Wasserstein GAN based Chest X-Ray Dataset Augmentation for Deep Learning Models: COVID-19 Detection Use-Case.

The novel coronavirus infection (COVID-19) is still continuing to be a concern for the entire globe. Since early detection of COVID-19 is of particular importance, there have been multiple research efforts to supplement the current standard RT-PCR tests. Several deep learning models, with varying effectiveness, using Chest X-Ray images for such diagnosis have also been proposed. While some of the models are quite promising, there still remains a dearth of training data for such deep learning models. The present paper attempts to provide a viable solution to the problem of data deficiency in COVID-19 CXR images. We show that the use of a Wasserstein Generative Adversarial Network (WGAN) could lead to an effective and lightweight solution. It is demonstrated that the WGAN generated images are at par with the original images using inference tests on an already proposed COVID-19 detection model.

The Predictive Value of Peripheral Immune Cell Counts for the Presence of Brain Metastases in Stage IV Non-Small-Cell Lung Cancer (NSCLC).

Background High neutrophil-lymphocyte ratio (NLR) is associated with poor survival in lung cancer. This study evaluates whether NLR is associated with baseline brain metastasis in stage IV non-small cell lung cancer (NSCLC). Methods Medical records of stage IV NSCLC patients treated at King Hussein Cancer Center (Amman-Jordan) between 2006 and 2016 were reviewed. Patients with baseline brain imaging and complete blood count (CBC) were included. Receiver operating characteristic (ROC) curve was used to identify the optimal cutoff value for the association between NLR and baseline brain metastasis. Association between age, gender, location of the primary tumor, histology, and NLR was assessed using univariate and multivariate logistic regression analyses. Results A total of 722 stage IV NSCLC patients who had baseline brain imaging were included. Median age was 59 years. Baseline brain metastasis was present in 280 patients (39.3%). Nine patients had inconclusive findings about brain metastasis. The ROC curve value of 4.3 was the best fitting cutoff value for NLR association with baseline brain metastasis. NLR ≥ 4.3 was present in 340 patients (48%). The multivariate analyses showed that high baseline NLR (≥ 4.3) was significantly associated with higher odds of baseline brain metastasis (odds ratio [OR]: 1.6, 95% confidence interval [CI]: 1.2-2.2; p = 0.0042). Adenocarcinoma histology was also associated with baseline brain metastasis (OR: 0.4, 95% CI: 0.25-0.6; p = 0.001). Conclusion High NLR is associated with baseline brain metastasis in advanced-stage NSCLC. In the era of immunotherapy and targeted therapies, whether high NLR predicts response of brain metastasis to treatment is unknown.

Histopathological alterations in gills, liver, kidney and muscles of Ictalurus punctatus collected from pollutes areas of River / Alterações histopatológicas em brânquias, fígado, rim e músculos de Ictalurus punctatus coletados em áreas poluídas do rio

Abstract Untreated sewage and industrial wastes from Faisalabad city are disposed to River Chenab through Chakbandi Main Drain (CMD). The present project is planned to investigate the effects of this freshwater pollution on the body of fish Ictalurus punctatus. The specimens of this fish species were collected upstream and downstream of the entrance of CMD into River Chenab. Fish gills, liver, kidney and muscles from dorsolateral regions of fish were subjected to histopathology. Farmed fish and fish from upstream areas were used as control. Fish collected from polluted experimental sites showed significant damage in selected organs. Gill tissues showed an abnormality in the form of an uplifting of the primary epithelium, fusion, vacuolation, hypertrophy, and necrosis. While liver tissues subjected to hepatocytes degeneration, necrosis, mitochondrial granular hepatocyte, and sinusoids dilation. Kidney tissues indicated increased bowmen space and constricted glomerulus and degenerated nephrons. Edema, necrosis, and atrophy were observed in muscle tissues of fish from polluted areas. Fish from the upstream area showed fused gill lamellae, inflammatory cell infiltration, hypertrophy and vacuolation in hepatocytes. Kidney tissues indicated the presence of nuclear tubular cells, destructive renal tubules, hemorrhage, and necrosis at tubular epithelium. Intra myofibril spaces were also observed in muscles. Specimens of control fish indicated no variation in gills, liver, kidney, and muscles. The present study revealed a strong correlation between the degree of tissue damage and environmental contamination. Present findings also compel global warnings to protect our water bodies and fish to rescue the human population.

