Small cell neuroendocrine carcinoma with adenocarcinoma and high grade squamous intraepithelial neoplasia of the cervix

ABSTRACT Neuroendocrine neoplasm (NEN) of the cervix is a malignant tumor and is classified into low and intermediate-grade neuroendocrine tumor (NET), and high-grade small cell neuroendocrine carcinoma (SCNEC), and large cells neuroendocrine carcinoma (LCNEC). SCNEC of the cervix is an Infrequent tumor with an incidence of less than 1% of all gynecological malignancies. It is characterized by small to medium-sized tumor cells with scant cytoplasm and neuroendocrine differentiation. Most cases of SCNEC of the cervix manifest in pure forms, and only cases show coexisting, non-neuroendocrine component of HPV-associated adenocarcinoma or squamous cell carcinoma. In this report, reviewing the literature, we present one such unique case of SCNEC of the cervix with adenocarcinoma and high-grade squamous intraepithelial neoplasia.

Association of Unfavorable Social Determinants of Health With Stroke/Transient Ischemic Attack and Vascular Risk Factors in Hispanic/Latino Adults: Results From Hispanic Community Health Study/Study of Latinos / 대한뇌졸중학회지

Background@#and Purpose Social determinants of health (SDOH) are non-medical factors that may contribute to the development of diseases, with a higher representation in underserved populations. Our objective is to determine the association of unfavorable SDOH with self-reported stroke/transient ischemic attack (TIA) and vascular risk factors (VRFs) among Hispanic/Latino adults living in the US. @*Methods@#We used cross-sectional data from the Hispanic Community Health Study/Study of Latinos. SDOH and VRFs were assessed using questionnaires and validated scales and measurements. We investigated the association between the SDOH (individually and as count: ≤1, 2, 3, 4, or ≥5 SDOH), VRFs and stroke/TIA using regression analyses. @*Results@#For individuals with stroke/TIA (n=388), the mean age (58.9 years) differed from those without stroke/TIA (n=11,210; 46.8 years; P<0.0001). In bivariate analysis, income <$20,000, education less than high school, no health insurance, perceived discrimination, not currently employed, upper tertile for chronic stress, and lower tertiles for social support and language- and social-based acculturation were associated with stroke/TIA and retained further. A higher number of SDOH was directly associated with all individual VRFs investigated, except for at-risk alcohol, and with number of VRFs (β=0.11, 95% confidence interval [CI]=0.09–0.14). In the fully adjusted model, income, discrimination, social support, chronic stress, and employment status were individually associated with stroke/TIA; the odds of stroke/TIA were 2.3 times higher in individuals with 3 SDOH (95% CI 1.6–3.2) and 2.7 times (95% CI 1.9–3.7) for those with ≥5 versus ≤1 SDOH. @*Conclusion@#Among Hispanic/Latino adults, a higher number of SDOH is associated with increased odds for stroke/TIA and VRFs. The association remained significant after adjustment for VRFs, suggesting involvement of non-vascular mechanisms.

Charmadala: Virudhaahar Janya Kushtha - A Case Study

In the midst of movement and chaos of life, we forget to pay heed to our health and as a result of which susceptibility to various allergens is increasing day by day. Allergens can be dust, smoke, fumes, pollen and even food. A person can either be allergic to certain allergen right from his birth or can acquire hypersensitivity in later stage of his life. Food allergy is quite common in present era and is affecting the lives of many people. Although there are a number of manifestations of food allergy like nausea, vomiting, diarrhoea, headache etc, most commonly seen are skin manifestations like blisters, itching, redness, burning sensation, oozing, discolouration etc. Acharyas have also mentioned Virudhaahar as one of the most prominent cause of Kushtha. Virudhaahar is any food that causes sensitivity reactions in a person. In contemporary sciences, there are no such permanent cures for hypersensitivity induced skin diseases. But in Ayurveda, through Shodhana and Shamana, these can be treated effectively and occurrence can also be avoided to some extent. This case report is of 38 yrs old male who visited our OPD with itching, oozing, blisters with intense burning sensation in palms and redness and itching in groin areas. The disease was diagnosed here as Charmdala. The treatment protocol opted was Virechan and Shamana. The patient was assessed every 7 days for a month and showed significant relief. This case thus proves that Ayurveda has the potential for curing Virudhaahar janya Kushtha which is often unresponsive to the contemporary treatment protocol.

