Background: We previously described harms experienced by clinicians and scientists after they published accounts of adverse drug reactions. We now report on threats and intimidation leveled against these individuals. Methods: Data were from governmental hearings or agencies, universities, university-affiliated associations, media, and journals. Content and timing of threats and intimidation were evaluated. Findings: Twenty-six individuals reported 27 findings contrary to corporate interests, and were targets of threats and intimidation from corporate employees (23 individuals), university employers (11 individuals), and regulatory personnel (4 individuals). Actions occurred after individuals communicated with pharmaceutical employees (14 threats/intimidations), presented at government/ regulatory agency hearings (4 actions), published their findings (4 actions), presented at conferences (3 actions), had news media interviews (2 actions), or communicated with regulatory agency personnel (2 actions), a research ethics board (1 action), or journal editors (1 action). Threats began within weeks of the initial communication of findings. Scientists’ and clinicians’ stated reasons for communicating findings included concerns over: drug safety (21 individuals), drug efficacy (3 individuals), and data integrity (2 individuals). Communications resulted in drug or device withdrawals (14) andblack box warnings (7). At two institutions (12.5%), department chairs supported clinicians over corporate executives. Fourteen individuals experienced harms, including loss of academic positions.
Charles L Bennett MD, PhD, MPP is a professor in the Clinical Pharmacy and Outcome Science Department at the University of South Carolina – College of Pharmacy. Additionally, he is a hematologist and oncologist with a research focus in adverse drug reactions and drug safety. He serves as the Frank P and Josie M Fletcher Endowed Chair of the Medication Safety and Efficacy Center of Economic Excellence, with the primary objective of making drug information easier to understand by the consumer and decreasing the prevalence of adverse drug events. He promotes drug safety and medical integrity within healthcare system
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Introduction: Pre-eclampsia is a pregnancy-related syndrome characterized by hypertension and proteinuria that makes its appearance after 20 weeks of gestation. It develops approximately in 2–10% of all pregnancies. Pre-eclampsia, as a severe complication during pregnancy, is a major cause of maternal and perinatal morbidity and mortality. Objectives: The aim of the study was to assess the possibility of utilizing selected microRNAs at the earliest possible stage as safe biomarkers of severe complications of pregnancy, such as pre-eclampsia. State of konowledge: Nowadays, there are many trials aimed at finding effective methods for pre-eclampsia prediction at the early stage of pregnancy, before the onset of clinical signs. Although the precise pathophysiology of pre-eclampsia remains unknown, early prediction of the syndrome would allow the initiation of proper preventive therapy to savethe mother and future child. Current strategies for pre-eclampsia prediction are assessments of combinations of maternal risk factors, ultrasound parameters and different biomarkers (proteins, circulating cell free DNA and microRNAs). Studies of microRNAs in particular offer great potential for diagnosis and therapy in pregnancy-related disorders. The fraction of specific placenta-related circulating microRNAs in the serum of pregnant women who present symptoms of pre-eclampsia after 20 weeks of gestation, and show the strongest changes in the level, can play an important role in the development of placenta-related complications. Conclusions: Further research into the level of microRNAs in the blood serum of pregnant women with pre-eclampsia will allow a practical way of utilizing selected microRNAs at the earliest possible stage as safe biomarkers of severe complications of pregnancy.
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On the past few decades, medical student’s interest in a surgical career has been decreasing. AcademicLeagues are institutions linked to medical school,that are managedby medical students. Simulationis an educational technic based on tasks and reproductionof procedures throughan artificial model. This article reports a practical course on Pediatric Surgery from students to students using simulation based learning. A practicalCourse for 30 students (divided in fivegroups). Groups take turns on each proposed subject matter on pediatricsurgery (acuteabdomen, acutescrotum, bowelobstruction, obstructivejaundiceand abdominal masses). Students received flowcharts on managing each syndrome. Before the course begins, a pretest was given to all students to evaluate performance on the subjects. At the end of the course the same tests were applied as an evaluation of learning for comparison. At the end a course evaluation chart was submitted. 25 students answered the evaluation chart and 21 of the man swered both tests. Pretest grades rangedfrom 0 to 9,2, (4,1 average), post test grades rangedfrom 3,5 to 10 (7,5 average) students’s grades variatedfrom 8% to 77% (34% average). The course was well evaluated by the participants regarding classes, organization, instructors and subject matter. All participants showed positive variationontest grades. Results suggests that simulation based learning helps acquataince with the subject matter. Academic leagues make students to learn with themselves and stimulate teaching, research and extension. We believe that courses like the secan enhance students interest for surgery.
