Loss of plasticity in deep continual learning.

Artificial neural networks, deep-learning methods and the backpropagation algorithm1 form the foundation of modern machine learning and artificial intelligence. These methods are almost always used in two phases, one in which the weights of the network are updated and one in which the weights are held constant while the network is used or evaluated. This contrasts with natural learning and many applications, which require continual learning. It has been unclear whether or not deep learning methods work in continual learning settings. Here we show that they do not-that standard deep-learning methods gradually lose plasticity in continual-learning settings until they learn no better than a shallow network. We show such loss of plasticity using the classic ImageNet dataset and reinforcement-learning problems across a wide range of variations in the network and the learning algorithm. Plasticity is maintained indefinitely only by algorithms that continually inject diversity into the network, such as our continual backpropagation algorithm, a variation of backpropagation in which a small fraction of less-used units are continually and randomly reinitialized. Our results indicate that methods based on gradient descent are not enough-that sustained deep learning requires a random, non-gradient component to maintain variability and plasticity.

Willingness and self-confidence of healthcare workers in Bahrain in assisting with in-flight emergencies.

BACKGROUND: In-flight medical emergency (IFE) impose considerable challenges on healthcare workers (HCWs) because of limited resources, constrained environment, and medico-legal issues. This study assessed HCWs knowledge, willingness, and confidence in addressing in-flight medical emergencies. MATERIALS AND METHODS: A cross-sectional study was conducted between June and August 2023 among nurses and physicians working in primary healthcare centers and governmental hospitals in Bahrain. Subjects were selected using stratified random sampling; a self-administered online questionnaire of high reliability (Cronbach alpha = 0.914) was used to collect the data. Logistic regression analysis were performed to determine association of knowledge, willingness, and confidence in dealing with in-flight emergencies with various characteristics of HCWs. RESULTS: The study included 805 HCWs with mean age of 35.5 years (SD=9.2). The findings indicated deficiency in training, with <10% of participants trained on IFE. A considerable proportion of participants exhibited low levels of knowledge (88.3%) and confidence (75.9%) with IFE. Nonetheless, more than half of the participants expressed the willingness to assist in IFE (59.1%). Non-Bahraini healthcare professionals (odds ratio [OR] = 2.901, P < 0.001) had higher knowledge of IFE. Nurses (OR = 1.642, P = 0.047) and participants with longer work experience had higher willingness to assist in IFE. In addition, professionals who were non-Bahraini (OR = 3.249, P < 0.001), working in secondary care (OR = 1.619, 95% confidence interval P = 0.021), had had training on IFE (OR = 2.247, P = 0.004), and had encountered IFE before (OR = 1.974, P = 0.006) had greater self-confidence levels. CONCLUSION: Considering the low levels of knowledge and confidence healthcare professionals in Bahrain had with regard to IFE, targeted training initiatives and educational programs are necessary to improve HCW's confidence and preparedness to deal with such emergencies.

Pediatric Myringoplasty using the Periosteum: An Institutional Overview.

Introduction Myringoplasty is a common otologic procedure to restore the integrity of the tympanic membrane in cases of traumatic or pathologic perforations. Many grafting materials have been used with different techniques. Objective In the present work, we evaluate the surgical and audiological outcomes of periosteal graft overlying the mastoid cortex through a retroauricular incision in a pediatric cohort. Methods A retrospective study was carried out involving all children aged ≤ 16 years who underwent periosteal graft myringoplasty for the treatment of chronic suppurative otitis media with dry central perforation in our hospital from April 2019 to April 2021. All patients were followed up for one year to assess the anatomical success and functional outcomes by comparing the preoperative and postoperative (after six months) results of pure tone audiometry (PTA). Results The sample was composed of 36 patients; 20 of them were female (55.6%) and 16 were male (44.4%) subjects, with ages ranging from 7 to 16 (mean: 12.7) years. Four patients underwent surgery in both ears (with an interval of 6 to 9 months). Out of 40 surgeries performed, 38 ears have shown anatomical success (95%). A highly significant improvement in hearing was obtained (the mean difference between the pre- and postoperative results of the PTA was of 14.6 ± 3.45 dB ( p < 0.001). Conclusion We advocate the use of periosteal graft in the pediatric population as a good alternative for other types of grafts, with comparable and even better functional and anatomical outcomes.