Resumo O esgoto não tratado e os resíduos industriais da cidade de Faisalabad, no Paquistão, são descartados no Rio Chenab através do dreno principal de Chakbandi (CMD). O presente projeto busca investigar os efeitos dessa poluição de água doce no corpo de peixes Ictalurus punctatus. Os espécimes deste peixe foram coletados a montante e a jusante da entrada do CMD no Rio Chenab. Brânquias, fígado, rim e músculos das regiões dorsolaterais dos peixes foram submetidos à histopatologia. Peixes de criação e peixes de áreas a montante foram utilizados como controle. Peixes coletados em locais experimentais poluídos mostraram danos significativos em órgãos selecionados. Os tecidos branquiais mostraram uma anormalidade na forma de elevação do epitélio primário, fusão, vacuolação, hipertrofia e necrose. Observou-se que os tecidos hepáticos estão sujeitos a degeneração de hepatócitos, necrose, hepatócitos mitocondriais granulares e dilatação de sinusoides. Os tecidos renais indicaram aumento do espaço dos arqueiros, glomérulos contraídos e néfrons degenerados. Edema, necrose e atrofia foram observados nos tecidos musculares de peixes de áreas poluídas. Peixes da área a montante apresentaram lamelas branquiais fundidas, infiltração de células inflamatórias, hipertrofia e vacuolização em hepatócitos. Os tecidos renais indicaram a presença de células tubulares nucleares, túbulos renais destrutivos, hemorragia e necrose no epitélio tubular. Os espaços intramiofibrilas também foram observados nos músculos. Amostras de peixes controle não indicaram variação em brânquias, fígado, rim e músculos. O presente estudo revelou uma forte correlação entre o grau de dano tecidual e a contaminação ambiental. As descobertas atuais também constituem avisos globais para proteger nossos corpos d'água e peixes para resguardar a população humana.

A national audit of estimated glomerular filtration rate and proteinuria and the MACD CKD task force recommendations.

INTRODUCTION: The Malaysian Association of Clinical Biochemists (MACB) established a Task Force for Chronic Kidney Disease. A survey was undertaken by the Task Force on the reporting of estimated glomerular filtration rate (eGFR) and urine albumin by hospital laboratories in Malaysia in both the government and private sectors. MATERIALS AND METHODS: An e-mail invitation to participate in an online survey was sent to hospital laboratories in Malaysia (n=140). Questions regarding methods for measuring creatinine, equations for calculating eGFR, eGFR reporting, the terminology used in reporting urine albumin, types of samples and the cut-off values used for normal albuminuria. RESULTS: A total of 42/140 (30%) laboratories answered the questionnaire. The prevalent method used for serum creatinine measurement was the Jaffé method (88.1%) traceable to isotope-dilution mass spectrometry. eGFR was reported along with serum creatinine by 61.9% of laboratories while 33.3% of laboratories report eGFR on request. The formula used for eGFR reporting was mainly MDRD (64.3%) and results were reported as exact numbers even when the eGFR was <60 ml/min/1.73m2. The term microalbumin is still used by 83.3% of laboratories. There is a large heterogeneity among the labs regarding the type of sample recommended for measuring urine albumin, reference interval and reporting units. CONCLUSION: It is evident that the laboratory assessment of chronic kidney disease in Malaysia is not standardised. It is essential to provide a national framework for standardised reporting of eGFR and urine albumin. Recommendations developed by the MACB CKD Task Force, if adopted by all laboratories, will lead to a reduction in this variability.