Til Tail (Sesamum Indicum): A Hidden Cause Behind Tamaka Shwasa (Bronchial Asthma): A Literary Review

Respiratory problems are very common due to the devastating pollution, irritants and infections. Asthma is one of the chronic inflammatory respiratory illnesses throughout the world and is characterized by breathlessness, chest tightness, wheeze and coughing. It occurs as a result of hypersensitivity reaction mainly due to allergens. These allergies mostly can be from the food. Like other allergies, sesame allergy is quite common yet unknown but it’s prevalence has been continuously increasing in recent years. A lot of modern researches proved Sesame as a food allergen causing airway inflammation and IgE mediated airway hyper responsiveness and finally causes asthma. In Ayurveda, asthma is well correlated as Tamaka shwasa. In classical texts of Ayurveda like Charaka Samhita and Sushrut Samhita similar etiological factors are described for Shwasa roga, in addition to that dietary factors (Aharaj Nidan) are also mentioned such as Nishpava, Masha, Til tail, Pinyak, Pishti, Aam ksheer etc. which vitiates the Doshas and finally causes Tamaka shwasa. This review article mainly focuses the role of Til tail (Sesamum indicum) in the etiopathogenesis of Tamaka shwasa and also, for better understanding of textual facts and may be used as an effective key to control the mortality and morbidity related to it.

Resource maximization during COVID-19 crunch – A novel graft marking technique to use one cornea for two recipients for either Descemet membrane endothelial keratoplasty or deep anterior lamellar keratoplasty

During pandemic, eye banks worldwide faced drastic reduction of corneal retrieval. Since precut tissues are uncommon in India, the onus is on corneal surgeons to maximize the donor corneal usage. The stumbling block making the stromal part unusable in the graft preparation of the Descemet membrane endothelial Keratoplasty is the stromal window creation to place the orientation mark on the stromal side of the folded graft. To overcome this, we simply marked directly on the folded Descemet graft, after partly stripping it from the donor cornea. Then, we unfolded, punched, and created two grafts after completely stripping it, retaining the Descemet part for the endothelial Keratoplasty and the stromal part for lamellar Keratoplasty. Initially, we used a special F marker, and later we marked an L using just a spatula. This simple technique needing no extra donor tissue or instrumentation maximizes the tissue utility with proper patient selection.

Abdominal and thoracic wall closure: damage control surgery's cinderella / El cierre de la pared abdominal y torácica: La cenicienta en la cirugía control de daños

Abstract Damage control surgery principles allow delayed management of traumatic lesions and early metabolic resuscitation by performing abbreviated procedures and prompt resuscitation maneuvers in severely injured trauma patients. However, the initial physiological response to trauma and surgery, along with the hemostatic resuscitation efforts, causes important side effects on intracavitary organs such as tissue edema, increased cavity pressure, and hemodynamic collapse. Consequently, different techniques have been developed over the years for a delayed cavity closure. Nonetheless, the optimal management of abdominal and thoracic surgical closure remains controversial. This article aims to describe the indications and surgical techniques for delayed abdominal or thoracic closure following damage control surgery in severely injured trauma patients, based on the experience obtained by the Trauma and Emergency Surgery Group (CTE) of Cali, Colombia. We recommend negative pressure dressing as the gold standard technique for delayed cavity closure, associated with higher wall closure success rates and lower complication and mortality rates.

