Carotid Interventions for Women: The Hazards and Benefits

The goal of the current review is to examine the hazards and benefits of carotid interventions in women and to provide recommendations for the indications for carotid intervention in female patients. Stroke and cerebrovascular disease are prevalent in women. There are inherent biological and other differences in men and women, which affect the manifestations and outcome of stroke, with women experiencing worse disability and higher mortality following ischemic stroke than men. Due to the underrepresentation of female patients in most clinical trials, the ability to make firm but alternative recommendations for women specifically on the management of carotid stenosis is challenging. Although some data suggest that women might have worse periprocedural outcomes as compared to men following all carotid revascularization procedures, there is also an abundance of data to support a similar risk for carotid procedures in men and women, especially with carotid endarterectomy and transcarotid artery revascularization. Therefore, the indications for carotid revascularization are the same in women as they are in men. The choice of a carotid revascularization procedure in women is based upon the same factors as in men and requires careful evaluation of a particular patient’s risk profile, anatomic criteria, plaque morphology, and medical comorbidities that might favor one technique over the other. When performing carotid revascularization procedures in women, tailored techniques and procedures to address the small diameter of the female artery are warranted.

mRNA COVID-19 vaccine: A future hope for cancer treatment

Background: mRNA vaccines have a strong potential for a possible cancer therapy platform. They express tumor antigens in antigen-presenting cells (APCs) after immunization, facilitating innate/adaptive immune stimulation. Because of its high effectiveness, safe administration, rapid development potential, and cost-efficient manufacturing, the mRNA cancer vaccine surpasses other traditional vaccination platforms. Conclusion: Careful evaluation of promising mRNA vaccines to supervise as carriers of lipids for cancer patients needs to be done. In addition, a possible revaluation for optimal protection is required. However, the extent to which solid tumours might take a significant part of the vaccine doses is still unknown.

Spontaneous heterotopic pregnancy: a case report

Heterotopic pregnancy is defined as multiple gestation in which intrauterine and extrauterine gestational sacs co-exist. The extra uterine gestational sac is most commonly tubal ectopic pregnancy. We presented case of a 26 years old multigravida who presented to emergency with complaints of pain abdomen and giddiness for 2-3 days. She was at period of gestation (POG) 7 weeks and on clinical examination patient was anxious with mild pallor, mildly tachycardiac and blood pressure (BP) was 90/60 mm of Hg. After thorough clinical examination and sonography diagnosis of heterotopic pregnancy with ruptured tubal ectopic was made. She was taken up for Emergency laparotomy after investigations and consent. Left salpingectomy was done and she was discharged with a single intrauterine live pregnancy on 6th post op day. For early detection of cases of heterotopic pregnancy careful evaluation of adnexa is mandatory in early gestation scan.

Nociceptive Response Is a Possible Marker of Evolution in the Level of Consciousness in Unresponsive Wakefulness Syndrome Patients

The Nociception Coma Scale (NCS) and its revised version (NCS-R) were used to evaluate behavioral responses to pain in non-communicative patients. We hypothesized that if patients demonstrate changes to their NCS(-R) scores over time, their evolving behavioral abilities could indicate a forthcoming diagnostic improvement with the Coma Recovery Scale-Revised (CRS-R). Forty-three Vegetative State/Unresponsive Wakefulness Syndrome (VS/UWS) patients were enrolled in the study. The patients were assessed weekly using the CRS-R and NCS(-R) for four consecutive weeks. The first assessment was within 10 days after hospitalization. The assessments were performed between 09:30 and 11:30 AM in a room with constant levels of humidity, light and temperature, as well as an absence of transient noise. Noxious stimuli were administered using a Newton-meter, with pressure applied to the fingernail bed for a maximum of 5 s unless interrupted by a behavioral response from subjects. Seventeen patients demonstrated improvements in their level of consciousness, 13 of whom showed significant behavioral changes through the NCS(-R) before being diagnosed with a Minimally Conscious State (MCS) according to the CRS-R. The behavioral changes observed using the NCS(-R) corresponded to a high probability of observing an improvement from VS/UWS to MCS. To characterize the increased likelihood of this transition, our results present threshold scores of ≥5 for the NCS (accuracy 86%, sensitivity 87%, and specificity 86%) and ≥3 for the NCS-R (accuracy 77%, sensitivity 89%, and specificity 73%). In conclusion, a careful evaluation of responses to nociceptive stimuli in DOC patients could constitute an effective procedure in assessing their evolving conscious state.