Histopathological alterations in gills, liver, kidney and muscles of Ictalurus punctatus collected from pollutes areas of River.

Untreated sewage and industrial wastes from Faisalabad city are disposed to River Chenab through Chakbandi Main Drain (CMD). The present project is planned to investigate the effects of this freshwater pollution on the body of fish Ictalurus punctatus. The specimens of this fish species were collected upstream and downstream of the entrance of CMD into River Chenab. Fish gills, liver, kidney and muscles from dorsolateral regions of fish were subjected to histopathology. Farmed fish and fish from upstream areas were used as control. Fish collected from polluted experimental sites showed significant damage in selected organs. Gill tissues showed an abnormality in the form of an uplifting of the primary epithelium, fusion, vacuolation, hypertrophy, and necrosis. While liver tissues subjected to hepatocytes degeneration, necrosis, mitochondrial granular hepatocyte, and sinusoids dilation. Kidney tissues indicated increased bowmen space and constricted glomerulus and degenerated nephrons. Edema, necrosis, and atrophy were observed in muscle tissues of fish from polluted areas. Fish from the upstream area showed fused gill lamellae, inflammatory cell infiltration, hypertrophy and vacuolation in hepatocytes. Kidney tissues indicated the presence of nuclear tubular cells, destructive renal tubules, hemorrhage, and necrosis at tubular epithelium. Intra myofibril spaces were also observed in muscles. Specimens of control fish indicated no variation in gills, liver, kidney, and muscles. The present study revealed a strong correlation between the degree of tissue damage and environmental contamination. Present findings also compel global warnings to protect our water bodies and fish to rescue the human population.

Correlation between Echocardiography and Cardiac Catheterization for the Assessment of Pulmonary Hypertension in Pediatric Patients.

Introduction Cardiac catheterization is widely considered the "gold standard" for the diagnosis of pulmonary hypertension. However, its routine use is limited due to its invasive nature. Therefore, the aim of this study was to evaluate the correlation between pulmonary artery pressures obtained by various parameters of transthoracic echocardiography and cardiac catheterization. Methods This study includes 50 consecutive patients with intracardiac shunt lesions diagnosed with severe pulmonary hypertension on echocardiography and admitted for cardiac catheterization at the National Institute of Cardiovascular Diseases (NICVD) in Karachi, Pakistan. Cardiac catheterization and transthoracic echocardiography were performed in all patients simultaneously and systolic (sPAP) and mean pulmonary artery pressure (mPAP) were assessed with both modalities. Correlations and agreement, in terms of Bland-Altman plot, were computed between both modalities for sPAP and mPAP. Results Out of 50 patients, 46% (23) were male and mean age was 7.49 ± 4.45 years. On cardiac catheterization, sPAP was 93.92 ± 17.91 mmHg and mPAP was 67.0 ± 14.28 mmHg. Correlation between cardiac catheterization and echocardiography for the assessment of sPAP was 0.917 (p<0.001), and mPAP was 0.832 (p<0.001) for mean gradient of tricuspid regurgitation (PGTRmean), 0.749 (p<0.001) for peak gradient of pulmonary regurgitation (PGPRpeak), 0.691 (p<0.001) for Acceleration time across right ventricular outflow tract (RVOT), and 0.752 (p<0.001) for end gradient of pulmonary regurgitation (PGPRend). Bland-Altman plot showed moderate agreement between two modalities. Conclusion A positive but modest correlation was observed between hemodynamic parameters of transthoracic echocardiography and cardiac catheterization for assessment of pulmonary artery pressures. Transthoracic echocardiography can reliably be used as an initial non-invasive modality for the assessment of pulmonary artery hypertension and can obviate the need of right heart catheterization in some patient especially with mild pulmonary hypertension.