Correlates of susceptibility to waterpipe tobacco smoking in young adults.

INTRODUCTION: Many US young adults are susceptible to waterpipe (i.e., hookah) tobacco smoking (WTS) initiation, but research on factors associated with WTS susceptibility is limited. We examined sociodemographic, other tobacco and substance use, and attitudes and perceptions correlates of WTS susceptibility among young adults. METHODS: Baseline data from a randomized trial testing WTS risk messages was collected in US young adults aged 18 to 30 years who never used waterpipe tobacco but were susceptible to WTS (n = 294). Extent of susceptibility to WTS was defined using the average score of a valid scale with higher scores indicating higher susceptibility. Correlates were sociodemographics, other tobacco and substance use, and attitudes and perceptions. Multiple linear regression models identified correlates of greater WTS susceptibility. RESULTS: Participants averaged 25 (SD 3.2) years of age, 60% were male, 22% were Black non-Hispanic, 47% completed some college education, and 66% were employed. Our models consistently showed that more positive attitudes toward WTS (ß = -0.08, p<0.01), lower perceived addictiveness relative to cigarettes (ß = -0.09, p = 0.04), and greater perceived social acceptability of WTS (ß = 0.05, p<0.01) were positively correlated with WTS susceptibility. Additionally, young adults who smoked cigarillos (ß = 0.53, p<0.01), used cannabis (ß = 0.14, p = 0.02), and Black non-Hispanic versus White non-Hispanic young adults (ß = 0.18, p = 0.03) also had higher WTS susceptibility. CONCLUSIONS: Findings suggest that WTS prevention efforts require multicomponent interventions including targeting subpopulations at greater risk based on race/ethnicity and other tobacco and substance use. These interventions should consider attitudes and social acceptability of WTS as modifiable targets to maximize public health benefits.

Hydroxopalladium(IV) complexes prepared using oxygen or hydrogen peroxide as oxidants.

The cycloneophylpalladium(II) complexes [Pd(CH2CMe2C6H4)(κ2-N,N'-L)], 1 or 2, with L = RO(CH2)3N(CH2-2-C5H4N)2, with R = H or Me, respectively, react with either dioxygen or hydrogen peroxide in the presence of NH4[PF6] to give rare examples of the corresponding hydroxopalladium(IV) complexes [Pd(OH)(CH2CMe2C6H4)(κ3-N,N',N''-L)][PF6], 3 or 4. The complexes 3 and 4 are stable at room temperature and have been structurally characterized. On heating a solution of 3 or 4 in moist dimethylsulphoxide, selective reductive elimination with C(sp2)-O bond formation is observed, followed by hydrolysis, to give the corresponding pincer complex [Pd(OH)(κ3-N,N',N''-L)][PF6] and 2-t-butylphenol as major products. A more complex reaction occurs in chloroform solution. The mechanisms of reaction are discussed, supported by DFT calculations.

miR-4716-3p and the target AKT2 Gene/rs2304186 SNP are associated with blood cancer pathogenesis in Pakistani population.

AKT2 is crucial for cancer cells' invasion, metastasis, and survival. It is a possible downstream gene target of cancer glycolysis-related microRNAs. The study investigated the role of miRNA-4716-3p, rs2304186, and the AKT2 gene in blood cancer pathogenesis. RT-qPCR was used to analyze AKT2 gene mRNA and miRNA-4716-3p expression in 200 blood cancer samples and 200 healthy controls. Furthermore, Tetra-ARMS PCR was used to examine the rs2304186 AKT2 SNP in 300 patients and 290 control samples. miRNA-4716-3p was shown to be significantly downregulated (p = 0.0294), whereas mRNA expression of the AKT2 gene was found to be significantly upregulated (p = 0.0034) in blood cancer patients compared to healthy individuals. miRNA-4716-3p downregulation (p = 0.0466) was more pronounced, while AKT2 upregulation was non-significant (p = 0.1661) in untreated patients compared to chemotherapy-treated patients. Blood cancer risk was significantly associated with the rs2304186 GT genotype (p = 0.0432), TT genotype (p = 0.0502), and mutant allele (T) frequency (p = 0.0008). Polymorphism rs2304186 was associated with an increased risk of blood cancer in dominant (p = 0.0011), recessive (p = 0.0502), and additive (p = 0.0008) genetic models. The results suggested that the rs2304186 and the deregulated expression of miRNA-4716-3p and AKT2 gene at the mRNA level may significantly increase the incidence of blood cancer, particularly in the Pakistani population. Therefore, these may function as suitable biomarkers for blood cancer diagnosis and prognosis. Additional, larger-scale investigations may be required to affirm these results.

