vs 67%; p 0.02). Independent risk factors for 12-month mortality were congenital heart disease, higher pulmonary vascular resistance indexed to body surface area (> 2.2 Woods U/m), and higher creatinine. Higher panel reactive antibody levels were associated with 12-month mortality in the late graft failure group only. CONCLUSIONS: Extracorporeal membrane oxygenation can be effectively used to rescue patients with graft dysfunction after heart transplantation but is associated with high early mortality. Factors associated with mortality within 12 months include presence of congenital heart disease, renal dysfunction, elevated pulmonary vascular resistance indexed to body surface area and in those supported with extracorporeal membrane oxygenation late after heart transplantation, significant human leukocyte antigen sensitization.

Partial thromboplastin time is more predictive of bleeding than anti-Xa levels in heparinized pediatric patients after cardiac surgery.

OBJECTIVES: Anticoagulation with unfractionated heparin (UFH) after pediatric cardiac surgery can be monitored using either activated partial thromboplastin time (aPTT) or anti-factor Xa activity (anti-Xa). However, correlation of bleeding with either of these laboratory values has not been established. We sought to determine the correlation between bleeding events and aPTT and anti-Xa in patients who undergo anticoagulation after congenital heart surgery. METHODS: We prospectively studied pediatric patients treated with UFH after cardiac surgery over an 11-month period. Bleeding events were prospectively assessed and adjudicated. The highest aPTT and corresponding anti-Xa for the 24 hours before bleeding events were collected to assess for association with bleeding. Statistical analysis was performed using generalized additive logistic regression. RESULTS: A total of 202 patients received UFH over 1488 patient-days. The median age at surgery was 0.4 years (interquartile range, 0.1-2.2). A total of 45 major or clinically relevant bleeding events were observed. The correlation between aPTT and anti-Xa was of moderate strength (R = 0.58; P < .001). The odds of bleeding increased significantly when aPTT exceeded 150 (odds ratio, 1.71 per 10-second increase in aPTT, 95% confidence interval, 1.21-2.42; P = .003). Anti-Xa was not associated with bleeding (odds ratio, 1.11 per 0.1 IU/mL increase, 95% confidence interval, 0.89-1.29; P = .34). CONCLUSIONS: In heparinized pediatric patients after cardiac surgery, increased risk of bleeding is more closely associated with elevated aPTT levels than elevated anti-Xa levels. In addition to anti-Xa, monitoring of aPTT levels should be considered during titration of UFH in pediatric patients after cardiac surgery.

An anticoagulation protocol for use after congenital cardiac surgery.

BACKGROUND: Patients undergoing surgery for congenital heart disease are at high risk for bleeding as well as thrombosis in the postoperative period. The objective of the study was to describe the design and effects of implementing a standardized unfractionated heparin anticoagulation protocol for children after congenital heart surgery. METHODS: We created a tiered guideline for the postoperative management of bleeding and thrombosis. In patients treated with unfractionated heparin, anti-factor Xa activity level as well as activated partial thromboplastin time were used for dose titration. Clinical outcomes, including bleeding and thrombosis events, were prospectively collected for 5 months before and after protocol implementation and adjudicated as either minor, clinically relevant nonmajor, or major. RESULTS: Among 792 surgical patients followed during the study period, a total of 203 patients (87 preimplementation, 116 postimplementation) were treated with therapeutic unfractionated heparin over a total of 1481 patient days. Of these, 28% were neonates and 35% were infants (29 days to 1 year), with a trend toward fewer neonates and lower Risk Adjustment for Congenital Heart Surgery (RACHS) scores after protocol implementation. Among 1321 time-matched pairs, activated partial thromboplastin time and antifactor Xa activity levels were poorly correlated (r2 = 0.33). Clinically relevant bleeding events, which required increased medical care, including blood transfusion, decreased after protocol implementation (4.14 vs 1.62 bleeding events per 100 patient-days; risk ratio, 0.39 [0.20-0.75]; P = .005), even after correcting for differences in age and RACHS scores (P = .006). This finding was primarily found after RACHS category 1 to 3 procedures (risk ratio, 0.27 [0.10-0.73]; P = .0099) and in noninfants (risk ratio, 0.25 [0.09-0.65]; P = .005). There were no significant differences in the incidences of major bleeding (P = .88) or any thrombosis (P = .55). CONCLUSIONS: The use of a standardized anticoagulation protocol is feasible and might reduce the incidence of bleeding and thrombosis events in postcardiotomy patients.

Surgery resident participation in short-term humanitarian international surgical missions can supplement exposure where program case volumes are low.

BACKGROUND: General surgery training programs face declining case volume and diversity. We wanted to determine if resident participation in international surgical missions would increase exposure to cases underrepresented in our program case mix. METHODS: Accreditation Council for Graduate Medical Education program data from 2008 to 2011 (University of Medicine and Dentistry-New Jersey Medical School, Newark, NJ) were analyzed to identify categories where volume was below national average. This was compared with case logs from 3 missions conducted by International Surgical Health Initiatives between 2011 and 2012. RESULTS: All chief residents completed more than minimum required index cases. Categories head and neck, alimentary tract, abdomen, and endocrine showed percentile below national average. Seven residents participated in 3 missions to Philippines and Sierra Leone. Sixty-five percent of the operations performed were in the 4 low-volume categories. CONCLUSIONS: International surgery missions expose residents to a high volume and variety of cases. Participation can be one way to increase case volume and diversity during training. Cases completed on missions with board certified surgeons should be considered for Accreditation Council for Graduate Medical Education credit.