Potential of natural repellents methylanthranilate and anthraquinone applied on maize seeds and seedlings against house sparrow (Passer domesticus) in captivity / Potencial de repelentes naturais, metilantranilato e antraquinona aplicados em sementes de milho e mudas contra o pardal (Passer domesticus) em cativeiro

Abstract Various bird pests caused severe economic losses to valuable crops and fruit orchards all over the world. Among the birds, house sparrow is also considered to cause heavy plunder, not only to seeds of crops but also seedlings especially in organic farming. In present study two bird repellents, methylanthranilate and anthraquinone tested against house sparrows on maize seeds and seedlings in aviary conditions. Trial group in aviary-I, the treated maize seeds and seedlings with different doses of both bird repellents, control group in aviary-II, untreated seeds and seedlings were provided for three hours in the early morning. In each aviary, two closed circuit cameras were also installed to monitor the behavioral responses against different concentrations of both chemical repellents. Statistical analysis showed that there existed highly significant (P<0.01) variations among the trial and control groups for seeds and seedlings. By comparing both repellents, significant (P<0.05) differences were detected and anthraquinone showed better efficacy when compared to methylanthranilate, but in maize seedlings both repellents equal repellent properties. Non-significant (P>0.05) differences were observed in different grading of both natural chemical repellents for maize seeds while significant (P<0.05) variations were noticed for maize seedlings when provided to sparrows. By videotaped behavior sparrows presented manifest head juddering and feather upsetting activities by consumption of treated seeds and seedlings with higher concentrations of both natural bird repellents.

Resumo Várias pragas de aves causaram graves perdas econômicas para cultivos valiosos e pomares de frutas em todo o mundo. Entre os pássaros, o pardal da casa também é considerado um grande saqueo, não só para as sementes das culturas, mas também para as mudas, especialmente na agricultura orgânica. No presente estudo, dois repelentes de aves, metilantranilato e antraquinona testados contra pardais de casa em sementes de milho e mudas em condições de aviário. O grupo de ensaio em aviary-I, as sementes de milho tratadas e as mudas com diferentes doses de repelentes de aves, grupo de controle em aviary-II, sementes não tratadas e mudas foram fornecidas por três horas no início da manhã. Em cada aviário, duas câmeras de circuito fechado também foram instaladas para monitorar as respostas comportamentais contra diferentes concentrações de ambos os repelentes químicos. A análise estatística mostrou que existiam variações altamente significativas (P<0,01) entre os grupos de teste e controle para sementes e mudas. Ao comparar os dois repelentes, detectaram-se diferenças significativas (P<0,05) e a antraquinona apresentou maior eficácia quando comparada ao metilantranilato, mas em mudas de milho, ambos os repelentes são iguais às propriedades repelentes. As diferenças não significantes (P>0,05) foram observadas em diferentes classificações de repelentes químicos naturais para sementes de milho, enquanto as variações significativas (P<0,05) foram observadas para as mudas de milho quando fornecidas aos pardais. Por um comportamento gravado em video, os pardais apresentaram manifestações de cabeça e vibrações de penas por consumo de sementes tratadas e mudas com maiores concentrações de repelentes de aves naturais.

Potential of natural repellents methylanthranilate and anthraquinone applied on maize seeds and seedlings against house sparrow (Passer domesticus) in captivity.

Various bird pests caused severe economic losses to valuable crops and fruit orchards all over the world. Among the birds, house sparrow is also considered to cause heavy plunder, not only to seeds of crops but also seedlings especially in organic farming. In present study two bird repellents, methylanthranilate and anthraquinone tested against house sparrows on maize seeds and seedlings in aviary conditions. Trial group in aviary-I, the treated maize seeds and seedlings with different doses of both bird repellents, control group in aviary-II, untreated seeds and seedlings were provided for three hours in the early morning. In each aviary, two closed circuit cameras were also installed to monitor the behavioral responses against different concentrations of both chemical repellents. Statistical analysis showed that there existed highly significant (P<0.01) variations among the trial and control groups for seeds and seedlings. By comparing both repellents, significant (P<0.05) differences were detected and anthraquinone showed better efficacy when compared to methylanthranilate, but in maize seedlings both repellents equal repellent properties. Non-significant (P>0.05) differences were observed in different grading of both natural chemical repellents for maize seeds while significant (P<0.05) variations were noticed for maize seedlings when provided to sparrows. By videotaped behavior sparrows presented manifest head juddering and feather upsetting activities by consumption of treated seeds and seedlings with higher concentrations of both natural bird repellents.