Heart Rate Variability and Its Ability to Detect Worsening Suicidality in Adolescents: A Pilot Trial of Wearable Technology

Objective@#Suicide is the 2nd leading cause of death in adolescence, and acute pediatric mental health emergency department (ED) visits have doubled in the past decade. The objective of this study was to evaluate physiologic parameters relationship to suicide severity. @*Methods@#This was a prospective, observational study from April 2018 thru November 2019 in a tertiary care pediatric emergency department (ED) and inpatient pediatric psychiatric unit enrolling acutely suicidal adolescent patients. Patients wore a wrist device that used photoplethysmography for 7 days during their acute hospitalization to measure heart rate variability (HRV). During that time, Columbia Suicide Severity Scores (CSSRS) were assessed at 3 time points. @*Results@#There was complete device data and follow-up for 51 patients. There was an increase in the high frequency (HF) component of HRV in patients that had a 25% or greater decrease in their CSSRS (mean difference 11.89 ms/ Hz ; p-value 0.005). Patients with a CSSRS≥15 on day of enrollment had a lower, although not statistically significant, HF component (mean difference -8.34 ms/ Hz; p-value 0.071). @*Conclusion@#We found an inverse correlation between parasympathetic activity measured through the HF component and suicidality in an acutely suicidal population of adolescents. Wearable technology may have the ability to improve outpatient monitoring for earlier detection and intervention.

Neuropathic Pain after Adolescent Idiopathic Scoliosis Correction Surgery

Methods@#Forty AIS patients were recruited. Demographic, preoperative, and postoperative data were recorded. The magnitude and characteristics of postoperative pain were assessed using the painDETECT questionnaire through telephone enquiries at intervals of 2, 6, 12, and 24 weeks. Statistical analyses were followed by Pearson correlation test to determine the relationship between pain scores at 6, 12, and 24 weeks with the risk factors. @*Results@#Based on the painDETECT questionnaire, 90% of the patients had nociceptive pain, and 10% had a possible neuropathic pain component at 2 weeks postoperatively as per a mean painDETECT score of 7.1±4.5. Assessments at 6, 12, and 24 weeks showed that no patients had neuropathic pain with painDETECT scores of 4.4±3.2, 2.9±2.9, and 1.5±2.0, respectively. There was a significant correlation between total postoperative morphine use during 48 hours after the surgery and a tendency to develop neuropathic pain (p=0.022). @*Conclusions@#Chronic neuropathic pain was uncommon in AIS patients who had undergone PSF surgery. Higher opioid consumption will increase the possibility of developing chronic neuropathic pain.

Medical students’ pattern of self-directed learning prior to and during the coronavirus disease 2019 pandemic period and its implications for Free Open Access Meducation within the United Kingdom / 보건의료교육평가

Purpose@#Self-directed learning (SDL) has been increasingly emphasized within medical education. However, little is known about the SDL resources medical students use. This study aimed to identify patterns in medical students’ SDL behaviors, their SDL resource choices, factors motivating these choices, and the potential impact of the coronavirus disease 2019 (COVID-19) pandemic on these variables. @*Methods@#An online cross-sectional survey comprising multiple-choice, ranked, and free-text response questions were disseminated to medical students across all 41 UK medical schools between April and July 2020. Independent study hours and sources of study materials prior to and during the COVID-19 pandemic were compared. Motivational factors guiding resource choices and awareness of Free Open Access Meducation were also investigated. @*Results@#The target sample was 75 students per medical school across a total of 41 medical schools within the United Kingdom (3,075 total students), and 1,564 responses were analyzed. University-provided information comprised the most commonly used component of independent study time, but a minority of total independent study time. Independent study time increased as a result of the COVID-19 pandemic (P<0.001). All sub-cohorts except males reported a significant increase in the use of resources such as free websites and question banks (P<0.05) and paid websites (P<0.05) as a result of the pandemic. Accessibility was the most influential factor guiding resource choice (Friedman’s μrank=3.97, P<0.001). @*Conclusion@#The use of learning resources independent of university provision is increasing. Educators must ensure equitable access to such materials while supporting students in making informed choices regarding their independent study behaviors.