HPLC-ESI/MS-MS metabolic profiling of white pitaya fruit and cytotoxic potential against cervical cancer: Comparative studies, synergistic effects, and molecular mechanistic approaches.

Natural approach became a high demand for the prevention and treatment of such diseases for their proven safety and efficacy. This study is aimed to perform comparative phytochemical analysis of white pitaya (Hylocereus undatus) peel, pulp and seed extracts via determination of total flavonoid content, phenolic content, and antioxidant capacity, coupled with HPLC-ESI/MS-MS analysis. Further, we evaluated the synergistic cytotoxic potential with Cisplatin against cervical cancer cells with investigation of underlying mechanism. The highest content of phenolics and antioxidants were found in both seed and peel extracts. The HPLC-ESI/MS-MS revealed identification of flavonoids, phenolic acids, anthocyanin glycosides, lignans, stilbenes, and coumarins. The cytotoxicity effects were evaluated by MTT assay against prostate, breast and cervical (HeLa) and Vero cell lines. The seed and peel extracts showed remarkable cytotoxic effect against all tested cell lines. Moreover, the selectivity index confirmed high selectivity of pitaya extracts to cancer cells and safety on normal cells. The combined therapy with Cisplatin effectively enhanced its efficacy and optimized the treatment outcomes, through the apoptotic ability of pitaya extracts in HeLa cells, as evaluated by flow cytometry. Besides, RT-PCR and western blotting analysis showed downregulation of Bcl-2 and overexpression of P53, BAX among HeLa cells treated with pitaya extracts, which eventually activated apoptosis process. Thus, pitaya extract could be used as adjuvant therapy with cisplatin for treatment of cervical cancer. Furthermore, in-vivo extensive studies on the seed and peel extracts, and their compounds are recommended to gain more clarification about the required dose, and side effects.

Glutaraldehyde and terephthaldehyde-crosslinked chitosan for cationic and anionic dyes removal from aqueous solutions: Experimental, DFT, kinetic and thermodynamic studies.

Novel chitosan polymers were synthesized using two cross-linkers, Glutaraldehyde and Terephthaldehyde, to enhance stability and efficiency. Characterization techniques (XRD, FTIR, FE-SEM, TGA, DTG, BJH, and BET) confirmed successful synthesis. These polymers were employed as adsorbents for removing Malachite Green (MG) and Congo Red (CR) dyes from water. Batch experiments and DFT calculations investigated the adsorption process, thermodynamics, and kinetics. Results showed the CSGT-III polymer achieved the highest removal efficiency. For initial dye concentrations ([CR]o = 50 mg/L, [MG]o = 20 mg/L) and adsorbent doses (0.8 g/L for CR, 0.4 g/L for MG), removal efficiencies were 96.99 % for CR and 99.07 % for MG. Thermodynamic analysis confirmed the spontaneous nature of adsorption, and the process was endothermic for both dyes. The Langmuir model fitted adsorption isotherms well, indicating a homogeneous surface. Kinetic analysis revealed a pseudo-second-order model for both dyes.

Nicotine dependence among undergraduates who use nicotine salt-based e-cigarettes.

OBJECTIVE: This study examined the relationship between use patterns of a popular e-cigarette brand using nicotine salts, JUUL, and symptoms of nicotine dependence in a college cohort. PARTICIPANTS: Data for this study came from a prospective cohort of undergraduate students at a large Midwestern university from 2018 to 2019. METHODS: Among participants who had ever tried a JUUL (N = 411), univariate and multivariable logistic regression were used to test the associations between use frequency (past 30-day use) and quantity (time to finish a pod) and nicotine dependence at follow up. RESULTS: In the multivariable models, both frequency of use and quantity of use were associated with subsequent nicotine dependence, based on most indicators of dependence. CONCLUSIONS: As salt-based nicotine is now present in the most popular e-cigarette brands used by young people, such findings inform our contemporary understanding of e-cigarettes' addictive potential and can help inform campus-based interventions.