Graduated in medical school at Universidade Federal da Bahia- Brazil in 2017. During graduation, was a co-founder of Pediatric Surgery Academic League (LACIPE) and attended Trauma And Medical Emergency Academic League (LAEME). After graduation, completed General Surgery residency at Hospital das Clínicas da Universidade de São Paulo- Brazil in 2020. Currently, Pediatric Surgery resident at Hospital de Clínicas de Porto Alegre- Brazil.
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Human semen quality is affected by metabolic, lifestyle and environmental factors. The latter may be responsible for low semen quality and for substantial differences in different areas of the same country or region in relation to the environmental pressure conditions of the territories. The aim of this study (Fertilità, Ambiente, Stili di Vita, FASt Study, grant of Italian Ministry of Health) was to evaluate the short-term effects of mediterranean diet and physical activity intervention on semen quality of healthy young men living in three highly polluted areas of Italy (Brescia-Caffaro, Sacco River Valley, Land of Fires).344 healthy young men (18-22 years) were enrolled and after randomization 1:1, 188 were allocated to lifestyle change intervention group (4-month Mediterranean diet pathway and a program of moderate physical activity) and 156 were allocated to control group. The two groups were homogeneous at baseline foranthropometric characteristics and semen parameters. Of the 344 subjects enrolled, 263 subjects (76%) completed the follow-up attending all visits, undergoing examinations and laboratory analyses: 137 in the intervention group and 126 in the control one. The adherence to Mediterranean diet and physical activity level increased more in the intervention than control group from start (t0) to the end (t4) of the study period (t-tests for unpaired data at t4: p<0.0001 and p=0.03, respectively). Sperm concentration, total and progressive motility and proportion of normal morphology cells increased in the intervention but decreased in the control group, with statistically significant differences between the two groups at t4 (p=0.03; p=0.0001; p=0.0003; p=0.002, respectively). Study results showed that an intervention based on Mediterranean diet and regular physical activity determine an improvement of semen quality.To our knowledge, our study is the first Randomized Controlled Trial to evaluate the effects of a dietary and physical activity intervention on semen quality of healthy young men.
Luigi Montano, MD, UroAndrologist, Head of Andrology Unit and Lifestyle Medicinein UroAndrology, Local Health Authority (ASL) Salerno, Coordination Unit of the network for Environmental and Reproductive Health (EcoFoodFertility Project), Italy “Oliveto Citra Hospital”, Salerno, Italy.