Potential of natural repellents methylanthranilate and anthraquinone applied on maize seeds and seedlings against house sparrow (Passer domesticus) in captivity

Abstract Various bird pests caused severe economic losses to valuable crops and fruit orchards all over the world. Among the birds, house sparrow is also considered to cause heavy plunder, not only to seeds of crops but also seedlings especially in organic farming. In present study two bird repellents, methylanthranilate and anthraquinone tested against house sparrows on maize seeds and seedlings in aviary conditions. Trial group in aviary-I, the treated maize seeds and seedlings with different doses of both bird repellents, control group in aviary-II, untreated seeds and seedlings were provided for three hours in the early morning. In each aviary, two closed circuit cameras were also installed to monitor the behavioral responses against different concentrations of both chemical repellents. Statistical analysis showed that there existed highly significant (P 0.01) variations among the trial and control groups for seeds and seedlings. By comparing both repellents, significant (P 0.05) differences were detected and anthraquinone showed better efficacy when compared to methylanthranilate, but in maize seedlings both repellents equal repellent properties. Non-significant (P>0.05) differences were observed in different grading of both natural chemical repellents for maize seeds while significant (P 0.05) variations were noticed for maize seedlings when provided to sparrows. By videotaped behavior sparrows presented manifest head juddering and feather upsetting activities by consumption of treated seeds and seedlings with higher concentrations of both natural bird repellents.

Resumo Várias pragas de aves causaram graves perdas econômicas para cultivos valiosos e pomares de frutas em todo o mundo. Entre os pássaros, o pardal da casa também é considerado um grande saqueo, não só para as sementes das culturas, mas também para as mudas, especialmente na agricultura orgânica. No presente estudo, dois repelentes de aves, metilantranilato e antraquinona testados contra pardais de casa em sementes de milho e mudas em condições de aviário. O grupo de ensaio em aviary-I, as sementes de milho tratadas e as mudas com diferentes doses de repelentes de aves, grupo de controle em aviary-II, sementes não tratadas e mudas foram fornecidas por três horas no início da manhã. Em cada aviário, duas câmeras de circuito fechado também foram instaladas para monitorar as respostas comportamentais contra diferentes concentrações de ambos os repelentes químicos. A análise estatística mostrou que existiam variações altamente significativas (P 0,01) entre os grupos de teste e controle para sementes e mudas. Ao comparar os dois repelentes, detectaram-se diferenças significativas (P 0,05) e a antraquinona apresentou maior eficácia quando comparada ao metilantranilato, mas em mudas de milho, ambos os repelentes são iguais às propriedades repelentes. As diferenças não significantes (P>0,05) foram observadas em diferentes classificações de repelentes químicos naturais para sementes de milho, enquanto as variações significativas (P 0,05) foram observadas para as mudas de milho quando fornecidas aos pardais. Por um comportamento gravado em video, os pardais apresentaram manifestações de cabeça e vibrações de penas por consumo de sementes tratadas e mudas com maiores concentrações de repelentes de aves naturais.