Disinfection by methylthionine chloride and chitosan in combination with Photo radiation therapy on caries affected dentin nano hardness, adhesive integrity, and bond failure.

OBJECTIVE: The aim of the study was to assess the disinfection efficacy, bond integrity, and nano hardness of caries-affected dentin (CAD) surface bonded to resin cement when disinfected with chlorhexidine (CHX), Methylene blue activated by Photodynamic therapy (MB-PDT), chitosan, silver diamine fluoride (SDF), chitosan activated by PDT, and SDF-diode laser against S. mutans. MATERIALS AND METHODS: A total of 60 human mandibular molars were extracted non-traumatically and gathered using ICDAS criteria. The dentin surface was prepared, leaving CAD to receive a disinfection procedure. After inoculation with S. mutans, the CAD samples were divided into six groups and disinfected with various disinfectants (n = 10) CHX, MB-PDT, chitosan, chitosan-PDT, SDF, and SDF+ diode laser. Survival rates of S. mutans were analyzed following the restoration of samples with resin cement via the etch and rinse method to assess SBS. Also, nano hardness was analyzed. Statistical analysis was performed by using the ANOVA and the Tukey multiple test (p<0.05). The Kruskal-Wallis test was used to evaluate the change in survival rate. RESULTS: Related to the survival rates, the SDF+ diode laser displayed the highest reduction in S. mutans levels and chitosan presented the lowest level of disinfection. The intergroup comparison revealed that CHX and chitosan-PDT displayed comparable outcomes of S. mutans survival rate to that of SDF+ diode laser (p>0.05). Likewise, MB-PDT and SDF displayed a comparable survival rate of S. mutans to Chitosan disinfection (p>0.05). Considering SBS and nano hardness, the highest SBS and NH were exhibited by the SDF+ diode laser, and the lowest SBS and NH values were exhibited by MB-PDT. The intragroup comparison revealed that CAD specimens disinfected with Chitosan-PDT showed comparable SBS and NH values to the SDF+ diode laser (p>0.05). CHX, chitosan, and SDF exhibited bond values and NH comparable to MB-PDT (p<0.05). CONCLUSIONS: Synergistic use of Silver diamine fluoride with diode laser and chitosan activated by PDT can be used as an alternative to CHX for controlling S. mutans growth, promoting enhanced bond efficacy and nano hardness for bonding resin cement to the caries-affected dentin.

Association of Fracture Location and Pattern With Nonunion or Malunion in Tibia Fractures Managed With Intramedullary Nailing: A Retrospective Study.

Background and objective Extra-articular fractures of the tibia are common orthopedic injuries that are frequently treated with rigid intramedullary nailing. Fracture location and pattern may increase the risk of nonunion or malunion in fractures managed with intramedullary nails. This study aimed to assess the relationship between fracture pattern and location with malunion and nonunion. The primary objective was to evaluate the influence of fracture location and pattern on adverse clinical outcomes such as nonunion, delayed union, and malunion in tibial shaft fractures that are treated operatively with rigid intramedullary nails. Methodology This was a retrospective cross-sectional study conducted on patients operated in a tertiary care center in the Kingdom of Bahrain. The study included patients who sustained tibia shaft fractures and were subsequently operated with intramedullary of the tibia. The primary endpoint was the rate of adverse outcomes associated with fracture patterns. Fracture characteristics were to determine which fracture patterns healed well with intramedullary nailing and which fractures ended up with malunion or nonunion and would likely benefit from additional measures to augment the nail fixation and help encourage union. Results One hundred and eighty-nine patients were included in the study. The level of associated fibula fracture was significantly associated with an increased risk of nonunion and malunion (P = 0.0034, P = 0.001). The presence of a concomitant distal fibula fracture in association with tibia fractures increased the odds of nonunion (odds ratio [OR] = 4.871, P = 0.033, confidence interval [CI] = 1.133-20.948). Conclusions The level and pattern of some tibia and fibula fractures were associated with nonunion, malunion, and delayed union. Further studies with more robust follow-up are needed to examine these findings in greater detail.