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Introduction: Early postnatal hypotension (EPH) has been associated with mortality and long-term neurodisabilities in extremely low-birth-weight (ELBW) infants (birth weight <1000 g). Despite extensive research and multiple therapeutic options, there is no consensus among clinicians on the optimum pharmacological management of this morbidity. Recent evidence has suggested that the adverse outcomes associated with EPH may be attributable to the therapeutic interventions and not to the morbidity per se. The current standard of care of hypotension in ELBW involves a regimen of volume expansion, inotropes, and hydrocortisone, instituted in a sequential and escalating order until the desired improvement in blood pressure is achieved. There is no recent systematic report on the adverse effects of this standard clinical practice. Objective: We investigated the complications associated with the current practice of managing EPH with escalating doses of inotropes (VI) followed by hydrocortisone (HC) given sequentially for refractory hypotension in ELBW neonates. We also evaluated effects of maternal conditions on EPH and its treatment. Methodology: In a retrospective case-control study the complications and adverse outcomes associated with VI (VI) and HC (HCVI) treatments in ELBW neonates were compared with contemporaneous normotensive medication naïve controls (C) via standard univariate and multivariate analyses. Neonatal demographics and clinical characteristics, as well as maternal factors were also compared between the groups. Results: VI (n=74) Vs. C (n=124): Birth weight (BW), gestational age (GA) and receipt of antenatal steroid (ANS) did not differ. The occurrence of gestation associated diabetes mellitus (GDM) and risks for patent ductus arteriosus (PDA), intraventricular-periventricular hemorrhage (IVH), spontaneous intestinal perforation (SIP), ventriculomegaly (VM) and oxygen dependence at 36 postmenstrual week of life (BPD) were higher in VI group. HCVI (n=69) Vs. C: HCVI recipients had lower BW, GA and receipt of ANS. The risks for IVH, BPD, air leaks and PDA were higher in the treated infants. The occurrences of SIP, VM and GDM did not differ while that of maternal hypertension trended to be less in HCIV recipients (p = 0.06). Conclusions: Hypotensive ELBW infants treated with either vasopressor-inotropes or with hydrocortisone-vasopressor-inotropes are susceptible to IVH, BPD and PDA. Those who receive inotropes may be at additional risks for SIP and VM. GDM increases the occurrence of hypotension which responds to VI and does not need HC. Maternal hypertension does not contribute to VI responsive and trends to decreases VI refractory hypotension.
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Introduction: On January 30, 2020, the World Health Organization (WHO) designated the COVID-19 outbreak a "public health emergency of international concern." Several COVID-19 vaccines are now being developed, but little is known regarding public acceptance of the vaccine in low and middle-income nations like Nepal. Objective: This study aimed to determine the prevalence of COVID-19 vaccination acceptance and its factors among Nepalese people. Method: On December 2020, a web-based cross-sectional survey was conducted using a convenience sample technique. A bilingual, self-administered questionnaire was sent to research participants via social media sites and email. Logistic regression analysis (SPSS Version 26.0) was used to model important variables that predict vaccination uptake among respondents. Result: Out of 576 individuals polled, 540 (93.8 percent) said they would accept COVID-19 immunization whenever it became available, with 232 (42.96 percent) wanting to get vaccinated as soon as possible and others (57.04 percent) delaying vaccination until the vaccine's safety was established. Being male, believing the pandemic's effect on income is high or very high, and believing in the efficacy of COVID-19 vaccination or valuing doctor's recommendations all increased the likelihood of accepting COVID-19 vaccination. Conclusion: Nepalese people have a high level of acceptance and belief in COVID-19 immunization (93.8 percent).If the vaccination is given away for free or is covered by health insurance, acceptance jumps to 98.1% according to survey. It was a reflection of the strong demand for the vaccination. To increase vaccination coverage, immunization programs should be structured to eliminate barriers such as vaccine cost and accessibility. The public's concerns regarding vaccination safety can be resolved via health education and communication from authoritative sources.
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The PBD (Permuted Block Design) is the most widely usedrandomization method in clinical trials due to its comparatively simplicity. However, greater selection bias may appear, especiallyin open-labeled trials, because thePBD requires absolute balanceat the end of each block . The BSD(Big Stick Design) method is one of the MTI(Maximum Tolerated Imbalance)procedures, which can make the allocation process more unpredictable while maintaining the advantages the PBD. So it is theoretically superior to the PBD method. However,some practical problems in stratified randomization hinder the application of the BSD method: such as the risk of serious imbalance for entire trials with the increasing of strata, the uncertainty of the reproducibility of randomization schedule, and the danger of greater selection bias in extreme cases.We propose solutions to the above three implementation problems, and explores the feasibility and effects of the solutions through simulations.
