Lateral Pancreaticojejunostomy in a Rare Case of Chronic Calcific Pancreatitis With Peripancreatic Pseudocyst in an 18-Year-Old Male: A Case Report.

Another name for the Puestow surgery is a lateral pancreaticojejunostomy. The primary pancreatic duct, which runs from the head to the tail of the organ, is opened, exposing the pancreas. In order to allow the pancreas to empty straight into the intestines, the opening of the pancreatic duct is subsequently joined to a tiny intestinal loop. For more than 50 years, this process has been used to effectively relieve pain caused by chronic pancreatitis. This technique has a very low mortality rate and a low rate of surgical complications, and a high success rate. The gradual fibrosis of the pancreas resulting in the loss of exocrine and endocrine function is known as chronic pancreatitis. Intense pain is the disease's most typical symptom. It is unclear what causes the discomfort in chronic pancreatitis. Nonetheless, a large number of these patients have dilated ducts that are made up of intervening structures and saccular dilations, a condition known as the "chain of lakes" phenomenon. Radiological investigations can be used for diagnosis in these patients. Lateral pancreaticojejunostomy is the most effective treatment option for these individuals. Preservation of endocrine and exocrine pancreatic function is another benefit of lateral pancreaticojejunostomy. With lateral pancreaticojejunostomy, chronic fibrocalcific pancreatitis that manifests as pancreatic ductal dilatation and persistent discomfort can be effectively treated. Excellent early outcomes have been observed in terms of pain alleviation as well as post-operative morbidity and mortality; however, the patient's overall outcome and long-term follow-up have not been as well defined.

Chilaiditi Sign: A Rare Radiographic Encounter and Diagnostic Exploration.

This case report explores the complex diagnostic dilemma between the Chilaiditi sign and the pneumoperitoneum. The patient presented with chronic complaints of vague abdominal pain, abdominal distension, and breathlessness. A chest X-ray indicated an elevated right hemidiaphragm with transverse colon interposition, leading to the diagnosis of Chilaiditi's sign. Subsequent imaging, including abdominal ultrasound and contrast-enhanced computed tomography, revealed a large non-enhancing multilobulated multicystic mass adherent to the anterior wall of the uterus, raising suspicions of malignancy. Managed by gynecologists, the patient underwent a total abdominal hysterectomy, mass excision, and bilateral salpingo-oophorectomy. The discussion delves into Chilaiditi's sign, its historical context, and its complex pathophysiology involving intestinal, hepatic, and/or diaphragmatic components. Various anatomical and functional factors contributing to this condition are explored. This case highlights the importance of considering the Chilaiditi sign in patients with radiologic evidence of subdiaphragmatic air. It emphasizes the need for timely and accurate diagnosis to differentiate it from more severe conditions like pneumoperitoneum. Such consideration aids in optimizing management strategies and preventing unnecessary investigations.

Postnatal Assessment of Minipuberty in Indian Preterm and Full-term Male Infants.

OBJECTIVES: To study the differences in the timing and magnitude of postnatal urinary gonadotropins and testosterone secretion during minipuberty in Indian preterm (PT) and full-term (FT) male infants. METHODS: This prospective observational study included 30 PT and 60 FT male infants. Urinary luteinizing hormone (LH), follicular stimulating hormone (FSH), and testosterone, and stretched penile length (SPL) and testicular volume (TV) were measured on day 7, first month, second month, fourth month and at six months of age. RESULTS: The highest elevation of mean (SD) urinary LH was observed in PT infants in comparison to FT infants [12.6 (1.4) vs 4.9 (0.6) µIU/mg, respectively; P < 0.001] in the first month. FSH levels were lower in PT than FT infants on day 7 (P < 0.001). Testosterone was significantly elevated in PT than FT infants [70.8 (5.6) vs 44.6 (3.2) ng/mg; P < 0.001] with a greater mean percentage increase in SPL (P < 0.001) and TV (P < 0.001) by the first month. CONCLUSIONS: Indian PT male infants showed a greater increase in urinary LH and testosterone, with a faster increase in SPL and TV.