Characteristics, glycemic control and outcomes of adults with type-2 diabetes mellitus attending specialized clinics in primary healthcare centers in Bahrain-A cross-sectional study.

Introduction: Diabetes mellitus is a global health challenge that requires continuous and multidisciplinary management. Suboptimal diabetes management results in serious complications that impose a huge burden on patients and the healthcare system. This study aimed to assess the characteristics, glycemic control and outcomes of patients with type-2 diabetes attending primary healthcare centers in Bahrain according to the new American Diabetes Association (ADA) guidelines. Materials and Methods: A cross-sectional study was conducted among adult patients with type-2 diabetes mellitus attending diabetic clinics in Bahrain. A multi-stage sampling technique was adopted. The data collection tool consisted of three parts: baseline and sociodemographic data, the physical measures of the patients and the most recent laboratory results. An A1C of less than 7% was indicative of good glycemic control. Results: A total of 721 patients with type-2 diabetes mellitus were included with an average age of 58.4 years. Most patients were hypertensive (n = 457, 63.4%), and half of them were hyperlipidemic (n = 373, 51.7%). Around 57% (n = 402) of the patients adopted lifestyle modifications, 14.8% adopted diet control measures and around half performed weekly regular exercises. More than 92% of the cohort were on metformin, 52.0% (n = 375) were on Sulphonylurea medications and 41% (n = 298) were on insulin formulations. While only 40% of the patients had controlled diabetes (n = 283, 39.3%) and hypertension (n = 298, 41.3%), most patients achieved adequate cholesterol and low-density lipoprotein levels (83.2% and 76.6%, respectively). Non-Bahraini (P ≤ 0.001), young (P = 0.027) and obese patients (P = 0.003) had lower glycemic control measures. Adequate cholesterol levels were seen more in patients with a controlled glycemic index (P = 0.015). Conclusion: Considering the new glycemic targets, glycemic and hypertension control was poor among diabetic patients, especially non-Bahraini, obese and young patients. Urgent interventions by policymakers, physicians and caregivers are needed to improve the outcomes of diabetes.

Enhancing date seed phenolic bioaccessibility in soft cheese through a dehydrated liposome delivery system and its effect on testosterone-induced benign prostatic hyperplasia in rats.

Introduction: The consumption of dairy products, including soft cheese, has been associated with numerous health benefits due to their high nutritional value. However, the phenolic compounds bioaccessibility present in soft cheese is limited due to their poor solubility and stability during digestion. So, this study aimed to develop an innovative soft cheese enriched with date seed phenolic compounds (DSP) extracted ultrasonically and incorporated into homogeneous liposomes and study its attenuation effect on testosterone-induced benign prostatic hyperplasia (BPH) in rats. Methods: Date seed phenolic compounds were extracted using 98 and 50% ethanol along with water as solvents, employing ultrasonication at 10, 20, and 30-min intervals. The primary and secondary DSP-liposomes were prepared and dehydrated. The particle size, zeta potential, encapsulation efficiency, and morphology were measured. Incorporating dehydrated liposomes (1-3% w/w) into soft cheese and their impact on BPH using male Sprague-Dawley rats was assessed. After inducing BPH, rats were fed a cheese diet with dehydrated DSP-liposomes. Over 8 weeks, parameters including nutrition parameters, prostate enlargement analysis, biochemical parameters, hormones level, oxidative stress, and cytokines were analyzed. Results and Discussion: The results showed that ultrasound-assisted extraction effectively reduced the extraction time and 30 min extraction EtOH 50% was enough to extract high yield of phenolic compounds (558 mg GA/g) and flavonoids (55 mg qu/g) with high antioxidant activity (74%). The biological results indicate that prostate weight and prostate index% were diminished in the treatment groups (1 and 2) compared to the BPH control group. The high antioxidant content present in the DSP-liposomes acted as the catalyst for suppressing the responses of the inflammatory cytokines, inhibiting the anti-inflammatory IL-10 production, and suppressing the elevated levels of lipid peroxidation products compared to the BPH group. Conclusion: The treatment group (2) supplemented with dehydrated secondary DSP-liposomes exhibited the most significant variance (p < 0.05) as opposed to the BPH group. Liposomal encapsulation was proved to be a feasible approach for administering DSP in soft cheese, thereby establishing new functional food category possessing prophylactic properties against the advancement of BPH in rats.