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Background: Victims of flame burns invariably inhale smoke which contains potentially toxic gases that may contribute to their morbidity and mortality. The most significant inhalational toxin in many fires is carbon monoxide (CO). This study aimed to assess clinical evidence for possible CO poisoning and measureCarboxyhemoglobin(COHb)levelsonfirecasualtiespresentingtoatertiaryteachingandreferral hospital in Kenya. The gold standard, serum COHb spectrophotometry was unavailable hence pulse CO- oximetry was utilised to measure carboxyhemoglobinsaturation(SpCO). Methodology:Thiswasaprospectivedescriptivestudy.Itwasapprovedbyinstitutionalethicscommittee. Eighty non-pediatric patients presenting with acute (<24 hours) flame burns were recruited and assessed forpotentialCOpoisoning.COHblevelswereassessedbyMasimoSETRRadical57TMpulseCO-oximeter; a device approved by the US Food and Drug Administration (2008) and validated for non invasiveSpCO measurement. Statistical Package for Social Sciences version 21 was used foranalysis. Results:44% of the patients were females and 56% males. Excluding wound pain, common complaints were confusion (28.7%) and headache (26%). Mean total burn surface area (%TBSA) was 30.9% and SpCO was 5.48%. Only 7 patients had SpCO above 10%. Average time lapse between incident to SpCO measurement was 8 hours 50 minutes. Twenty-eight-day mortality was 38.7%. Analysis revealed non- correlation of SpCO with clinical features suggestive of CO poisoning (p=0.183); neither did SpCOcorrelatewithmortality(p=0.708).However,%TBSA(p=0.001),GCS(p=0.001)andoropharyngealinjury (p=0.024) did. Conclusion:SpCO measurements in 9% of the flame burned patients were found to be >10% indicating CO toxicity. However, the majority recorded nontoxic levels of <10% on a background of a relatively longtimelapse.Neitherclinicalsymptomsnormortalitycouldbeascribedtocarbonmonoxideexposure. %TBSA, GCS and oropharyngeal injury correlated significantly with mortality.
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Background: India has ratified with the United Nations Convention on the Rights of Persons with Disabilities and has passed the Rights of People with Disabilities Act in 2016. There is need for training healthcare professionals in disability competencies as people with disabilities are many and marginalized. Disability competencies were introduced in the foundation course of revised competency based medical curriculum for Indian medical graduates by the Medical Council of India [MCI] just prior to the rollout of the programme. We intend describing our center’s experience in implementing the same. Methods: FC 4.5.1 TO 4.5.8 of MCI foundation course guidelines were resource material. Eight faculty members participated. Setting was the lecture theatre. The suggested and actual teaching learning methods are compared for each competency. Notes made from delivering disability competencies, photographs, videos and reflections from students were source of data. Results: We used sensitizing lectures of 15 minutes each for FC 4.5.1, 4.5.2 and 4.5.4[cognitive] with interesting set induction, student narratives of family members with disability, buzz groups for interaction and self-directed learning activity using mobile phones. We facilitated FC 4.5.3 and 4.5.5 [skill/affective domain] demonstrating unacceptable and acceptable disability etiquettesusing standardized patients and role play. We conducted a forum theatre of the oppressed for FC 4.5.6. We introduced our learners to universal design in our campus for teaching 4.5.7. As a part of the principle of inclusivity we involved two staff members with motor disabilities for delivering FC 4.5.8 in an interview. We assessed the learners using written reflections and obtained feedback on a rating scale.
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Background: Diabetic foot ulcer is the most costly and complex challenge for patients with diabetes. We herebyassessed the effectiveness of different preconditioned adipose-derived mesenchymal stem cells (AD-MSCs) andphotobiomodulation protocols on treating an infected ischemic wound in type 1 diabetic rats. Methods: There were five groups of rats: (1) control, (2) control AD-MSCs [diabetic AD-MSCs were transplanted(grafted) into the wound bed], (3) AD-MSC + photobiomodulation in vivo (diabetic AD-MSCs were grafted into thewound, followed by in vivo PBM treatment), (4) AD-MSCs + photobiomodulation in vitro, and (5) AD-MSCs +photobiomodulation in vitro + in vivo. Results: Diabetic AD-MSCs preconditioned with photobiomodulation had significantly risen cell function comparedto diabetic AD-MSC. Groups 3 and 5 had significantly decreased microbial flora correlated to groups 1 and 2 (all,p = 0.000). Groups 2, 3, 4, and 5 had significantly improved wound closure rate (0.4, 0.4, 0.4, and 0.8, respectively)compared to group 1 (0.2). Groups 2–5 had significantly increased wound strength compared to group 1 (all p =0.000). In most cases, group 5 had significantly better results than groups 2, 3, and 4. Conclusions: Preconditioning diabetic AD-MSCs with photobiomodulation in vitro plus photo biomodulation in vivo significantly hastened healing in the diabetic rat model of an ischemic infected delayed healing wound.