Utility of Colour Flow Doppler Ultrasonography to Differentiate Gestational Transient Thyrotoxicosis and Graves Disease in Pregnancy.

Introduction: Accurate diagnosis of the etiology of thyrotoxicosis in pregnancy is important to guide appropriate treatment. The role of thyroid blood flow velocities by color Doppler to differentiate between Graves' disease (GD) in pregnancy and gestational transient thyrotoxicosis (GTT) is not well explored. This study evaluated inferior thyroid artery (ITA)-peak systolic velocity (PSV) as a marker for differential diagnosis of thyrotoxicosis in pregnancy. Methods: Fifty-six pregnant patients with thyrotoxicosis (30 with GTT and 26 with GD) along with 30 age-matched healthy euthyroid pregnant subjects were enrolled. Thyroid ultrasound examinations and color Doppler was performed by an ultrasound scanner. The studies of the right and left ITAs were performed with Doppler, and the PSV and End diastolic velocity (EDV) values were obtained from the right and left ITA. Results: The mean total T4 value in GD and GTT were almost similar (25.04 ± 2.43 vs 23.25 ± 2.81, P value = 0.14). Beta HCG levels were significantly higher in cases of GTT as compared to GD (152946 ± 26694 vs 120608 ± 21244 mIU/ml, P < 0.0001). The ITA-PSV and EDV in patients with GTT were significantly lower than those of pregnant patients with GD (right: 22.5 ± 6.8 and 8.3 ± 2.3; left: 22.97 ± 6.3 and 8.13 ± 2.01; P < 0.001). receiver-operating-characteristic (ROC) curve demonstrated an optimal cutoff value of mean right ITA-PSV of 35 cm/sec to differentiate GTT from GD during pregnancy, with 84.6% and 93.3% sensitivity and specificity. Conclusion: Thyroid artery velocities can help to differentiate between GD and GTT. The cutoff point of mean ITA-PSV at 35 cm/s had an excellent value in differentiating between the two, with good sensitivity and specificity.

Successful Surgical Management of Chronic Lower Limb Lymphedema: A Case Report.

Chronic lower limb lymphedema is a challenging and often debilitating medical condition characterized by the abnormal accumulation of lymphatic fluid in the extremities, leading to persistent swelling and discomfort. While this condition can be caused by various underlying factors, early diagnosis, and appropriate management are crucial for improving the patient's quality of life. This case report presents the successful surgical management of chronic lower limb lymphedema in a 30-year-old male patient who had been grappling with this condition for a decade. The patient's journey from the onset of symptoms, including swelling and difficulty in walking, to the eventual diagnosis and treatment is documented herein. Despite seeking medical care from allopathic and homeopathic sources, the patient's condition continued to deteriorate over the years, underscoring the complexity of chronic lower limb lymphedema and its challenges in clinical management. This case highlights the importance of accurate diagnosis, multidisciplinary evaluation, and a comprehensive surgical approach in addressing the complexities of chronic lower limb lymphedema. It also sheds light on the potential complications that may arise during treatment and the postoperative care required to achieve a favorable outcome. By sharing this case, we aim to contribute to understanding this condition and provide insights into the effective management of chronic lower limb lymphedema.

Are acoustics enough? Semantic effects on auditory salience in natural scenes.