Histopathological alterations in gills, liver, kidney and muscles of Ictalurus punctatus collected from pollutes areas of River

Abstract Untreated sewage and industrial wastes from Faisalabad city are disposed to River Chenab through Chakbandi Main Drain (CMD). The present project is planned to investigate the effects of this freshwater pollution on the body of fish Ictalurus punctatus. The specimens of this fish species were collected upstream and downstream of the entrance of CMD into River Chenab. Fish gills, liver, kidney and muscles from dorsolateral regions of fish were subjected to histopathology. Farmed fish and fish from upstream areas were used as control. Fish collected from polluted experimental sites showed significant damage in selected organs. Gill tissues showed an abnormality in the form of an uplifting of the primary epithelium, fusion, vacuolation, hypertrophy, and necrosis. While liver tissues subjected to hepatocytes degeneration, necrosis, mitochondrial granular hepatocyte, and sinusoids dilation. Kidney tissues indicated increased bowmen space and constricted glomerulus and degenerated nephrons. Edema, necrosis, and atrophy were observed in muscle tissues of fish from polluted areas. Fish from the upstream area showed fused gill lamellae, inflammatory cell infiltration, hypertrophy and vacuolation in hepatocytes. Kidney tissues indicated the presence of nuclear tubular cells, destructive renal tubules, hemorrhage, and necrosis at tubular epithelium. Intra myofibril spaces were also observed in muscles. Specimens of control fish indicated no variation in gills, liver, kidney, and muscles. The present study revealed a strong correlation between the degree of tissue damage and environmental contamination. Present findings also compel global warnings to protect our water bodies and fish to rescue the human population.

Resumo O esgoto não tratado e os resíduos industriais da cidade de Faisalabad, no Paquistão, são descartados no Rio Chenab através do dreno principal de Chakbandi (CMD). O presente projeto busca investigar os efeitos dessa poluição de água doce no corpo de peixes Ictalurus punctatus. Os espécimes deste peixe foram coletados a montante e a jusante da entrada do CMD no Rio Chenab. Brânquias, fígado, rim e músculos das regiões dorsolaterais dos peixes foram submetidos à histopatologia. Peixes de criação e peixes de áreas a montante foram utilizados como controle. Peixes coletados em locais experimentais poluídos mostraram danos significativos em órgãos selecionados. Os tecidos branquiais mostraram uma anormalidade na forma de elevação do epitélio primário, fusão, vacuolação, hipertrofia e necrose. Observou-se que os tecidos hepáticos estão sujeitos a degeneração de hepatócitos, necrose, hepatócitos mitocondriais granulares e dilatação de sinusoides. Os tecidos renais indicaram aumento do espaço dos arqueiros, glomérulos contraídos e néfrons degenerados. Edema, necrose e atrofia foram observados nos tecidos musculares de peixes de áreas poluídas. Peixes da área a montante apresentaram lamelas branquiais fundidas, infiltração de células inflamatórias, hipertrofia e vacuolização em hepatócitos. Os tecidos renais indicaram a presença de células tubulares nucleares, túbulos renais destrutivos, hemorragia e necrose no epitélio tubular. Os espaços intramiofibrilas também foram observados nos músculos. Amostras de peixes controle não indicaram variação em brânquias, fígado, rim e músculos. O presente estudo revelou uma forte correlação entre o grau de dano tecidual e a contaminação ambiental. As descobertas atuais também constituem avisos globais para proteger nossos corpos d'água e peixes para resguardar a população humana.

Intraplaque Hemorrhage and the Plaque Surface in Carotid Atherosclerosis: The Plaque At RISK Study (PARISK).