Medical students’ pattern of self-directed learning prior to and during the coronavirus disease 2019 pandemic period and its implications for Free Open Access Meducation within the United Kingdom / 보건의료교육평가

Purpose@#Self-directed learning (SDL) has been increasingly emphasized within medical education. However, little is known about the SDL resources medical students use. This study aimed to identify patterns in medical students’ SDL behaviors, their SDL resource choices, factors motivating these choices, and the potential impact of the coronavirus disease 2019 (COVID-19) pandemic on these variables. @*Methods@#An online cross-sectional survey comprising multiple-choice, ranked, and free-text response questions were disseminated to medical students across all 41 UK medical schools between April and July 2020. Independent study hours and sources of study materials prior to and during the COVID-19 pandemic were compared. Motivational factors guiding resource choices and awareness of Free Open Access Meducation were also investigated. @*Results@#The target sample was 75 students per medical school across a total of 41 medical schools within the United Kingdom (3,075 total students), and 1,564 responses were analyzed. University-provided information comprised the most commonly used component of independent study time, but a minority of total independent study time. Independent study time increased as a result of the COVID-19 pandemic (P<0.001). All sub-cohorts except males reported a significant increase in the use of resources such as free websites and question banks (P<0.05) and paid websites (P<0.05) as a result of the pandemic. Accessibility was the most influential factor guiding resource choice (Friedman’s μrank=3.97, P<0.001). @*Conclusion@#The use of learning resources independent of university provision is increasing. Educators must ensure equitable access to such materials while supporting students in making informed choices regarding their independent study behaviors.

Comparative Effectiveness of Laterally Placed Expandable versus Static Interbody Spacers: A 1-Year Follow-Up Radiographic and Clinical Outcomes Study

Methods@#This is an Institutional Review Board-exempt review of 69 patients (static, n=32; expandable, n=37) diagnosed with DDD who underwent MIS-LLIF at 1–2 contiguous level(s) using static or expandable spacers. Radiographic and clinical outcomes were collected and compared at pre- and postoperative time points up to 12 months. @*Results@#The expandable group had a significantly higher mean change in Visual Analog Scale (VAS) scores at 6 weeks, 6 months, and 12 months vs. static (∆VAS at 12 months: expandable, 6.7±1.3; static, 5.1±2.6). Mean improvement of Oswestry Disability Index (ODI) scores at 3, 6, and 12 months were significantly better for the expandable group vs. static (∆ODI at 12 months: expandable, 63.2±13.2; static, 29.8±23.4). Mean DH and NH significantly increased at final follow-up for both groups, with no significant difference in DH improvement between groups. The expandable mean NH improvement at 6 weeks and 6 months was significantly greater vs. static. Segmental lordosis significantly improved in the expandable group at all time intervals vs static. Subsidence rate at 12 months was significantly lower in the expandable group (1/46, 2.2%) vs. static (12/37, 32.4%). @*Conclusions@#Expandable spacers resulted in a significantly lower subsidence rate, improve segmental lordosis, and VAS and ODI outcomes at 12 months vs. static.

Eufemismos numéricos y conceptuales del paro español: cifras, fuentes y perfiles formativos / Eufemismos numéricos e conceptuais do desemprego espanhol: números, fontes e perfis formativos / Numerical and conceptual euphemisms for Spanish unemployment: numbers, sources and training profiles

España se enfrenta a una alta cifra de desempleo que aún no ha recuperado los valores previos a la crisis económica. Sin embargo, las cifras no muestran todo el entramado de precariedad laboral que afecta a la sociedad española. Este trabajo parte de la concreción de la terminología usada en la medición del paro para estudiar la realidad referida al desempleo y a la precariedad laboral a través del análisis de estadísticas oficiales, descubriendo vacíos de información y silencios que suavizan los datos. Como estrategia metodológica se utiliza el análisis secundario de los informes de empleo de las fuentes oficiales españolas. Los resultados muestran cómo las diferentes conceptualizaciones intervienen en las cifras oficiales. Se ofrecen pistas para una interpretación más cercana a la realidad y se aterriza en la concreción del perfil formativo de la población desempleada. Se concluye que las cifras oficiales no reflejan con exactitud la vulnerabilidad social, obviando parte de la población en situación de riesgo, y que la formación ayuda, pero no es suficiente para ofrecer una respuesta absoluta al desempleo.