Auditory salience is a fundamental property of a sound that allows it to grab a listener's attention regardless of their attentional state or behavioral goals. While previous research has shed light on acoustic factors influencing auditory salience, the semantic dimensions of this phenomenon have remained relatively unexplored owing both to the complexity of measuring salience in audition as well as limited focus on complex natural scenes. In this study, we examine the relationship between acoustic, contextual, and semantic attributes and their impact on the auditory salience of natural audio scenes using a dichotic listening paradigm. The experiments present acoustic scenes in forward and backward directions; the latter allows to diminish semantic effects, providing a counterpoint to the effects observed in forward scenes. The behavioral data collected from a crowd-sourced platform reveal a striking convergence in temporal salience maps for certain sound events, while marked disparities emerge in others. Our main hypothesis posits that differences in the perceptual salience of events are predominantly driven by semantic and contextual cues, particularly evident in those cases displaying substantial disparities between forward and backward presentations. Conversely, events exhibiting a high degree of alignment can largely be attributed to low-level acoustic attributes. To evaluate this hypothesis, we employ analytical techniques that combine rich low-level mappings from acoustic profiles with high-level embeddings extracted from a deep neural network. This integrated approach captures both acoustic and semantic attributes of acoustic scenes along with their temporal trajectories. The results demonstrate that perceptual salience is a careful interplay between low-level and high-level attributes that shapes which moments stand out in a natural soundscape. Furthermore, our findings underscore the important role of longer-term context as a critical component of auditory salience, enabling us to discern and adapt to temporal regularities within an acoustic scene. The experimental and model-based validation of semantic factors of salience paves the way for a complete understanding of auditory salience. Ultimately, the empirical and computational analyses have implications for developing large-scale models for auditory salience and audio analytics.

Role of Multidetector Computed Tomography in the Evaluation of Maxillofacial Trauma.

INTRODUCTION: Maxillofacial fractures are among the commonest injuries occurring in trauma patients. Multislice computed tomography (CT) is a widely used radiological investigation that accurately reveals the number, location, and extent of the fractures as well as concomitant soft tissue injuries and has been found to be superior in the diagnosis of maxillofacial fractures owing to high sensitivity and specificity. This study was performed to assess the efficacy of axial, coronal, sagittal, and three-dimensional (3D) reformatted images in the detection of fractures in maxillofacial trauma. MATERIALS AND METHODS: This was a cross-sectional descriptive study conducted on 49 adult patients with maxillofacial injuries undergoing multislice CT using a multidetector SiemensSOMATOM Emotion eco 16 slice CT scanner (Siemens AG, Munich, Germany). CT protocol consisted of non-contrast axial 16-slice helical series beam collimation ~ 3 mm, pitch ~ 0.8 - 1, tube current ~ 270 mAs, voltage ~ 130 kV, Total exposure time ~ 18 seconds, total radiation ~ 200 mGy. Along with the axial, coronal and sagittal images were reconstructed with 0.5 mm increment. 3D volume-rendering images were also obtained. 3D images were compared with axial images, coronal and sagittal plane images. RESULTS: The maximum number of cases was in the age group of 21-30 years with the male: female ratio being 5.12:1. The most common cause of injury was road traffic accidents (RTA). Mandible fractures were found to be the most common (20 patients, 40.8%) followed by fractures of nasal bone (18 patients, 36.7%). The incidence of frontal bone fractures was found to be the least (six patients, 12.24%). Our study found that 3D images are superior to axial in assessing the extent and degree of displacement of maxillofacial fractures in general. The maxillary sinus was found to be the most commonly fractured sinus (19 patients, 38.7%). Sphenoid sinus fractures were the least common (seen in two patients, 4.08%). CT findings correlated with the operative findings in most types of fractures. CONCLUSION: Multidetector CT with multiplanar and 3D reformation is highly accurate in the identification of fractures and assessing the extent and degree of displacement of fractures; hence, it is the imaging modality of choice in maxillofacial trauma. 3D images are much better for the detection of maxillofacial fractures compared to axial, coronal, or sagittal views, especially in maxilla and mandibular bone fractures. It is also found to be better at providing information on the patterns of the fracture lines and the displacement of the fracture fragments. Another added advantage of multidetector CT is that it is a non-invasive technique with good accuracy and a short scan time.

A Comprehensive Review of Breast Fibroadenoma: Correlating Clinical and Pathological Findings.