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Head and neck squamous cell carcinomas (HNSCC) are a major cause of cancer morbidity and mortality. Tobacco smoking and chewing, areca (betel) nut chewing, alcohol consumption and poor oral hygiene are major risk factors for HNSCC. Human papilloma virus (HPV) infection is another known risk factor for oropharyngeal cancer (OPC). Despite advancement in cancer treatment, HNSCC has a poor prognosis with 5-year survival rates of <50%. Bacterial infection is one of the major causes of chronic inflammation which facilitates development of oral cancer through cell proliferation, the inhibition of apoptosis, oncogene activation, and angiogenesis. Recent advancement in metagenomic technologies may be useful in identifying oral cancer–related microbiome, their genomes, virulence properties, and their interaction with host immunity. It is very important to address which bacterial species is responsible for driving oral carcinogenesis. Alteration in the oral commensal microbial communities have potential application as a diagnostic tool to predict oral squamous cell carcinoma. The study aims to develop saliva-based oral microbiome and cytokine biomarker panel that screen oral cancer patients based on the level of the microbiome and cytokine differences. Streptococcus anginosus may be considered as a non-invasive diagnostic biomarker for oral cancer patients only. Oncobacteria such as S. anginosus, V. parvula, P. endodontalis, and P. anaerobius may contribute to the development of OSCC by increasing inflammation via increased expression of inflammatory cytokines such as IL-6, IL-8, TNF-α, IFN-γ, and GM-CSF. These oncobacteria and cytokines panels could potentially be used as a non-invasive biomarker in clinical practice for more efficient screening and early detection of OSCC patients
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Background: The majority of COVID-19 research has been devoted to characterizing the epidemiology and early clinical aspects of the virus. In Lagos, Nigeria, we looked at the temporal progression of COVID-19 patients. We included 1337 confirmed COVID-19 cases in our study from February 27th to March 27th 2020. Of the 1337 patients enrolled, the median age was 50 years old, and 800 (59.83%) were male while 537(40.16%) were female. Method: In symptomatic patients, the time from the beginning of signs to admission was 4(2–7) days. Fever occurred in 217(16.2%) while cough occurred in 211(15.78%) patients respectively. Patients were given 5–6 treatment, including nutrition support, supplementary oxygen, and antiviral medicines (e.g., Remdesivir, dexamethasone) in a limited percentage of cases. The assessed median period of infection in all patients was 10 days after the start of symptoms (95 confidential intervals [CIs]: 8–11 days). The duration of fever was slightly longer in patients admitted to intensive care units (ICU) than in those who were not (31 days versus 9 days, respectively, P<0.003). Results: On day 7 after the onset of symptoms, radiological deterioration of the original picture was found in 500 (37.39%) patients. On day 13, 154 of these patients (94.5%) showed signs of radiological improvement. The average time it took for upper respiratory tract samples to test negative for reverse transcriptase PCR was 10 days (90 percent confidence interval: 10–12 days). Virus clearance was more significant in ICU patients than in non-ICU patients (P<0.003). Conclusions: Community members should continue to adhere to the recommended methods of preventing the spread of COVID-19 infection and patients should seek care early to reduce the risk of mortality associated with the infection as rapidly as possible.