BACKGROUND AND PURPOSE: An important characteristic of vulnerable plaque, intraplaque hemorrhage, may predict plaque rupture. Plaque rupture can be visible on noninvasive imaging as a disruption of the plaque surface. We investigated the association between intraplaque hemorrhage and disruption of the plaque surface. MATERIALS AND METHODS: We selected the first 100 patients of the Plaque At RISK study, an ongoing prospective noninvasive plaque imaging study in patients with mild-to-moderate atherosclerotic lesions in the carotid artery. In carotid artery plaques, disruption of the plaque surface (defined as ulcerated plaques and/or fissured fibrous cap) and intraplaque hemorrhage were assessed by using MDCTA and 3T MR imaging, respectively. We used a χ(2) test and multivariable logistic regression to assess the association between intraplaque hemorrhage and disrupted plaque surface. RESULTS: One hundred forty-nine carotid arteries in 78 patients could be used for the current analyses. Intraplaque hemorrhage and plaque ulcerations were more prevalent in symptomatic compared with contralateral vessels (hemorrhage, 38% versus 11%; P < .001; and ulcerations, 27% versus 7%; P = .001). Fissured fibrous cap was more prevalent in symptomatic compared with contralateral vessels (13% versus 4%; P = .06). After adjustment for age, sex, diabetes mellitus, and degree of stenosis, intraplaque hemorrhage was associated with disrupted plaque surface (OR, 3.13; 95% CI, 1.25-7.84) in all vessels. CONCLUSIONS: Intraplaque hemorrhage is associated with disruption of the plaque surface in patients with a carotid artery stenosis of <70%. Serial studies are needed to investigate whether intraplaque hemorrhage indeed increases the risk of plaque rupture and subsequent ischemic stroke during follow-up.

Influencing factors of paediatric dental anxiety levels in an undergraduate dental clinic.

AIM: To examine the nature of dental anxiety in paediatric patients, and to identify factors relevant to paediatric dental anxiety in a sample of 5 to 17 year-old children residing in Cairns, Australia. MATERIALS AND METHODS: A convenient sample of 125 children, their parents and corresponding student practitioners were selected. Each was assessed with questionnaires. RESULTS: A higher level of dental anxiety was seen in children who were subject to radiographic examination as part of their treatment (b=0.462; p=0.012). Similarly, children of Asian ethnicity showed higher dental anxiety levels than their Caucasian counterparts (b=1.187; p=0.010). Finally, the childrens' overall dental anxiety levels decreased after being treated by student practitioners (t=2.311;df=124; p=0.022). CONCLUSION: Children experienced greater anxiety before receiving dental treatment than after. Treatment involving radiographic examination exacerbated dental anxiety and children of Asian descent were more anxious prior to receiving treatment. Further investigation is indicated.

The development of a virtual reality training programme for ophthalmology: repeatability and reproducibility (part of the International Forum for Ophthalmic Simulation Studies).

PURPOSE: To evaluate the variability of performance among novice ophthalmic trainees in a range of repeated tasks using the Eyesi virtual reality (VR) simulator. METHODS: Eighteen subjects undertook three attempts of five cataract specific and generic three-dimensional tasks: continuous curvilinear capsulorhexis, cracking and chopping, cataract navigation, bimanual cataract training, anti-tremor. Scores for each attempt were out of a maximum of 100 points. A non-parametric test was used to analyse the data, where a P-value of <0.05 was considered statistically significant. RESULTS: Highly significant differences were found between the scores achieved in the first attempt and that during the second (P<0.0001) and third (P<0.0001) but not between the second and third attempt (P=0.65). There was no significant variability in the overall score between the users (P=0.1104) or in the difference between their highest and lowest score (P=0.3878). Highly significant differences between tasks were shown both in the overall score (P=0.0001) and in the difference between highest and lowest score (P=0.003). CONCLUSION: This study, which is the first to quantify reproducibility of performance in entry level trainees using a VR tool, demonstrated significant intra-novice variability. The cohort of subjects performed equally overall in the range of tasks (no inter-novice variability) but each showed that performance varies significantly with the complexity of the task when using this high-fidelity instrument.

Counseling for male BRCA mutation carriers: a review.