Breast fibroadenomas, common benign conditions, exhibit distinct clinical and histopathological features. This review highlights clinical presentation and histology correlations, providing insights for healthcare providers. Palpable masses, pain, and changes in breast appearance align with glandular and stromal components, emphasizing accurate diagnosis. Mammography, ultrasound, and MRI guide tailored treatment decisions. Challenges in differentiating atypical fibroadenomas highlight the need for meticulous histopathological evaluation. Clinical implications stress patient-centered care, shared decision-making, and ongoing follow-up. Future research focuses on genetic investigations and long-term studies. A multidisciplinary approach to breast fibroadenomas ensures comprehensive care for improved outcomes in both medical and emotional aspects.

Auditory salience using natural scenes: An online study.

Salience is the quality of a sensory signal that attracts involuntary attention in humans. While it primarily reflects conspicuous physical attributes of a scene, our understanding of processes underlying what makes a certain object or event salient remains limited. In the vision literature, experimental results, theoretical accounts, and large amounts of eye-tracking data using rich stimuli have shed light on some of the underpinnings of visual salience in the brain. In contrast, studies of auditory salience have lagged behind due to limitations in both experimental designs and stimulus datasets used to probe the question of salience in complex everyday soundscapes. In this work, we deploy an online platform to study salience using a dichotic listening paradigm with natural auditory stimuli. The study validates crowd-sourcing as a reliable platform to collect behavioral responses to auditory salience by comparing experimental outcomes to findings acquired in a controlled laboratory setting. A model-based analysis demonstrates the benefits of extending behavioral measures of salience to broader selection of auditory scenes and larger pools of subjects. Overall, this effort extends our current knowledge of auditory salience in everyday soundscapes and highlights the limitations of low-level acoustic attributes in capturing the richness of natural soundscapes.

Single Prime hAd5 Spike (S) + Nucleocapsid (N) Dual Antigen Vaccination of Healthy Volunteers Induces a Ten-Fold Increase in Mean S- and N- T-Cell Responses Equivalent to T-Cell Responses from Patients Previously Infected with SARS-CoV-2

In response to the need for a safe, efficacious vaccine that elicits vigorous T cell as well as humoral protection against SARS-CoV-2 infection, we have developed a dual-antigen COVID-19 vaccine comprising both the viral spike (S) protein modified to increase cell-surface expression (S-Fusion) and nucleocapsid (N) protein with an Enhanced T-cell Stimulation Domain (N-ETSD) to enhance MHC class I and II presentation and T-cell responses. The antigens are delivered using a human adenovirus serotype 5 (hAd5) platform with E1, E2b, and E3 regions deleted that has been shown previously in cancer vaccine studies to be safe and effective in the presence of pre-existing hAd5 immunity. The findings reported here are focused on human T-cell responses due to the likelihood that such responses will sustain efficacy against emerging variants, a hypothesis supported by our in silico prediction of T-cell epitope HLA binding for both the first-wave SARS-CoV-2 A strain and the B.1.351 strain K417N, E484K, and N501Y spike and T201I N variants. We demonstrate the hAd5 S-Fusion + N-ETSD vaccine antigens expressed by previously SARS-CoV-2-infected patient dendritic cells elicit Th1 dominant activation of autologous patient T cells, indicating the vaccine antigens have the potential to elicit immune responses in previously infected patients. For participants in our open-label Phase 1b study of the vaccine (NCT04591717; https://clinicaltrials.gov/ct2/show/NCT04591717), the magnitude of Th-1 dominant S- and N-specific T-cell responses after a single prime subcutaneous injection were comparable to T-cell responses from previously infected patients. Furthermore, vaccinated participant T-cell responses to S were similar for A strain S and a series of spike variant peptides, including S variants in the B.1.1.7 and B.1.351 strains. The findings that this dual-antigen vaccine elicits SARS-CoV-2-relevant T-cell responses and that such cell-mediated protection is likely to be sustained against emerging variants supports the testing of this vaccine as a universal booster that would enhance and broaden existing immune protection conferred by currently approved S-based vaccines.