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Background: Current evidence does not recommend screening urine culture and curing asymptomatic bacteriuria (ASB) before joint arthroplasty. The bacteriuria count on pre-operative urinalysis is a more common clinical parameter. We aimed to investigate whetherthe bacteriuria count on preoperative urinalysis can increase postoperative wound complications in primary total hip arthroplasty (THA). Methods: We conducted a retrospective study that included patients who underwent primary THA in our institution from 2012 to 2018.Receiver operating characteristic (ROC) curves were first generated to evaluate the predicted value of leukocyte esterase(LE), nitrite, bacteriuria, and pyuria in the urinalysis for superficial wound infection. Then, all included patients were divided into two groups according to the preoperative urinalysis: a bacteriuria-positive group and a bacteriuria-negative group.The primary outcome was the superficial wound infection rate within three months postoperatively, and the secondary outcomes included wound leakage, prosthetic joint infection (PJI), pulmonary infection, urinary tract infection (UTI), readmission rateand length of stay (LOS) during hospitalization. We utilized univariable analyses to compare the outcomes between the two groups. A multivariable logistic regression model was generated to explore the potential association between bacteriuria andoutcomes. Results: A total of 963 patients wereincluded in the study. One hundred sixty patients had abnormal urinalysis. Bacteriuria was diagnostically superior to LE, nitrite, and pyuria according to AUCs.Among thepatients, 95 had a positive bacteriuria on preoperative urinalysis, and only 9 (9.5%) had a positive urine culture. The bacteriuria-positive group had a higher superficial wound infection rate (4.2% vs. 0.6%, P=0.008), higher wound leakage rate (11.6% vs. 4.5%, P=0.007),higher readmission rate (5.3% vs. 1.3%, P=0.015) within three months postoperatively and longer LOS (6.19± 2.89 days vs. 5.58± 2.14 days, P=0.011). After adjustment, the bacteriuria-positive group had a significantly increased risk of superficial wound infection (OR=7.587, 95%CI: 2.002 to 28.755, P=0.003), wound leakage (OR=3.044, 95%CI: 1.461 to 6.342, P=0.003), and readmission (OR=4.410, 95%CI: 1.485 to 13.097, P=0.008). Conclusion: Preoperative bacteriuria positivity on urinalysis significantly increased the risk of postoperative wound complications, readmission, and LOS in primary THA regardless of the result of the urine culture. Urinalysis is a fast and cost-acceptable test whose advantages have been underestimated.
Linbo Peng, a doctoral student in West China Hospital of Sichuan University, is majoring in Joint Surgery, Orthopedics. His supervisor is Professor Bin Shen of West China Hospital. Peng has participated in two National Natural Science Foundation projects of China and published several academic papers.
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Background: The prevalence of tuberculosis (TB) in low-to-middle-income countries is larger than that observed in developed countries. This study aimed to characterize TB disease among patients diagnosed at Kenyatta National Hospital (KNH) in Nairobi, Kenya, for public health action. Methods: We conducted a descriptive cross-sectional study at KNH TB clinic from January to December 2015. Data were extracted from TB clinic in- and out-patient registers, entered into MS-Excel.Descriptive and associative statistics were calculated with Open-Epi software. Results: A total of 1,551 TB cases were identified, with mean age of 31.5±16.5 years while 771 (49.7%) were <32 years old. Bivariate analyses showed significant associations between younger age (<32 years) and being hospitalized for the infection (OR 8.18, 95% CI 6.47-10.38, p<0.0001) and being diagnosed by sputum microscopy (OR 2.12, 95% CI 1.39-3.25, p=0.0005). Conclusion: Younger patients were more likely to be diagnosed at a sicker stage of disease than their older counterparts and to be hospitalized as a result. This calls for intensified TB case finding among younger people by use of more rapid TB tests to diagnose TB earlier.
Linet Makori is a Senior Nursing Officer at the Kenyatta National Hospital, Nairobi, Kenya She received her Bachelor of Science in Public Health from Jomo Kenyatta University of Science and Technology and currently perusing her MSc in Epidemiology from the same University.