A Espanha enfrenta uma alta taxa de desemprego e ainda não recuperou os patamares prévios à crise econômica. Não obstante, os números não mostram a trama de precariedade laboral que afeta a sociedade. O presente estudo parte da concretização da terminologia usada na medição do desemprego, para estudar a realidade referida ao desemprego e à precariedade laboral por meio da análise de estatísticas oficiais, descobrindo lacunas de informação e silêncios que suavizam os dados. Como estratégia metodológica é utilizada a análise secundária dos informes de emprego das fontes oficiais espanholas. Os resultados mostram como as diferentes conceptualizações intervêm nos números oficiais. Oferecem-se pistas para uma interpretação mais próxima no que se refere ao perfil formativo da população desempregada. Conclui-se que os números oficiais não refletem a vulnerabilidade social, ignorando parte da população em risco, e que a formação ajuda, mas não é suficiente para oferecer uma resposta absoluta ao desemprego.

Spain deals with a high unemployment rate that has not yet recovered the values prior to the economic crisis. However, this does not show the grid of job insecurity that affects society. This study starts from the conciseness of the terminology used to quantify unemployment, to study the reality regarding unemployment and job insecurity through an analysis of official statistics given the lack of information and silence that obscure the data. As a methodological strategy, the secondary analysis of unemployment reports provided by Spanish official sources is used. Results show how different conceptualizations affect official figures. Clues are offered for a closer interpretation of reality grounded on the conciseness of a training profile of the unemployed people. It is concluded that official figures do not accurately represent social vulnerability, ignoring part of the population at risk, and that, although training does help, it is not enough to offer a comprehensive response to unemployment.

Whole blood for blood loss: hemostatic resuscitation in damage control / Sangre total: la nueva alternativa en la resucitación hemostática

Abstract Hemorrhagic shock and its complications are a major cause of death among trauma patients. The management of hemorrhagic shock using a damage control resuscitation strategy has been shown to decrease mortality and improve patient outcomes. One of the components of damage control resuscitation is hemostatic resuscitation, which involves the replacement of lost blood volume with components such as packed red blood cells, fresh frozen plasma, cryoprecipitate, and platelets in a 1:1:1:1 ratio. However, this is a strategy that is not applicable in many parts of Latin America and other low-and-middle-income countries throughout the world, where there is a lack of well-equipped blood banks and an insufficient availability of blood products. To overcome these barriers, we propose the use of cold fresh whole blood for hemostatic resuscitation in exsanguinating patients. Over 6 years of experience in Ecuador has shown that resuscitation with cold fresh whole blood has similar outcomes and a similar safety profile compared to resuscitation with hemocomponents. Whole blood confers many advantages over component therapy including, but not limited to the transfusion of blood with a physiologic ratio of components, ease of transport and transfusion, less volume of anticoagulants and additives transfused to the patient, and exposure to fewer donors. Whole blood is a tool with reemerging potential that can be implemented in civilian trauma centers with optimal results and less technical demand.

Resumen El choque hemorrágico y sus complicaciones son la principal causa de muerte en los pacientes con trauma. La resucitación en control de daños ha demostrado una disminución en la mortalidad y mejoría en el manejo del paciente. La resucitación hemostática consiste en la recuperación del volumen con hemoderivados como glóbulos rojos, plasma, crioprecipitado y plaquetas, en proporciones de 1:1:1:1. Sin embargo, esta demanda de hemo componentes podría no aplicarse para toda Latinoamérica u otros países de medianos y bajos ingresos. Las principales barreras para la implementación de esta estrategia serían la escasa disponibilidad de bancos de sangre y de hemoderivados insuficientes para contar con un protocolo de transfusión masiva. Una propuesta para superar estas barreras es el uso de sangre total fresca fría para la resucitación hemostática de los pacientes exsanguinados. Ecuador ha sido pionero en la implementación de esta estrategia con una experiencia ya de seis años, en que han demostrado que la sangre total tiene ventajas sobre la terapia de hemo componentes incluyendo, pero no limitando, la trasfusión de sangre con una razón fisiológica de componentes, fácil transporte y transfusión, menor volumen de anticoagulantes y aditivos trasfundidos al paciente, y menor exposición a donantes. La sangre total es una herramienta con un potencial reemergente que puede ser implementado en centros de trauma civil con óptimos resultados y menor demanda técnica.

