Treatment of Infertility in Women with Polycystic Ovary Syndrome in a Single Center Study

Background: Anovulatory infertility is caused by polycystic ovarian syndrome in 80 percent of patients. Preconception guidelines, such as lifestyle modification (weight loss) to avoid fetal neural tube abnormalities, and quitting smoking and drinking alcohol, are all part of the early treatment. A clomiphene citrate medication for timed intercourse is the first-line pharmacological treatment for producing ovulation. Exogenous gonadotropins or laparoscopic ovarian surgery are two options for second-line pharmaceutical treatment (ovarian drilling). Ovulation induction using clomiphene citrate or gonadotropins is effective, with a 70 % cumulative live birth rate. When laparoscopy is necessary, ovarian drilling should be done; this operation is usually successful in around half of the instances. Finally, when the previous interventions have failed, a high-complexity reproduction treatment (in vitro fertilization or intracytoplasmic sperm injection) is recommended. There is no evidence that metformin should be used routinely in the treatment of infertility in anovulatory women with polycystic ovary syndrome. Aromatase inhibitors show promise, but more research is needed to confirm their safety.Methods:This study was conducted in Department of gynecology and obstetrics, Dhaka Medical College Hospital, Dhaka, from January 2019 to December 2019. A total number of 100 patients with multiple myeloma were analyzed cytogenetically by interphase fluorescence in situ hybridization (iFISH). The collected data were analyzed by using the Statistical Package for Social Science (SPSS-24) for windows version 24.0.Conclusion:PCOS is a frequent syndrome and the most frequent cause of infertility. PCOS is defined as a syndrome with at least two of three of the Rotterdam criteria. A complete evaluation of the infertility is needed to exclude other causes of infertility..

Do You Ever Get Off Track in a Conversation? The Conversational System’s Anatomy and Evaluation Metrics

Conversational systems are now applicable to almost every business domain. Evaluation is an important step in the creation of dialog systems so that they may be readily tested and prototyped. There is no universally agreed upon metric for evaluating all dialog systems. Human evaluation, which is not computerized, is now the most effective and complete evaluation approach. Data gathering and analysis are evaluation activities that need human intervention. In this work, we address the many types of dialog systems and the assessment methods that may be used with them. The benefits and drawbacks of each sort of evaluation approach are also explored, which could better help us understand the expectations associated with developing an automated evaluation system. The objective of this study is to investigate conversational agents, their design approaches and evaluation metrics. This approach can help us to better understand the overall process of dialog system development, and future possibilities to enhance user experience. Because human assessment is costly and time consuming, we emphasize the need of having a generally recognized and automated evaluation model for conversational systems, which may significantly minimize the amount of time required for analysis.

Mortality Rate in Covid-19 Positive Patients with Acute Kidney Injury Requiring Hemodialysis

Introduction: According to statistics till April, 2020 1,995,983 cases and 131,037 deaths have been reported globally with COVID-19 being a global threat posing great challenges to the healthcare system. Clinical data reviews and researchers have revealed that COVID-19 affects multiple organ especially liver, kidney and heart with primary damage to the respiratory system. Acute kidney injury and COVID-19 infection has been found to be linked to each other but the etiology remains unclear still. Method: This is an observational retrospective study conducted in nephrology department of Patel Hospital, Karachi. Data was collected retrospectively from medical records of patients. The study was carried out during the time period of March, 2020 till May 2021 for duration of 15 months. Patients with positive COVID-19 PCR and having AKI requiring hemodialysis were included in the study. Data was collected by complete evaluation of COVID-19 patient records and their symptoms, clinical status and final outcome during their hospital stay was noted. Results: The frequency of acute kidney injury requiring hemodialysis in our tertiary care setup was found to be 12.2% (n=41). Amongst these there were 53.7% males (n=22) and 46.3% females (n=19) and the mean age of patients was found to be 64.82+ 11.2 years. The mean level of lymphocyte count was found to be 11.3 + 4.8 *109/L. The in hospital mortality of COVID-19 positive patients having AKI was documented to be 73.2% (n=30) as shown in table-4. The other group of patients included 11 patients who recovered from acute kidney injury after hemodialysis sessions and were discharged from the hospital. Conclusion: Since COVID-19 infection became pandemic in 2020 there still needs to be a lot of research done in different populations. Hospitalized patients with COVID-19 infection should be Screen for kidney impairment and provided proper treatment. There has been found a very close association between the severity of acute kidney injury and mortality among the critically ill patients.

