Anatomical variation in the rudimentary horns of a unicornuate uterus: implications for laparoscopic surgery

A case of laparoscopic excision of a rudimentary horn is presented. The anatomical features of this case are contrasted with others in the published literature. A 23 year old nulligravida presented with severe dysmenorrhoea and a pelvic mass. At laparoscopy a unicornuate uterus with a rudimentary horn was identified. The patient had stage III endometriosis. The rudimentary horn was attached to the unicornuate uterus by a band of tissue. The blood supply was identified within this band of tissue. The rudimentary horn was removed laparoscopically with no complications. There are two anatomical variations in the attachment of the rudimentary horn to the unicornuate uterus. Knowledge of both types is important to avoid complications such as bleeding and possible compromise of myometrial wall thickness.      

Investigation of the dopamine D5 receptor gene (DRD5) in adult attention deficit hyperactivity disorder

Several lines of evidence from neuroimaging, pharmacology and genetics support the involvement of the dopaminergic system in the etiology of Attention Deficit Hyperactivity Disorder (ADHD). Previous candidate gene studies have investigated the association between a dinucleotide (CA)_n repeat polymorphism, located 18.5 kb from the start codon of the DRD5 gene, and ADHD. Association between the 148 bp allele and ADHD has been reported in some studies, however replication of the finding has not been consistent. We tested for an association between the (CA)_n repeat and adult ADHD in a sample comprised of 119 families with adult ADHD probands and 88 unrelated adult ADHD cases with a corresponding number of controls matched for age, ethnicity and sex. In the family sample we found a non-significant trend for association between the 148 bp allele and ADHD (Z = 1.91, p = 0.055). An excess of non-transmissions was detected for the 150 and 152 bp alleles (Z = −2.26, p = 0.023; Z = −2.20, p = 0.028). Quantitative analysis performed using the Brown Attention Deficit Disorder Scale (BADDS) showed association between the 150 bp allele and lower total score (p = 0.011), and lower effort (p = 0.008), activation (p = 0.008) and attention (p = 0.01) cluster scores. We did not replicate association findings in the case–control group, likely due to the lack of statistical power of this sample. Our findings add to the literature suggesting DRD5 (CA)_n repeat has a modest effect in modulating susceptibility to adult ADHD but further studies are required.     

Clinical Concept-Based Radiology Reports Classification Pipeline for Lung Carcinoma

Rising incidence and mortality of cancer have led to an incremental amount of research in the field. To learn from preexisting data, it has become important to capture maximum information related to disease type, stage, treatment, and outcomes. Medical imaging reports are rich in this kind of information but are only present as free text. The extraction of information from such unstructured text reports is labor-intensive. The use of Natural Language Processing (NLP) tools to extract information from radiology reports can make it less time-consuming as well as more effective. In this study, we have developed and compared different models for the classification of lung carcinoma reports using clinical concepts. This study was approved by the institutional ethics committee as a retrospective study with a waiver of informed consent. A clinical concept-based classification pipeline for lung carcinoma radiology reports was developed using rule-based as well as machine learning models and compared. The machine learning models used were XGBoost and two more deep learning model architectures with bidirectional long short-term neural networks. A corpus consisting of 1700 radiology reports including computed tomography (CT) and positron emission tomography/computed tomography (PET/CT) reports were used for development and testing. Five hundred one radiology reports from MIMIC-III Clinical Database version 1.4 was used for external validation. The pipeline achieved an overall F1 score of 0.94 on the internal set and 0.74 on external validation with the rule-based algorithm using expert input giving the best performance. Among the machine learning models, the Bi-LSTM_dropout model performed better than the ML model using XGBoost and the Bi-LSTM_simple model on internal set, whereas on external validation, the Bi-LSTM_simple model performed relatively better than other 2. This pipeline can be used for clinical concept-based classification of radiology reports related to lung carcinoma from a huge corpus and also for automated annotation of these reports.