Origin of Novel Coronavirus (COVID-19): A Computational Biology Study using Artificial Intelligence

Origin of the COVID-19 virus (SARS-CoV-2) has been intensely debated in the scientific community since the first infected cases were detected in December 2019. The disease has caused a global pandemic, leading to deaths of thousands of people across the world and thus finding origin of this novel coronavirus is important in responding and controlling the pandemic. Recent research results suggest that bats or pangolins might be the hosts for SARS-CoV-2 based on comparative studies using its genomic sequences. This paper investigates the SARS-CoV-2 origin by using artificial intelligence (AI) and raw genomic sequences of the virus. More than 300 genome sequences of COVID-19 infected cases collected from different countries are explored and analysed using unsupervised clustering methods. The results obtained from various AI-enabled experiments using clustering algorithms demonstrate that all examined SARS-CoV-2 genomes belong to a cluster that also contains bat and pangolin coronavirus genomes. This provides evidence strongly supporting scientific hypotheses that bats and pangolins are probable hosts for SARS-CoV-2. At the whole genome analysis level, our findings also indicate that bats are more likely the hosts for the COVID-19 virus than pangolins.

Use of biochar to produce reclaimed water for irrigation use.

Emerging contaminants, especially, pharmaceutical and personal care products (PPCPs) are not removed well during conventional wastewater treatment and hence pose water quality risk to the environment and potentially to public health. Long-term use of reclaimed wastewater for irrigation can lead to accumulation of trace contaminants in the soil, ground water and their subsequent uptake by plants and potentially can enter human food chain. This paper uses biochar as an adsorbent to remove emerging contaminants from treated wastewater by performing fixed bed experiments. Ten emerging contaminants namely, carbamazepine (CBZ), caffeine, diethyltoluamide (DEET), diphenhydramine (DPH), meprobamate (MPB), primidone (PMD), sulfamethoxazole (SMX), fluoxetine (FXT), perfluorooctanoic acid (PFOA) and trimethoprim (TMP) were monitored during lab scale experiments. Results from the continuous flow runs showed that the breakthrough curve for compounds caffeine, CBZ, DEET and PFOA follow second order Thomas model with adsorption capacities of 396 µg g-1, 392 µg g-1, 1160 µg g-1 and 32 µg g-1 biochar, respectively. Whereas compounds such as DPH, TMP and FXT were completely removed throughout the column runs by biochar. Results for rest of the compounds were interfered by leaching of these compounds from biochar. It was observed that commercially available GAC performed much better than biochar for all the compounds considered. Even at 1% of obtained capacity, biochar amendment to soils where reclaimed water is used for irrigation can reduce the uptake of these compounds by plants.

Fetal MR Imaging Analysis of Sirenomelia with Clinico Radiographic Correlation: A Case Report.

Sirenomelia is a social curiosity, a medical and diagnostic challenge prenatally compounded by varied diagnostic difficulties. Prenatal diagnosis of sirenomelia was and continues to be a challenge although von klippel et al., described a case at 10 weeks of gestational age. However, they needed a second imaging at 12(th) week for confirmation. First trimester or early second trimester anatomic survey on ultrasound and MRI is accurate for the diagnosis thereby avoiding unnecessary complex pregnancy. We report a case of second trimester diagnosed sirenomelia, with detailed analysis of image findings on ultrasound and fetal MRI.

Electrolyte and hemodynamic changes following percutaneous left atrial appendage ligation with the LARIAT device.