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Systemic rheumatoid arthritis (RA) regimens fail to attain effective drug level at the affected joints and are associated with serious side effects. Herein, an attempt made to improve therapeutic outcomes of both leflunomide(LEF) which is a disease modifying antirheumatic and dexamethasone (Dex) through local delivery of combination therapy by intra-articular route. LEF and Dex were encapsulated in nanostructured lipid carriers (NLCs) and PLGA nanoparticles (NPs), respectively. Both nanocarriers were loaded into chitosan/b glycerophosphate (CS/bGP) thermo-sensitive hydrogels and injected intra-articularly in adjuvant induced RA rat model. Particle size of LEF NLCs and selected Dex NPs formulations were 200 and 119 nm, respectively. Dex NPs and LEF NLCs showed a sustained release profile for up to 58 and 17 days, respectively. After 14 days of treatment remarkable joint healing was observed for groups treated with Dex NPs in combination with either free LEF or LEF NLCs in CS/bGP hydrogel. Joint diameter measurements, TNF a levels and histopathological examination of dissected joints showed comparable values to the negative control group. This might be attributed to the synergistic effect of drug combination besides the ability of nano carriers loaded hydrogel to prolong joint residence time and enhance joint healing potential.
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We present a deep learning framework for epidemiology system identification from noisy and sparse observations with quantified uncertainty. The proposed approach employs an ensemble of deep neural networks to infer the time-dependent reproduction number of an infectious disease by formulating a tensor-based multi-step loss function that allows us to efficiently calibrate the model on multiple observed trajectories. The method is applied to a mobility and social behavior-based SEIR model of COVID-19 spread. The model is trained on Google and Unacast mobility data spanning a period of 66 days, and is able to yield accurate future forecasts of COVID-19 spread in 203 US counties within a time-window of 15 days. Interestingly, a sensitivity analysis that assesses the importance of different mobility and social behavior parameters reveals that attendance of close places, including workplaces, residential, and retail and recreational locations, has the largest impact on the effective reproduction number. The model enables us to rapidly probe and quantify the effects of government interventions, such as lock-down and re-opening strategies. Taken together, the proposed framework provides a robust workflow for data-driven epidemiology model discovery under uncertainty and produces probabilistic forecasts for the evolution of a pandemic that can judiciously inform policy and decision making. All codes and data accompanying this manuscript are available at https://github.com/PredictiveIntelligenceLab/DeepCOVID19.
Mohamed Aziz Bhouri is currently a postdoctoral researcher at Professor Paris Perdikaris lab at University of Pennsylvania. His work focuses on model order reduction and physics informed machine learning. He obtained his PhD in Mechanical engineering and Computational Science from MIT for his work within Professor Anthony T. Patera’s lab. He also obtained his Master of Science at MIT and conducted research within Dr. TianTian’s lab. He obtained bachelor degrees from EcoleCentrale Paris and University of Paris-Sud with triple-major in Mathematics, Physics and Mechanical Engineering. During his bachelor studies, he was rewarded a merit-based Campus France scholarship.
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Ataxia telangiectasia (A-T) is a rare childhood autosomal recessive neurodegenerative chromosomal instability disorder. It is characterized by high risk of haematological malignancies with T-cell phenotype being the most common, which can present first before the diagnosis of A-T made. The chromosomal instability in A-T increases the toxicity to radio- chemotherapeutic agents, creating the treatment modification challenges and the deviation from the optimal management protocols. In this case report we present a 14-month-old boy diagnosed as T cell –ALL. Based on his early presentation, family history of childhood lymphoma, and high AFP, inherited predisposition was suspected, and genetic testing confirm A-T. This report represents the crucial part of clinicalsuspicion of A-T in similar casesas well as highlighting the importance of an early A-T diagnosis that prevents toxic death due to the extensive regimen of radio- chemotherapeutic agents. The report summarizes the toxicity
OmaimaSaadeldin Mohamed Ahmed working as an Assistant consultant paediatric haematology oncology; Princess Norah oncology Center, King Abdul-Aziz medical city, Jeddah, Saudi Arabia. She was Graduated from GeziraUniversityinSudan. She has a MBBS Bachelor of Medicine &Surgery degree in 2001. She has been working as a paediatrician since 2007. Started as Paediatrics resident in King Faisal Specialist Hospital and Research Center (KFSHRC), Jeddah, Saudi Arabia. Completed her MRCPCH Ordinary Membership in NOV 2016: MRCPCH-UK.