Predicting Exertion from Metabolic, Physiological and Cognitive Variables in Older Adults / Predicción del esfuerzo con variables metabólicas, fisiológicas y cognitivas en adultos mayores / Predição do esforço com variáveis metabólicas, fisiológicas e congênitas em idosos

Abstract Objective. To determine the association between perceived exertion (RPE) and physiological variables and to determine the predictive factors of RPE during submaximal and maximal exertion in older adults. Method. Older adults from Kansas (n = 100) and Costa Rica (n = 79) performed a submaximal and maximal stress test. RPE, education level and a total score of cognitive function (CFTS) were collected. Correlation and multiple regression analyses were computed using RPE as the criterion variable and oxygen consumption (VO2), respiratory exchange ratio (RER), CFTS and education level as predictors. Results. There was a significant correlation between VEP and RER (r = 0.22, p = 0.029) at maximal exertion. The RPE predictors for women were VO2, RER, and CFTS at different stages of the test. For men, VEP was predicted by RER, education level, and VO2 at different stages. Conclusion. Metabolic and physiological variables predicted RPE in older adults. Age, cognition, and heart rate were unrelated to RPE at maximal exertion, and RER predicted RPE scores during submaximal and maximal exertion.

Resumen Objetivo. Determinar la asociación entre el esfuerzo percibido (VEP) y variables fisiológicas y determinar los factores predictivos de VEP durante el esfuerzo submáximo y máximo en adultos mayores. Método. Adultos mayores de Kansas (n = 100) y Costa Rica (n = 79) realizaron una prueba de esfuerzo submáxima y máxima. Se recopiló la VEP, nivel de educación y una puntuación total de la función cognitiva (PTFC). Se usaron análisis de correlación y regresión múltiple utilizando VEP como variable criterio y el consumo de oxígeno (VO2), tasa de intercambio respiratorio (RER), PTFC y nivel de educación como predictores. Resultados. Se encontró una correlación significativa entre la VEP y la RER (r = 0.22, p = 0.029) en el esfuerzo máximo. Los predictores de VEP para las mujeres fueron VO2, RER y PTFC en diferentes etapas de la prueba. Para los hombres, la VEP fue predicha por RER, nivel de educación y VO2 en diferentes etapas. Conclusión. Las variables metabólicas y fisiológicas predijeron los valores de VEP en adultos mayores. La edad, la cognición y la FC no se relacionaron con la VEP en el esfuerzo máximo y la RER predijo las puntuaciones de la VEP durante el esfuerzo submáximo y máximo.

Resumo Escopo. Determinar a associação entre o esforço percebido (VEP) e as variáveis fisiológicas e determinar os fatores preditivos de VEP durante o esforço submáximo e máximo em idosos. Metodologia. Idosos de Kansas (n= 100) e Costa Rica (n= 79) realizaram uma prova de esforço submáxima e máxima. Foi recopilada o VEP, nível de educação e pontuação total da função cognitiva (PTFCO. Foram usadas análises de correlação e regressão múltipla utilizando VEP como variável critério e o consumo de oxigeno (VO2), taxa de intercambio respiratório (RER), PTFC e nível de educação como preditores. Resultados. Foi encontrada uma correlação significativa entre a VEP e a RER (r = 0.22, p = 0.029)) no esforço máximo. Os preditores de VEP para as mulheres foram VO2, RER e PTFC em diferentes etapas da prova. Para os homens, a VEP foi predita por RER, nível de educação e VO2 em diferentes etapas. Conclusão. As variáveis metabólicas e fisiológicas predisseram os valores de VEP em idosos. A idade, a cognição e a FC não estiveram relacionadas com a VEP no esforço máximo e a RER predizia as pontuações da VEP durante o esforço submáximo e máximo.