PURPOSE: The left atrial appendage (LAA) is a well-known source of atrial natriuretic peptide (ANP) and therefore plays an important role in homeostasis. The neurohormonal impact of epicardial exclusion of the LAA with the LARIAT procedure is unknown. In this proof-of-concept study, we postulated that LAA exclusion would impact homeostasis as evidenced by changes in electrolytes and blood pressure (BP). METHODS: A total of 76 patients who underwent successful LAA exclusion were enrolled in this retrospective observational study utilizing a prospective registry. Electrolytes, BP, and heart rate (HR) were monitored before LARIAT and post-LARIAT (24 and 72 h and 6 months). RESULTS: There was a significant reduction of systolic BP (mmHg) at 24 h (113.3 ± 16.0; p < 0.0001) and 72 h (119.0 ± 18.4 mmHg; p < 0.0001) post-LARIAT when compared with pre-LARIAT BP (138.2 ± 21.3). The reduction in systolic BP persisted at 6-month follow-up (128.8 ± 17.3; p = 0.0005). There was significant reduction in serum sodium (mmol/L) at 24 h (135.4 ± 3.6; p < 0.0001) and 72 h (136.3 ± 3.7; p < 0.001) post-LARIAT when compared to pre-LARIAT (138.7 ± 3.2). The reduction in sodium was not persistent at 6-month follow-up (138.4 ± 3.3; p = 0.453). CONCLUSIONS: LAA exclusion results in an early and persistent decrease in systolic BP. Additionally, there is an early decline in serum sodium, which normalizes at long-term follow-up. The underlying mechanism leading to these changes is not entirely clear; however, it is likely related to neurohormonal changes post LAA exclusion.

Effect of microclimate alteration on milk production and composition in Murrah buffaloes.

AIM: The aim of this study was to assess the effect of microclimate alteration on temperature-humidity index (THI), milk yield, and milk composition of Murrah buffaloes during summer for a period of 90-day from March to May-2014 at Buffalo Research Station, Venkataramannagudem, Andhra Pradesh, India. MATERIALS AND METHODS: A total of 40 lactating Murrah buffaloes were selected having similar body weight, parity, and milk yield. They were divided into four groups of 10 each. Three groups of buffaloes were provided with microclimate alteration using supplemental cooling like foggers, fans and foggers plus fans, and the fourth group (control) was without any cooling system. The daily THI was measured using dry and wet bulb thermometer. The physiological responses viz. rectal temperature, respiration rate, and pulse rate were measured by a clinical thermometer, measuring the flank movements a minute and observing the pulsation of the middle coccygeal artery at the base of tail with the help of finger. Milk samples were analyzed for chemical composition viz., fat, solids-not-fat (SNF), total solids (TS), specific gravity. RESULTS: In the present study, significant (p<0.001) decrease in the average THI values were observed in experimental Murrah buffalo houses of GroupII (foggers), GroupIII (fans), and GroupIV (foggers and fans) compared to GroupI (control). Significant (p<0.001) decrease in average rectal temperature (°F), respiration rate (breaths/min) and pulse rate (beats/min) values were recorded in Murrah buffaloes of Groups II, III and IV compared to Group I. Significant (p<0.001) increase in the average milk yield (kg/day) was recorded in Murrah buffaloes of Groups II, III, and IV compared with Group I. Significant (p<0.001) increase in the average milk fat, SNF, and TS percent were recorded in Murrah buffalo Groups of II, III, and IV compared with Group I. CONCLUSION: Microclimate alteration by the provision of foggers and air circulators in the buffalo houses increased feed intake in buffaloes resulting increased milk production, fat and SNF yield which was due to decreased heat stress in buffaloes.

Hair dye related acute kidney injury--a clinical and experimental study.

We studied paraphenylenediamine (PPD)-related acute kidney injury (AKI) in 81 patients and also in albino rats experimentally. In the patients' group AKI was found in 32.7%. Of them, 81.4% needed dialysis support. The overall mortality was 25.9%. In experimental rats the renal lesions were noted in all and they were glomerular congestion, intertubular (interstitial) hemorrhages, acute tubular necrosis, mesangial proliferation, and intratubular casts. The severity of renal injury appears to be dose dependent.

Epitrochlear mass in a patient on maintenance hemodialysis--Kimura disease.

Kimura disease is a rare benign inflammatory disorder presenting as subcutaneous masses or lymphnodal mass in the cervical region. Kimura disease is reported sparsely in patients on maintenance hemodialysis. We report an unusual location of Kimura disease in a patient on maintenance hemodialysis, who had a prolonged, persistent asymptomatic eosinophilia.