COMPARISON BETWEEN PRE- AND POST-OPERATIVELY BOTOX INJECTION IN SECONDARY WOUNDS HEALING.

Tension impacts wound healing and scarring. Tissue stress reduces blood flow and promotes fibroblastic response in wound treatment. Botox injections reduce tension. A total of 18 male albino rats weighing 250-350 grams each got 1 IU of Botox and saline injected into a subcutaneous muscle in the center of each 1.5 CM two circles with 4.5 CM a gap between them. Group A seven days pre-operatively; group B, after wound incidence. The study compared Botox-treated wounds to those treated immediately after surgery. Group A animals were surgery-ready after 7 days, removed full-thickness skin. Group B got Botox and saline in separate cages following full-thickness skin excision. Each group had three equal subgroups. Each group had immunohistochemistry tests on days 3, 7, and 14. and histological test on day 14 only, Skin biopsies following euthanasia showed significant variations between A and B groups. On day three, the group A showed increase significantly MMP-9 expression than B group. On day 7, the group A displayed a significant increase CD31 expression, suggesting significant new blood vessel development than group B. On day 14, both groups showed strong MMP-9 and CD31 expression, demonstrated greater endothelial cell, and keratinocyte proliferation resulted in very well re-epithelialization. Botox injection before surgery improved wound healing and reduced fibrosis and scarring.

Production of natural flavor compounds using Bacillus subtilis-fermented soybean meal extract and their biological potential: a comprehensive in vitro study.

This study aims to investigate the production of natural flavor compounds through the utilization of Bacillus subtilis-fermented soybean meal extract and evaluate their biological potential. The experiment involved a comprehensive in vitro investigation to assess the capabilities and effects of the produced flavor compounds. The resulting flavor compounds were subjected to various in vitro tests to assess their properties, including cytotoxicity, antioxidant activity, anticancer potential, antiviral activity, and antimicrobial activity. To enhance the fermentation process, soybean meal extract was fortified with a combination of L-Lysine and L-Threonine. Gas chromatography-mass spectrometry (GC/MS) analysis was conducted on the fermented soybean meal using two strains of Bacillus subtilis, namely NRCH123 and NRCZ144. This analysis revealed the presence of various volatile compounds in all extracts, including Butylated hydroxytoluene. The fermented soybean extract with bacillus subtilis NRCZ144 (B2) fortified with a combination of 2.5% (w/w) L-Lysine and 2.5% w/w L-threonine (SLT2) exhibited a rich profile of flavor compounds, with Eucalyptol being identified as the predominant compound. The antioxidant activity of the SLT2 extract was found to be 72.04% at a concentration of 100 µg/mL, indicating significant antioxidant potential. Furthermore, when tested against the human liver cancer cell line HepG2, the extract demonstrated anticancer activity with an IC50 value of 2.26 µg/mL. The extract exhibited potent cytotoxicity, with an IC50 value of 1.02 µg/mL. Importantly, the SLT2 extract displayed strong antibacterial and antifungal activity, even at very low concentrations. The extract's antimicrobial properties indicate its potential for inhibiting the growth of bacteria and fungi.

Adoption of Euvax-B vaccine in Nineveh

Hepatitis B infection is one of the most important health problems around the world. The high mortality rate of the hepatitis B encouraged research that led to the finding of an effective vaccine against it. The aim of the present study was to find out the use of the Euvax-B vaccine in sectors of Nineveh province. According to the results obtained in this study, in the next five years, the vaccination coverage for the second and third doses needs to improve(AU)

La infección por hepatitis B es uno de los más importantes problemas de salud del mundo. La alta tasa de mortalidad de la hepatitis B impulsó las investigaciones que llevaron a encontrar una vacuna eficaz contra la misma. El objetivo del presente estudio fue conocer el uso de la vacuna Euvax-B en sectores de la provincia de Nínive. De acuerdo con los resultados obtenidos, en los próximos cinco años, se debe incrementar la cobertura de inmunización de la segunda y tercera dosis de la vacuna(AU)