A safer endovascular technique for pre-operative embolization of juvenile nasopharyngeal angiofibroma: avoiding the pitfalls of external carotid artery – internal carotid artery anastomoses

Intra-arterial embolization of juvenile nasopharyngeal angiofibroma (JNA) prior to surgical resection is the preferred approach to minimize blood loss during surgical resection of the tumor. However, the presence of external carotid artery–internal carotid artery (ECA-ICA) anastomoses may hinder complete tumor embolization due to the associated risk for embolic complications. Here, we evaluate the use of a balloon-assisted embolization (BAE) technique in the treatment of JNA. We conducted a retrospective review of JNA patients who underwent tumor embolization with injection of Onyx in a single session between 2013-2018. All cases displayed tumor arterial supply from ECA and ICA circulations on 2-D catheter angiograms. Procedural and surgical outcome data were analyzed. Results are given as mean±- standard deviation (range). Among 9 patients with JNA, all were males and mean age was 14.1±6.3 years (range, 9-29 years). The mean tumor volume embolization was 84.4±12.4% (range, 60-100%) and in 89% patients ≥80% of tumor volume embolization was achieved. There were no embolization-related complications reported. During surgical resection of the tumor there was a low average surgical blood loss of 722±651.5 mL (range, 50-2,000 mL) and the mean procedure time was 282.6±85.4 mins (range, 151-403 mins). In this series, the BAE technique showed to be a safe and effective approach to achieve successful tumor embolization while avoiding embolic complications and effectively reducing the risk for blood loss during surgical resection.

Heart Rate Variability Analysis: How Much Artifact Can We Remove?

Objective@#Heart rate variability (HRV) evaluates small beat-to-beat time interval (BBI) differences produced by the heart and suggested as a marker of the autonomic nervous system. Artifact produced by movement with wrist worn devices can significantly impact the validity of HRV analysis. The objective of this study was to determine the impact of small errors in BBI selection on HRV analysis and produce a foundation for future research in mental health wearable technology. @*Methods@#This was a sub-analysis from a prospective observational clinical trial registered with clinicaltrials.gov (NCT03030924). A cohort of 10 subject’s HRV tracings from a wearable wrist monitor without any artifact were manipulated by the study team to represent the most common forms of artifact encountered. @*Results@#Root mean square of successive differences stayed below a clinically significant change when up to 5 beats were selected at the wrong time interval and up to 36% of BBIs was removed. Standard deviation of next normal intervals stayed below a clinically significant change when up to 3 beats were selected at the wrong time interval and up to 36% of BBIs were removed. High frequency HRV shows significant changes when more than 2 beats were selected at the wrong time interval and any BBIs were removed. @*Conclusion@#Time domain HRV metrics appear to be more robust to artifact compared to frequency domains. Investigators examining wearable technology for mental health should be aware of these values for future analysis of HRV studies to improve data quality.

Elevated Neutrophil to Lymphocyte Ratio in Older Adults with Cocaine Use Disorder as a Marker of Chronic Inflammation