Evaluation of the performance of tropical cyclone track prediction techniques

ABSTRACT. This paper reviews the methods by which techniques for predicting tropical cyclone (TC) motion can be evaluated. Different error measures (forecast error, systematic error, and cross-track and along-track errors) are described in detail. Examples are then given to show how these techniques can be further evaluated by stratifying the forecasts based on factors related to the TC, including latitude, longitude, intensity change, size and past movement. Application of the Empirical-Orthogonal-Function (EOF) approach to represent the environmental flow associated with the TCs is also proposed. The magnitudes of the EOF coefficients can then be used to stratify the forecasts since these coefficients represent different types of flow fields. A complete evaluation of a forecast technique then consists of a combination of analyzing the different error measures based on both the storm- related factors and the EOF coefficients.

Variance in Variants: Propagating Genome Sequence Uncertainty into Phylogenetic Lineage Assignment

Genetic sequencing is subject to many different types of errors, but most analyses treat the resultant sequences as if they are known without error. Next generation sequencing methods rely on significantly larger numbers of reads than previous sequencing methods in exchange for a loss of accuracy in each individual read. Still, the coverage of such machines is imperfect and leaves uncertainty in many of the base calls. On top of this machine-level uncertainty, there is uncertainty induced by human error, such as errors in data entry or incorrect parameter settings. In this work, we demonstrate that the uncertainty in sequencing techniques will affect downstream analysis and propose a straightforward method to propagate the uncertainty. Our method uses a probabilistic matrix representation of individual sequences which incorporates base quality scores as a measure of uncertainty that naturally lead to resampling and replication as a framework for uncertainty propagation. With the matrix representation, resampling possible base calls according to quality scores provides a bootstrap- or prior distribution-like first step towards genetic analysis. Analyses based on these re-sampled sequences will include a more complete evaluation of the error involved in such analyses. We demonstrate our resampling method on SARS-CoV-2 data. The resampling procedures adds a linear computational cost to the analyses, but the large impact on the variance in downstream estimates makes it clear that ignoring this uncertainty may lead to overly confident conclusions. We show that SARS-CoV-2 lineage designations via Pangolin are much less certain than the bootstrap support reported by Pangolin would imply and the clock rate estimates for SARS-CoV-2 are much more variable than reported.

Detailed analysis and characterization of Subjective Assessment Indicators of manual and automated parking maneuvers

This paper presents a detailed analysis and characterization of Subjective Assessment Indicators for evaluating manual as well as fully automatic parking maneuvers. Parking is a huge challenge for many drivers. With the introduction of autonomous driving, parking maneuver assistants are essential functional components. For the development of automatic parking assistants, a detailed characterization of a subjective evaluation is essential. The characterization analysis presented here is based on general Subjective Assessment Indicators, which cover the subjective overall performance of a parking maneuver on a customer-oriented level in as many facets as necessary. This paper shows meaningful characteristics of the individual Subjective Assessment Indicators validated in a driving study with 497 performed parking maneuvers. The study results reveal different degrees of intensity of the characterizations for the different driving maneuvers. Here, it is shown that the characterization of the Final Parking Position has different reference points for longitudinal and lateral parking maneuvers. Furthermore, it was shown that an additional characteristic “Driving-Off Behavior” is required for the evaluation of the Safety Feeling, but for Parking Comfort the “Lateral Acceleration” and for Dynamic Performance the “Distance Traveled” can be neglected. The characteristics described in this paper can be used for all parking maneuvers and vehicle types. It forms the basis for a complete evaluation and enables OEMs to apply their individual requirements in the development of parking assistants.