Male mice are susceptible to high fat diet-induced hyperglycaemia and display increased circulatory retinol binding protein 4 (RBP4) levels and its expression in visceral adipose depots.

Vitamin A and its metabolites are known to modulate adipose tissue development and its associated complications. Here, we assessed the vitamin A status and its metabolic pathway gene expression in relation to sexual dimorphism by employing 35 days old C57BL/6J male and female mice, which were fed either stock or high fat (HF) diet for 26 weeks. HF diet feeding increased body weight/weight gain and white adipose tissue (WAT) of visceral and subcutaneous regions, however, increase in vitamin A levels observed only in subcutaneous WAT. Further, the expression of most of the vitamin A metabolic pathway genes showed no sexual dimorphism. The observed HF diet-induced hyperglycaemia in male corroborates with increased retinol binding protein 4 (RBP4) levels in plasma and its expression in visceral adipose depots. In conclusion, the male mice are susceptible to high fat diet-induced hyperglycaemia and display higher plasma RBP4 levels, possibly due to its over-expression in visceral adipose depots.

Mesalamine-induced myopericarditis in a paediatric patient with Crohn's disease.

Mesalamine-containing products are considered first-line treatment for inflammatory bowel disease. Myocarditis is recognised as a very rare possible side effect of these medications, but has not often been described in the paediatric population. We present a case of an adolescent with Crohn's disease who presented with myopericarditis after recent initiation of Pentasa. Once identified as the causative agent, the drug was discontinued, with subsequent normalisation of troponin and improvement of function. This case identifies the importance of prompt evaluation, diagnosis, and treatment of paediatric patients receiving mesalamine-containing medications that present with significant cardiovascular symptoms.

Antihistamines for children with otitis media.

QUESTION: Otitis media is a very common condition in pediatrics and can be quite distressing for children and their parents. Is there a role for antihistamines and decongestants in the management of acute otitis media orotitis media with effusion in children? ANSWER: Traditionally, antihistamines and decongestants have been used in the treatment of otitis media;however, recent guidelines, which are based on study findings with negative results, recommend against routine use. No antihistamine-decongestant combination has been shown to be of clinically significant benefit,and there are potential adverse events that need to be taken into account.

Pattern of pediatric dermatoses at a referral centre.

OBJECTIVE: To determine the pattern of skin disorders seen among children attending a Medical College Hospital, Bangalore METHODS: All children 18 y and below attending the Pediatric Dermatology OPD with skin diseases between the period of January 2011 and June 2011 were included in the study. RESULTS: A total of 1,090 new cases (boys 589; girls 501) with 1,118 dermatoses were recorded during this period. Twenty eight children had more than one dermatoses. Most of the disorders were seen between 5 and 11 y age group. The most common dermatoses was infections and infestations (32.47 %) followed by eczematous eruptions and dermatitis (20.66 %), papulosquamous and related disorders (6.08 %) and pigmentary disorders (5.81 %). Insect bite reactions and papular urticaria formed 5.1 %. Acne was seen in 5.28 % of children followed by urticaria (3.67 %), photodermatoses 2.5 % and genetic disorders (3.04 %). CONCLUSIONS: In the present setting bacterial infections and scabies still remained the most common pediatric dermatoses followed by molluscum contagiosum and atopic dermatitis. Childhood psoriasis contributed to major part of the study among papulosquamous disorders.

Dietary curcumin post-treatment enhances the disappearance of B(a)P-derived DNA adducts in mouse liver and lungs.

To study the post-treatment effects of dietary curcumin on the levels of benzo(a)pyrene [B(a)P]-induced DNA adducts, mice were administered oil or B(a)P and randomized into 7 subgroups after 24 h. One of the subgroups from both the oil and B(a)P groups was killed at 24 h while the remaining 6 subgroups were shifted to powdered control or 0.05% curcumin diet and killed after 24, 72 and 120 h (experiment 1), and 7, 14, and 28 days (experiment 2). Quantitative comparisons of BPDE-DNA nuclear adducts (area and intensity) in immunohistochemically stained lungs and liver sections was carried out by IHC profiler. A time-dependent decrease in the levels of adducts in B(a)P-treated animals was further enhanced by curcumin exposure compared to the levels in time-matched controls. To assess the contribution of apoptosis and cell proliferation in observed curcumin-mediated enhanced decrease of BPDE-DNA adducts, comparative evaluation of apoptosis and cell proliferation markers was undertaken. Results suggested enhancement of B(a)P-induced apoptosis in liver and lungs by curcumin during 24-120 h while no such enhancement was observed at 7-28 days. Results suggest curcumin-mediated enhancement in apoptosis (experiment 1) and adduct dilution (experiment 2) to be the reason for the observed higher decrease of BPDE-DNA adducts.