Objective@#The neutrophil to lymphocyte ratio (NLR) is a non-specific, easy-to-obtain marker of inflammation associated with morbidity and mortality in systemic, psychiatric, and age-related inflammatory conditions. Given the growing trend of substance use disorder (SUD) in older adults, and the relationship between inflammation and SUD elevated NLR may serve as a useful inflammatory biomarker of the combined burden of aging and SUD. The present study focused on cocaine use disorder (CUD) to examine if cocaine adds further inflammatory burden among older adults, by comparing NLR values between older adults with CUD and a non-cocaine using, aged-matched, nationally representative sample. @*Methods@#The dataset included 107 (86% male) participants (aged 50−65 years) with cocaine use disorder. NLR was derived from complete blood count tests by dividing the absolute value of peripheral neutrophil concentration by lymphocyte concentration. For comparison, we extracted data from age-matched adults without CUD using the National Health and Nutrition Examination Survey. Individuals with immunocompromising conditions were excluded (e.g., rheumatoid arthritis and sexually transmitted infections such as HIV). A doubly-robust inverse probability-weighted regression adjustment (IPWRA) propensity score method was used to estimate group differences on NLR while controlling for potential confounding variables (age, gender, race, income, nicotine, marijuana and alcohol use). @*Results@#The IPWRA model revealed that the CUD sample had significantly elevated NLR in comparison to non-cocaine users, with a moderate effect size ( weight = 0.67). @*Conclusion@#Although non-specific, NLR represents a readily obtainable inflammatory marker for SUD research. CUD may add further inflammatory burden to aging cocaine users.

Study of incidence of premature ovarian failure in patient attending outpatient department for infertility in a tertiary care centre

Background: To assess the incidence of premature ovarian failure in cases attending infertility outpatient Department of Obstetrics and Gynecology in a tertiary care centre. A total of 350 patients attending infertility opd were screened over period of 150 days from which authors observed premature menopause in 10 cases accounting for an incidence of 2.8%. POF affects approximately one in 10,000 women by age 20; one in 1,000 women by age 30; one in 100 women by age 40.  Premature ovarian failure is a common cause of infertility in women.Methods: Patient attending outpatient Department of Obstetrics and Gynecology with age less than 40 years and infertility, symptoms of menopause were enrolled for the study for duration of 150 days.Results: Present study authors found a total of 2.8% of patient presenting in our outpatient department for infertility had Premature ovarian failure.80% of them were symptomatic suffering with symptoms of hormonal deficiencies .100% of patient with infertility diagnosed as premature ovarian failure had low AMH and High FSH and LH levels indicating poor prognosis.Conclusions: Patient presenting with infertility and amenorrhoea can be cases of premature menopause. Here it is essential to investigate and treat the patient. Infertility might be one of the early presenting symptoms if not the first one. These patients if treated and diagnosed early can have a better living. Considering the wide spectrum of functional derangements in patient with early menopause and benefits of early hormone replacements these patients should be diagnosed and treated early.

An In-vitro Evaluation of Auto Apical Reverse Motion of Tri Auto ZX at Working Length Determined by Dentaport Root ZX

Objective: To evaluate the auto apical reverse motion of Tri Auto ZX at working length determined by Dentaport Root ZX. Study design: Cross-sectional design. Place and duration of study: Department of Operative Dentistry, Islamic International Dental College, and the duration of study was 6 months. Materials and methods: Total 72 extracted teeth were used in the present study and standard access cavities were prepared in all the teeth. For in vitro working of Dentaport Root ZX and Tri Auto ZX an apparatus was designed which used normal saline as the conducting medium to ensure free movement of ions between electrodes of electronic apex locator (EAL). Working length was measured electronically using Dentaport Root ZX and noted as Electronic length (EL). The canals were then prepared using Protpaer files till F2 using Tri Auto ZX and the length at which it starts auto apical revere motion (AAR) was noted as AAR. Results: EL showed a mean of 14.69 ± 1.137 mm and SD of 1.137. Measurement at which Tri Auto ZX started its AAR motion showed that the minimum length of canal was 12.5 mm and maximum length was 17.5 mm with a mean of 14.687 ± 1.089 and SD of 1.087. The difference of root canal length measurements taken by EL and AAR motion of Tri Auto ZX showed a minimum difference of -1.5 mm and a maximum of 1 mm with mean difference of -0.014 ± 0.4819 mm. Out of 72 extracted teeth that were used in the present study the difference between EL and AAR was insignificant (p<0.05). Conclusion: In this study it was also established that not only Root ZX is capable of correct determination of the working length but its canal preparation module i.e. Tri Auto ZX is also capable of preparing the canal at the length determined by Root ZX.