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Medication use during pregnancy carries risks of teratogenicity, preterm birth, and spontaneous abortion. CDC's guidelines advocate for the use of metronidazole for the treatment of bacterial vaginosis (BV) in pregnant women. A literature review assessing the safety of metronidazole during pregnancy was conducted. Metronidazole was found to be effective in preventing preterm births when used in conjunction with other antibiotics. Its use did not predict birth defects or congenital abnormalities. It was however associated with a 70% increased risk of spontaneous abortion. This risk should be interpreted cautiously in light of the confounder which is the severity of genitourinary infection.
Ozioma C. Nwosu is an advanced practice registered nurse. She is also a final year doctor of nursing practice student at the University of North Florida. She has about 10 years of experience in nursing ranging from staff nursing to advance practice nursing. She specializes in family practices and has recently completed her studies in psychiatric and mental health nursing. She is a mother, a wife and an advocate for quality health care.
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Machine learning techniques, such as feature selection, have been applied with increasing frequency in biomarker discovery. Feature selection usually has fewer required assumptions compared with statistical tests. Many of them can take the interaction between genes and their joint power into consideration. The genes that are weak biomarkers by themselves but have a strong joint power can therefore be identified. Biomarker discovery is a fast-growing field with many new ideas continuously being proposed. So far none are perfect, considering that the method is data dependent and no universal agreement on the evaluation of a method’s performance has been established. In this presentation, we will discuss importance of using neural networks, support vector machines, random forests and unsupervised clustering techniques for classification and predictions.
Pawar is an Associate Research Scientist at Yale Center for Genome Analysis (YCGA), Yale University. His research interests are focused on big data (next-generation sequencing, microarrays, X-ray crystallography etc.) analysis with machine learning techniques (Neural networks, SVM’s, Restricted boltzmann machines, Clustering algorithms etc.). He brings unique expertise in data science, bioinformatics, computer science and predictive analytics.
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Background: Previous studies have demonstrated the advantages of patient-specific implants (PSIs)for maxilla repositioning in orthognathicsurgery.However, its accuracy compared to the use of thesurgicalwafer fabricated with computer-aided design/computer-aided manufacturing (CAD/CAM) is unknown.This randomized controlled trial aimed to compare the accuracy of PSIs and CAD/CAM wafer for maxilla repositioning in orthognathic surgery. Methods:After registration (ClinicalTrials.gov ID: NCT02914431, registration date: September 20, 2016), 64 patients requiringorthognathic surgery were randomly assigned to use either PSIs (group I) or CAD/CAM surgical wafer (groupII)to reposition the maxilla in the Department of Oral and Craniomaxillofacial Surgery at Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, from November 2016 to August2019. The outcome evaluation (including the centroid position, translation and orientation discrepancies of the maxilla) was completed by comparing virtual plans with actual results. Results: The maxilla position discrepancy was 1.41 ± 0.58 mm in group I and 2.20 ± 0.94 mm in group II; the between-group difference was significant (p< 0.001). For group I, the largest translation discrepancy was 1.02 ± 0.66 mm in the anteroposterior direction, and the largest orientation discrepancy was 1.85 ± 1.42 ° in pitch. For the group II, the largest translation discrepancy was 1.23 ± 0.93 mm in the mediolateral direction, and the largest orientation discrepancy was 1.72 ± 1.56 ° in pitch. Conclusion: Using PSIs in orthognathic surgery resulted in a more accurate maxilla position than CAD/CAM surgical wafer.However, it is not clear whether the same results would be obtained at other clinical centers. We will conduct a multicenter randomized controlled study to further confirm this conclusion (ClinicalTrials.gov ID: ChiCTR1900027035, registration date: October29, 2019).
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