BRCA mutations in women confer a high risk for breast and ovarian cancers. The risks to male carriers are poorly understood and risk management strategies undescribed. This review summarizes current evidence and gives recommendations for counseling male BRCA mutation carriers. Reported risks for breast, prostate, pancreatic, gastric and hematologic cancers are higher in male BRCA mutation carriers vs non-carriers. Especially in male BRCA2 mutation carriers under age 65 prostate and pancreatic cancer risks are increased. The risk increase for primary cancers of organs like the liver, bone and brain is difficult to assess as these organs are common sites for metastases. Reports on colorectal cancer and melanoma risks are inconclusive. On the current limited evidence available, male BRCA mutation carriers should be regarded as at high risk for breast, prostate, gastric, pancreatic and colorectal cancers; surveillance by appropriate investigations should start at age 40 years.

Antioxidant activity of five vegetables traditionally consumed by South-Asian migrants in Bradford, Yorkshire, UK.

Five vegetables traditionally consumed among South-Asian migrants in Bradford (Yorkshire, UK) were tested for their free radical scavenging activity (FRSA) in the DPPH (1,1-diphenyl-2-picrylhydrazil radical) screening assay (using extracts prepared both by cold maceration and also by boiling the plant in the solvent under reflux) and for their in vitro non-enzymatic inhibition of bovine brain lipid peroxidation. In both antioxidant assays a strong activity was shown by extracts derived from okra (Abelmoschus esculentus, Malvaceae) fruits and charungli (Caralluma edulis, Asclepiadaceae) aerial parts. Extracts from bitter melon (Momordica charantia, Cucurbitaceae) and angular loofah (Luffa acutangula) showed a significant difference in the FRSA between the extract obtained by using cold maceration and that prepared by boiling the plant in the solvent under reflux, suggesting the chemical composition of the plant changed during the heating process, leading to an increase in the amount of antioxidant components. These findings confirm the great interest of the nutraceutical sciences in extracts of Caralluma edulis, whose phytochemistry and phytopharmacology should be investigated further in order to detect possible phytotherapeutic uses in the prevention of ageing related diseases (ARDs) and Alzheimer disease (AD).

Torsion of an ectopic liver in a young child.

A large ectopic liver nodule connected to the greater omentum had undergone infarction and separation because of torsion of its connecting stalk and was the cause of acute abdominal pain and elevated liver enzymes in a young female child. At laparotomy for a suspected perforated appendicitis, a hemorrhagic peritoneal fluid was found, together with an intraperitoneal solid mass lying freely in the right iliac fossa. The definitive diagnosis was obtained by histopathology. This is the first known such reported case.

Reliability and validity of the Malayalam hospital anxiety and depression scale (HADS) in cancer patients.

BACKGROUND & OBJECTIVE: The hospital anxiety and depression scale (HADS) has been widely used on cancer patients as an indicator of psychological morbidity. Though the scale has been used in India, no reports are available on translation of HADS in any Indian language and testing the reliability. The present study describes the translation process of HADS into Malayalam and testing its reliability and validity on psychological morbidity in cancer patients. METHODS: The English version of the HADS was translated into Malayalam and was used in this study. The questionnaire was administered to 240 cancer patients and statistical analysis was carried out using Chronbach's alpha to test the internal consistency of the HADS scale while confirmatory factor analysis was carried out using principal axis factoring with equimax rotation and Kaiser Normalization to test its construct validity. RESULTS: The Cronbach's alpha was found to be 0.81 for the HADS anxiety subscale, 0.71 for the HADS depression subscale, and 0.85 for HADS tool. Confirmatory factor analysis (CFA) indicated two depression items (i.e., enjoyment and anhedonia) loading onto the anxiety subscale. Clinical caseness for anxiety was observed in 8 per cent, while 11 per cent of the patients had borderline mood disorder. Clinical caseness for depression was identified in 7.6 and 13 per cent of patients were found to have borderline mood disturbances. INTERPRETATION & CONCLUSION: This preliminary validation study of the Malayalam version of the HADS showed it as an acceptable, and reliable measure of psychological morbidity among cancer patients. The prevalence of anxiety and depression in Indian population was low and enjoyment and anhedonia might present as anxiety initially.