An Unexpected GIST Causing Life-Threatening Bleeding after an Elective Hernia Repair.

Background Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the alimentary tract. They are usually manifested by GI bleeding. Case Presentation A 53-year-old male patient was admitted to the hospital for elective inguinal hernia repair. The patient did not have any history of GI symptoms in the past. A day after open inguinal hernia repair, the patient developed recurrent attacks of hematemesis resulting in hemodynamic instability and admission to the intensive care unit. An upper GI endoscopy identified a small bleeding gastric lesion. After multiple failed attempts to control the bleeding endoscopically, an emergency exploratory laparotomy was performed. An unexpected large fungating bleeding gastric mass was detected. The mass measured approximately 40 × 30 cm, and multiple peritoneal deposits were also discovered. A wedge resection of the anterior gastric wall along with the mass was performed. Histopathology revealed a high-grade (G2) GIST. Discussion GISTs appear in variable sizes and may lead to a variety of complications including abdominal pain, GI obstruction, and bleeding. This case highlights the unexpected presentation and sudden bleeding of a large GIST in a totally asymptomatic patient undergoing elective hernia surgery. It also illustrates that GIST can be asymptomatic and grow to large sizes before developing clinical manifestations. Conclusion The case report highlights a common complication of GIST with unexpected timing, immediately after routine hernia surgery.

Congenital absence of the cystic duct: Case report of a rare anomaly and review of the literature.

INTRODUCTION AND IMPORTANCE: Congenital absence of the cystic duct is one of the rare types of anomalies associated with the extrahepatic biliary tract (EHBT). It is often an incidental finding intraoperatively leading to significant implications during the perioperative period. CASE PRESENTATION: A 25-year-old lady was admitted for an elective laparoscopic cholecystectomy indicated for recurrent symptoms of right upper quadrant pain with evidence of cholelithiasis on ultrasound. During laparoscopy, the cystic duct could not be identified. After retrieval of the gallbladder, a blind ending orifice resembling an obliterated cystic duct was discovered. CLINICAL DISCUSSION: Absence of the cystic duct can result from a congenital or an acquired process. In both cases, they are difficult to diagnose pre-operatively even though magnetic resonance cholangiopancreatography (MRCP) has shown great potential in delineating the EHBT. It confers an increased risk of injury to the surrounding biliary tract during cholecystectomy. Therefore, the surgical approach depends on the surgeon's operative competency and knowledge related to EHBT anomalies. CONCLUSION: Definitive treatment for patients with symptomatic absent cystic duct is an open cholecystectomy, given its increased likelihood of iatrogenic morbidity. Nonetheless, it is important to highlight that laparoscopic cholecystectomy may be performed if the surgeon carries sufficient skills.

Religious Fasting of Muslim Patients After Metabolic and Bariatric Surgery: a Modified Delphi Consensus.

BACKGROUND: Fasting during Ramadan is one of the five pillars of the Muslim faith. Despite the positive effects of fasting on health, there are no guidelines or clear recommendations regarding fasting after metabolic/bariatric surgery (MBS). The current study reports the result of a modified Delphi consensus among expert metabolic/bariatric surgeons with experience in managing patients who fast after MBS. METHODS: A committee of 61 well-known metabolic and bariatric surgeons from 24 countries was created to participate in the Delphi consensus. The committee voted on 45 statements regarding recommendations and controversies around fasting after MBS. An agreement/disagreement ≥ of 70.0% was regarded as consensus. RESULTS: The experts reached a consensus on 40 out of 45 statements after two rounds of voting. One hundred percent of the experts believed that fasting needs special nutritional support in patients who underwent MBS. The decision regarding fasting must be coordinated among the surgeon, the nutritionist and the patient. At any time after MBS, 96.7% advised stopping fasting in the presence of persistent symptoms of intolerance. Seventy percent of the experts recommended delaying fasting after MBS for 6 to 12 months after combined and malabsorptive procedures according to the patient's situation and surgeon's experience, and 90.1% felt that proton pump inhibitors should be continued in patients who start fasting less than 6 months after MBS. There was consensus that fasting may help in weight loss, improvement/remission of non-alcoholic fatty liver disease, dyslipidemia, hypertension and type 2 diabetes mellitus among 88.5%, 90.2%, 88.5%, 85.2% and 85.2% of experts, respectively. CONCLUSION: Experts voted and reached a consensus on 40 statements covering various aspects of fasting after MBS.

Radiologists versus Deep Convolutional Neural Networks: A Comparative Study for Diagnosing COVID-19.

The reverse transcriptase polymerase chain reaction (RT-PCR) is still the routinely used test for the diagnosis of SARS-CoV-2 (COVID-19). However, according to several reports, RT-PCR showed a low sensitivity and multiple tests may be required to rule out false negative results. Recently, chest computed tomography (CT) has been an efficient tool to diagnose COVID-19 as it is directly affecting the lungs. In this paper, we investigate the application of pre-trained models in diagnosing patients who are positive for COVID-19 and differentiating it from normal patients, who tested negative for coronavirus. The study aims to compare the generalization capabilities of deep learning models with two thoracic radiologists in diagnosing COVID-19 chest CT images. A dataset of 3000 images was obtained from the Near East Hospital, Cyprus, and used to train and to test the three employed pre-trained models. In a test set of 250 images used to evaluate the deep neural networks and the radiologists, it was found that deep networks (ResNet-18, ResNet-50, and DenseNet-201) can outperform the radiologists in terms of higher accuracy (97.8%), sensitivity (98.1%), specificity (97.3%), precision (98.4%), and F1-score (198.25%), in classifying COVID-19 images.