Identification of Fungal Pathogens in Otomycosis and Their Drug Sensitivity: Our Experience

Abstract Introduction Otomycosis is a common problem in otolaryngology practice. However, we usually encounter some difficulties in its treatment because many patients show resistance to antifungal agents, and present high recurrence rate. Objectives To determine the fungal pathogens that cause otomycosis as well as their susceptibility to the commonly used antifungal agents. Additionally, to discover the main reasons for antifungal resistance. Methods We conducted an experimental descriptive study on 122 patients clinically diagnosed with otomycosis from April 2016 to April 2017. Aural discharge specimens were collected for direct microscopic examination and fungal culture. In vitro antifungal susceptibility testing was performed against the commonly used antifungal drugs. We tested the isolated fungi for their enzymatic activity. Results Positive fungal infection was found in 102 samples. The most common fungal pathogens were Aspergillus and Candida species, with Aspergillus niger being the predominant isolate (51%). The antifungal susceptibility testing showed that mold isolates had the highest sensitivity to voriconazole (93.48%), while the highest resistance was to fluconazole (100%). For yeast, the highest sensitivity was to nystatin (88.24%), followed by amphotericin B (82.35%), and the highest resistance was to terbinafine (100%), followed by Itraconazole (94.12%). Filamentous fungi expressed a high enzymatic ability, making them more virulent. Conclusion The Aspergillus and Candida species are the most common fungal isolates in otomycosis. Voriconazole and Nystatin are the medications of choice for the treatment of otomycosis in our community. The high virulence of fungal pathogens is owed to their high enzymatic activity. Empirical use of antifungals should be discouraged.

Cytokeratin 13, Cytokeratin 17, and Ki-67 Expression in Human Acquired Cholesteatoma and Their Correlation With Its Destructive Capacity

OBJECTIVES: Cholesteatoma is a nonneoplastic destructive lesion of the temporal bone with debated pathogenesis and bone resorptive mechanism. Both molecular and cellular events chiefly master its activity. Continued research is necessary to clarify factors related to its aggressiveness. We aimed to investigate the expression of Ki-67, cytokeratin 13 (CK13) and cytokeratin 17 (CK17) in acquired nonrecurrent human cholesteatoma and correlate them with its bone destructive capacity. METHODS: A prospective quantitative immunohistochemical study was carried out using fresh acquired cholesteatoma tissues (n=19), collected during cholesteatoma surgery. Deep meatal skin tissues from the same patients were used as control (n=8). Cholesteatoma patients were divided into 2 groups and compared (invasive and noninvasive) according to a grading score for bone resorption based upon clinical, radiologic and intraoperative findings. To our knowledge, the role of CK17 in cholesteatoma aggressiveness was first investigated in this paper. RESULTS: Both Ki-67 and CK17 were significantly overexpressed in cholesteatoma than control tissues (P < 0.001 for both Ki-67 and CK17). In addition, Ki-67 and CK17 were significantly higher in the invasive group than noninvasive group of cholesteatoma (P=0.029, P=0.033, respectively). Furthermore, Ki-67 and CK17 showed a moderate positive correlation with bone erosion scores (r=0.547, P=0.015 and r=0.588, P=0.008, respectively). In terms of CK13, no significant difference was found between cholesteatoma and skin (P=0.766). CONCLUSION: Both Ki-67 and CK17 were overexpressed in cholesteatoma tissue and positively correlated with bone resorption activity. The concept that Ki-67 can be a predictor for aggressiveness of cholesteatoma was supported. In addition, this is the first study demonstrating CK17 as a favoring marker in the aggressiveness of acquired cholesteatoma.

Complete pathological response in rectal cancer after neoadjuvant therapy - case report

A fifty-four year old woman underwent colonoscopy due to symptoms of altered bowel habit and weight loss. There was a malignant looking lesion at her rectosigmoid junction [Fig. 1a] which was confirmed histologically to be a moderately differentiated adenocarcinoma. Although the blood results were normal, her CT scan and MRI [Fig 2a] showed an apple core lesion at rectosigmoid junction which was deemed to be Stage IIIC (T4aN2aM0)