Impacts of COVID-19 on Global Healthcare Management and Research

The Coronavirus Infectious Disease 2019 (COVID-19) pandemic has affected most nations at all levels of functioning, individual to governmental. Therefore, it is imperative to evaluate the effects the virus has had on one of the most important socioeconomic global sectors, healthcare. This literature review explores key, recent research and management strategies that have been undertaken in healthcare systems around the world in order to make meaningful attempts at identifying the etiology, diagnosis, and treatment of the disease, and combating the spread of this deadly virus. Healthcare facilities have implemented a variety of changes, all geared towards reducing non-emergency patient visits and preventing transmission of the infection; this includes shifting appointments to online modality via telecommunication use, altering remedial options and procedures, and developing more effective personal protective equipment (PPE). Efforts have also been made to define appropriate treatment methods as well as a potential cure for COVID-19; many vaccines and antiviral drugs have been designed or are continuing to undergo clinical testing, and symptom management approaches are being employed along with careful evaluation or recommendation of already available medications to counter the disease. Our comprehensive analysis provides insights into prominent consequences as well as implications of COVID-19 in contemporary global healthcare research and management, and would help this crucial sector be better prepared for pandemics in the future.

Fifteen-minute consultation: Evaluation of paediatric torticollis

Torticollis refers to a state in which the neck is twisted due to excessive contraction or shortening of the muscles on one side. Congenital muscular torticollis, which is more common than acquired torticollis, has an incidence of 0.3%–1.9% among all live births. The clinical approach to torticollis depends on the age at presentation, duration of torticollis and presenting symptoms. The underlying aetiology for torticollis varies with the age of the child. Torticollis can be a presenting feature for life-threatening conditions and thus requires careful evaluation.

Assessment of AI-based Protein Structure Prediction for the NLRP3 Target

The recent success of AlphaFold and RoseTTAFold has demonstrated the values of AI methods in predicting highly accurate protein structures. Despite the advances, their roles in the context of small-molecule drug discovery need to be thoroughly explored. In this study, we evaluated the possibility whether the AI-based models can lead to reliable 3D structures of protein-ligand complexes. With the AI-generated protein structure, we were able to confidently predict the binding modes of small-molecule inhibitors for NLRP3, a challenging protein target in terms of obtaining the 3D model both experimentally and computationally. We therefore concluded that through careful evaluation, AI-predicted protein structures can be trusted and useful for small-molecule drug discovery projects.

The ontological turn revisited: Theoretical decline. Why cannot ontologists fulfil their promise?

Holbraad and Pedersen have revisited the ontological turn, suggesting that it is strictly concerned with methodology only. Holbraad goes even further, accepting an aesthetic criterion for ethnography only. This is a sign of theoretical decline. In my paper, I claim that ontologists’ tendency to overestimate the significance of ethnographic experience causes theoretical confusion. I claim that neo-pragmatic analysis can eliminate this confusion. I also argue that there is only one remaining issue from the ontological turn that is not entirely lost. A careful evaluation of all folk categories, with all its possible consequences, can boost the robustness of all competitive theories, Cognitive Evolutionary Science included.

Salivary Gland-type Tumors of the Lung

Context.— Salivary gland-type tumors (SGTs) of the lung represent a distinct group of lung neoplasms. Pulmonary SGTs often pose diagnostic challenges, especially in small biopsy and cytology samples because of limited sample volume and overlapping morphology among pulmonary SGTs, metastatic SGTs of head and neck origin, and other lung tumors. Objective.— To identify the clinical characteristics, histomorphology, immunophenotypic features, and molecular alterations that are crucial for the diagnosis and differential diagnosis of pulmonary SGTs, especially in small biopsy and cytology specimens. Data Sources.— Literature review and authors' personal practice experience. Conclusions.— An accurate diagnosis of pulmonary SGTs can be achieved by careful evaluation of clinical findings and histomorphology in conjunction with immunohistochemical studies and molecular analysis.

Estimated Density, Population Size and Distribution of the Endangered Western Hoolock Gibbon (Hoolock hoolock) in Forest Remnants in Bangladesh

Tropical forests are threatened worldwide due to deforestation. In South and Southeast Asia, gibbons (Hylobatidae) are important to seed dispersal and forest regeneration. Most gibbons are threatened due to deforestation. We studied the western hoolock gibbon (Hoolock hoolock) in Bangladesh to determine population size and extent of suitable habitat. We used distance sampling to estimate density across 22 sites in northeastern and southeastern Bangladesh. We used Maxent modeling to determine areas of highly suitable habitat throughout Bangladesh. Density was estimated to be 0.39 ± 0.09groups/km2, and the total estimated population was 468.96 ± 45.56 individuals in 135.31 ± 2.23 groups. The Maxent model accurately predicted gibbon distribution. Vegetation cover, isothermality, annual precipitation, elevation and mean temperature of the warmest quarter influenced distribution. Two areas in the northeast and two areas in the southeast have high potential for gibbon conservation in Bangladesh. We also found significantly more gibbons in areas that had some level of official protection. Thus, we suggest careful evaluation, comprehensive surveys and restoration of habitats identified as suitable for gibbons. We recommend bringing specific sites in the northeastern and southeastern regions under protection to secure habitat for remaining gibbon populations.