Clinical evaluation of the effects of a single oral dose of gabapentin on fear-based aggressive behaviors in cats during veterinary examinations

OBJECTIVE To investigate the effects of a single oral dose of gabapentin on fear-based aggressive behaviors (FABs) in cats during veterinary examinations. ANIMALS 55 healthy pet cats (26 with and 29 without a history of FAB during veterinary visits [FAB and untreated control groups, respectively]). PROCEDURES A standardized 9-step clinical examination protocol (with patient compliance scored from 0 to 9 according to the highest completed step) was tested on untreated control group cats. The protocol was then used in a double-blind, randomized, placebo-controlled, crossover-design trial in which FAB-group cats received owner-administered gabapentin (100 or 200 mg/cat) or placebo capsules 2 hours before the first of 2 veterinary visits and received the alternate treatment before the second visit ≥ 1 day later. Ease of administration (scored from 1 [very difficult] to 4 [very easy]) and adverse effects were recorded. Compliance scores were compared between treatments for the FAB group and between FAB and untreated control groups. Changes in scores between treatments for the FAB group were used to investigate associations between selected variables and the outcome of interest. RESULTS FAB group compliance scores after gabapentin administration (median, 9; range, 0 to 9) were significantly higher than scores after placebo administration (median 0.5; range, 0 to 7) and did not differ from scores for the untreated control group. Owner scores indicated capsule administration was easy. Adverse effects (most commonly drowsiness, myorelaxation, and ataxia) resolved ≤ 10 hours after detection. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested oral administration of gabapentin to cats 2 hours before a veterinary visit can reduce FAB during physical examination, enabling more complete evaluation.

Retinoblastoma Extending up to the Optic Chiasma and Presenting as a Suprasellar Mass

Retinoblastoma is the most common ocular malignancy of childhood. It is present in childhood with leukocoria and strabismus. Most patients are diagnosed under 3 years of age. Funduscopic examination can reveal an intraocular mass, but imaging is essential for complete evaluation of the lesion. Although ultrasound is a non-invasive and relatively inexpensive screening tool, cross-sectional imaging is required to assess the involvement of optic nerve and intracranial spread. We report a case of retinoblastoma in a 5 year old male child who presented with headache diminution of vision in both eyes. Contrast enhanced magnetic resonance imaging (MRI) revealed an enhancing soft tissue mass in the right eye with involvement of optic nerve and optic chiasma and contiguous with a large suprasellar mass causing hydrocephalus. Non-contrast computed tomography (CT) showed extensive calcifications in the mass lesion.

Measuring Cannulation Skills for Hemodialysis: Objective Versus Subjective Assessment

Lack of cannulation skill during hemodialysis treatments results in poor clinical outcomes due to infiltration and other cannulation-related trauma. Unfortunately, training of patient care technicians and nurses, specifically on the “technical” aspects of cannulation, has traditionally not received much attention. Simulators have been successfully deployed in many medical specialties for assessment and training of clinical skills. However, simulators have not been as widely used in nursing, especially in the context of training clinical personnel in the dialysis unit. We designed a state-of-the-art simulator for quantifying skill for hemodialysis cannulation. In this study, 52 nurses and patient care technicians with varying levels of clinical experience performed 16 cannulations on the simulator with different fistula properties. We formulated a composite metric for objectively measuring overall success of cannulation and compared this metric with subjective assessment by experts. In addition, we examined if years of clinical experience correlated with objective and subjective scores for cannulation skill. Results indicated that, while subjective and objective metrics generally correlated with each other, the objective metric was more precise and better suited for quantifying cannulation skill. Further, the simulator-based objective metric provides several advantages over subjective ratings, including providing fine-grained assessment of skill, consistency in measurement unaffected by subjective biases, and basing assessment on a more complete evaluation of performance. Years of clinical experience, however, demonstrated little correlation with either method of skill assessment. The methods presented for cannulation skill assessment in this study, if widely applied, could result in improved cannulation skill among our PCTs and nurses, which could positively impact patient outcomes in a tangible way.