An online survey and review about the awareness, coping style, and exercise behavior during the "COVID-19 pandemic situation" by implementing the cloud-based medical treatment technology system in China among the public.

To examine basic COVID-19 knowledge, coping style and exercise behavior among the public including government-provided medical cloud system treatment app based on the internet during the outbreak. Besides, to provide references for developing targeted strategies and measures on prevention and control of COVID-19. We conducted an online survey from 11th to 15th March 2020 via WeChat App using a designed questionnaire. As well as aim to diagnose COVID-19 earlier and to improve its treatment by applying medical technology, the "COVID-19 Intelligent Diagnosis and Treatment Assistant Program (nCapp)" based on the Internet of Things. Valid information was collected from 1893 responders (47.07% males and 52.93% females aged 18-80 years, with a mean age of 31.05 ± 9.86) in 20 provincial-level regions across China. From the responders, 92.90% and 34.81% were scaled pass and good and above scores for the knowledge about the novel coronavirus epidemic. 38.44% were scaled poor scores and only 5.40% were scaled good and above scores for appropriate behavior coping with the pandemic. Among the responders, 52.14% reported having active physical exercise in various places during the previous 1 week. For all the responders, appropriate behavior coping correlated positively with physical exercise (p < 0.05); the daily consumed time for getting the epidemic-related information correlated positively with the score for cognition on the epidemic's prevention measures (r = 0.111, p < 0.01) and on general knowledge about the epidemic (r = 0.087, p < 0.01). Targeted and multiple measures for guidance on the control of COVID-19 among the public should be promoted to improve the cognition on basic knowledge, behaviors and treatment.

HR practices and turnover intention; the mediating role of organizational commitment in Tehran: a cross-sectional study.

Background: Employees are increasingly being recognised as a valuable source of information, especially in knowledge-based businesses. Businesses, however, suffer financial and organisational memory losses related to re-hiring and training new staff, and lost productivity and intellectual property because of employee turnover. Hence, employee turnover should be considered an essential part of human resource management. Furthermore, employees' trust in management and human resource (HR) practices substantially impact organisational commitment (OC). Thus, anticipating employee commitment and turnover intentions is crucial, as people are the sole source for knowledge-based firms to maintain their competitive advantage. In the context of selected Tehran Renewable Energy (RE) firms, this study investigated the mediating impact of OC on the relationship between HR practices (recruitment and selection; training and development opportunities; performance appraisal and evaluation; teamwork; compensation and pay; and job security) and employee turnover intention. Methods: This is a cross-sectional study in Tehran that involved 90 experts and knowledgeable employees from four of Tehran's top RE businesses. A questionnaire was distributed to collect data which was later analysed with correlation, regression and bootstrapping analyses. Results: All six dimensions of HR practices were discovered to have an indirect impact on turnover intention and a direct impact on OC. OC among employees has an indirect effect on turnover intention. It was also revealed that the training and development opportunity has the most considerable effect on OC and turnover intention. OC was not found as a mediator between HR practices and turnover intention. Conclusions: The outcomes of this study showed that both training and development opportunities; and pay and compensation structure were found to be two significant components of HR practices in the relationship with OC. RE managers should employ appropriate HR strategies, particularly in these two dimensions, to improve an individual's degree of OC and reduce turnover intention.

Enterocutaneous fistula occurring 10 years after an open umbilical hernia repair with placement of an onlay polypropylene mesh: A case report.

INTRODUCTION: Ventral hernia repair is a common surgical procedure performed within the specialty of general surgery. Short and long term complications can arise after this procedure. Although rare, an enterocutaneous fistula may occur, leading to a significant morbidity and the possible need for surgical intervention. PRESENTATION OF CASE: We present a rare case of a 76 years old female, who presented with the sudden occurrence of an enterocutaneous fistula arising ten years after a primary umbilical hernia repair with placement of a polypropylene onlay mesh. She was also found to have a large recurrent umbilical hernia. She underwent a laparotomy with the identification of a mesh eroding into the small bowel lumen, causing an enterocutaneous fistula. An enterectomy was performed to remove the fistula with the mesh, and a small bowel anastomosis was created. DISCUSSION: Ventral hernia recurrence is associated with risk factors including old age, obesity, wound infection as well as the type and location of the mesh used. As in this case, enterocutaneous fistula after hernia repair can occur due to multiple factors including mesh migration and erosion into near-by structures including bowel. These risk factors can perhaps be modified to possibly reduce the incidence of complications like an enterocutaneous fistula. CONCLUSION: The case highlights a rare but serious complication associated with a ventral hernia repair. It also addresses key aspects with regards to the possible mechanisms involved in the occurrence of an enterocutaneous fistula following a hernia repair with the use of a synthetic mesh.

Deep Convolutional Neural Networks for Chest Diseases Detection.

Chest diseases are very serious health problems in the life of people. These diseases include chronic obstructive pulmonary disease, pneumonia, asthma, tuberculosis, and lung diseases. The timely diagnosis of chest diseases is very important. Many methods have been developed for this purpose. In this paper, we demonstrate the feasibility of classifying the chest pathologies in chest X-rays using conventional and deep learning approaches. In the paper, convolutional neural networks (CNNs) are presented for the diagnosis of chest diseases. The architecture of CNN and its design principle are presented. For comparative purpose, backpropagation neural networks (BPNNs) with supervised learning, competitive neural networks (CpNNs) with unsupervised learning are also constructed for diagnosis chest diseases. All the considered networks CNN, BPNN, and CpNN are trained and tested on the same chest X-ray database, and the performance of each network is discussed. Comparative results in terms of accuracy, error rate, and training time between the networks are presented.