     

Knowledge and practices among rural mothers in Haryana about childhood diarrhea

Knowledge and practices of 108 rural mothers about childhood diarrhea, were determined by using pretested semi-structured interview schedules. The common causes of diarrhea reported were eruption of teeth (67.59%), eating of mud (51.85%), worm infestation (47.22%), change of climate (35.18%), poor personal hygiene (34.25%) and changes in diet (25.92%). Majority (83.33%) of mothers practiced food restriction during diarrhea. Seventy seven percent consulted their mother-in-laws in the first instance for treatment of diarrhea. The home remedies tried by mothers were, isabgol husk with curd (30.55%), ghee with tea (28.70%) water boiled with mint leaves (25.92%), local ghutti (22.22%) and unripe mango juice (16.66%). Majority of mothers (83.33%) believed that oral rehydration therapy alone, cannot treat diarrhea.     

Knowledge and attitude towards breast feeding among adolescent girls

Majority of the urban adolescent girl students (n = 76) from middle socioeconomic group correctly reported that breast milk is the best food for infants (95%), and it has protective antibodies (98%). However, most of them (92%) had incorrect knowledge about the role of diet in breast milk secretion and continuation of breastfeeding while mother is suffering from tuberculosis (92%), malaria (84%).     

Tuberculosis in renal transplant recipients: Rifampicin sparing treatment protocol

The reactivation of mycobacterium infection inrenal transplant recipients in developingcountries is a common therapeutic dilemma,especially in those patients receivingcyclosporin immunosuppression. The inclusion ofrifampicin in the antituberculosis protocolincreases the risk of precipitating acuteallograft rejection due to its interaction withcyclosporin and also increases the financialburden. We successfully treated 16 patients whodeveloped mycobacterial infection post renaltransplant with a rifampicin sparingantituberculosis drug regimen. Pyrexia ofunknown origin was the most common manifestationobserved and a therapeutic trial withantituberculosis drugs is justified. De novodiabetes mellitus appears to be an added riskfactor and increases the susceptibility tomycobacterial infection.     

Bioterrorism-related anthrax surveillance,Connecticut, September-December, 2001

On November 19, 2001, a case of inhalational anthrax was identified in a 94-year-old Connecticut woman, who later died. We conducted intensive surveillance for additional anthrax cases, which included collecting data from hospitals, emergency departments, private practitioners, death certificates, postal facilities, veterinarians, and the state medical examiner. No additional cases of anthrax were identified. The absence of additional anthrax cases argued against an intentional environmental release of Bacillus anthracis in Connecticut and suggested that, if the source of anthrax had been cross-contaminated mail, the risk for anthrax in this setting was very low. This surveillance system provides a model that can be adapted for use in similar emergency settings.     

Decremental response of the nasalis and hypothenar muscles in myasthenia gravis

Repetitive nerve stimulation (RNS) is a standard diagnostic procedure in myasthenia gravis (MG). Although RNS sensitivity is highest in weak muscles, RNS is easier to perform in distal muscles that are often not affected. Twenty-five patients with MG were assessed to compare the sensitivity of RNS of the nasalis muscle to that of the hypothenar muscles. Abnormal decrement was found in hypothenar muscles in 9 patients (36%) and in the nasalis muscle in 13 patients (52%). RNS of the nasalis muscle appeared more useful to detect abnormal neuromuscular transmission in patients with oculobulbar MG (5 of 5) than hypothenar RNS (1 of 5). In patients with generalized MG, hypothenar muscles had a similar yield of abnormal RNS tests.     

A theoretical perspective using resource dependency to predict the potential migration of Medicare-eligible military beneficiaries into the Department of Defense's Managed Care System

TRICARE for Life (TFL) became effective on October 1, 2001. On that date, approximately 1.5 million Medicare-eligible military beneficiaries (MEMB) regained health care reimbursement privileges resulting in significantly reduced individual out-of-pocket costs. TFL acts as a secondary payer to an eligible beneficiary's Medicare or other health insurance. Currently, TFL beneficiaries are allowed to remain in their current health care system. However, early discussions of Public Law 106-398 recommended that MEMB seek care at military treatment facilities. The return of MEMB to military treatment facilities may have presented a number of management challenges to leaders of the Military Health System. This article applies resource dependence theory to the issue of MEMB returning to military treatment facilities under the TFL program. Resource dependency theory and a conceptual model assist in identifying a number of challenges that may adversely affect MEMB in future years should this option ever become a reality.