Management of Intraocular Inflammatory Disease

Background: Intra ocular inflammatory disease is a broad-spectrum eye inflammatory condition. Objective: To evaluate various management protocols for Intra ocular inflammatory disease. Study Design: Retrospective study Place and Duration of Study: Department of Ophthalmology, Lorallai Medical College, Loralai from 1st January 2020 to 31st March 2021. Methodology: One hundred and twenty medical files of patients with various intra ocular inflammatory diseases were recruited. Patients were managed by various pharmacological drugs including corticosteroids, second line agents, anti-metabolites as well as biologics (anti-TNF-alpha) therapy. Results: There were 45% females while 55% were males. The mean age of the patients was 45±4.4 years. Majority of the patients were within 41-50 years with 37.5% followed by those >50 years of age. Corticosteroids were efficient in 50% of patients with intra ocular inflammatory disease as a secondary condition while azathioprine in 75% patient and tacrolimus 93.4% patients. Conclusion: Second line agents and antimetabolites have higher prevalence of acceptance and efficacy in managing intra ocular inflammatory disease. Keywords: Management, Intraocular inflammatory disease, Broad spectrum

Investigation of Non-cooldown SG Secondary Condition on the Natural Circulation Cooling Procedure

In typical pressurized water reactor (PWR), in case that one steam generator (SG) cannot be credited for the primary cooldown, it is necessary to homogenize primary coolant temperature among loops using at least one reactor coolant pump (RCP) for the plant cooldown. If the natural circulation condition is established due to unavailability of all the RCPs, the continuous cooldown using intact SGs causes to disturb the smooth depressurization because it leads to void generation in the top of the non-cooldown SG tube where the high temperature coolant is remained. For this purpose, W.Sakuma, et al.[1] suggested the outline of asymmetric cooldown procedure without any RCPs restart. Since the suggested procedure is based on only one secondary condition (SG dry-out) of non-cooldown SG, and hence the impact of difference of the secondary condition should be investigated. In this paper, the sensitivity analyses were performed to confirm the impact on the asymmetric cooldown procedure, and consequently, it was confirmed that the coolable range used in the procedure was expanded if the water inventory exists in non-cooldown SG. Therefore it was concluded that the coolable range which was defined with the SG dry-out condition in non-cooldown SG can be conservatively applied for the operating procedure.

Patient stratification reveals the molecular basis of disease comorbidities

Epidemiological evidence shows that some diseases tend to co-occur; more exactly, certain groups of patients with a given disease are at a higher risk of developing a specific secondary condition. Despite the considerable interest, only a small number of connections between comorbidities and molecular processes have been identified. Here we develop a new approach to generate a disease network that uses the accumulating RNA-seq data on human diseases to significantly match a large number of known comorbidities, providing plausible biological models for such co-occurrences. Furthermore, 64% of the known disease pairs can be explained by analysing groups of patients with similar expression profiles, highlighting the importance of patient stratification in the study of comorbidities. These results solidly support the existence of molecular mechanisms behind many of the known comorbidities. All the information can be explored on a large scale and in detail at http://disease-perception.bsc.es/rgenexcom/.

Severe Hydroxyapatite Deposition Disease in Binturongs (Arctictis binturong)

In a collection of 6 young binturongs ( Arctictis binturong), 3 presented with anorexia, lethargy, and footpad swelling diagnosed by surgical biopsy as calcinosis circumscripta. Despite supportive care over the next 4 years, affected binturongs had progressive weight loss, hyperphosphatemia, and hyperkalemia and developed large radiodense deposits in tissues adjacent to appendicular joints, thoracolumbar vertebrae, and the sternum. Two binturongs died and necropsies showed severe periarticular mineral deposition with fibrosis and granulomatous inflammation. Additionally, binturongs had mineralization of distal renal tubules, mineralization of the renal interstitium, and marked mineralization of the pulmonary interstitium and peribronchiolar smooth muscle. Foot biopsies from the surviving binturong were evaluated by spectroscopic microanalysis and were positive for hydroxyapatite, Ca10(PO4)6(OH)2. Periarticular and footpad mineralization in these binturongs is consistent with hydroxyapatite deposition disease, which is rarely described in humans and animals as a primary familial condition or a secondary condition often associated with renal injury.

Veno-venous extracorporeal membrane oxygenation successfully treated a case of severe pulmonary hemorrhage caused by leptospirosis

Background Pulmonary hemorrhage is an important complication of leptospirosis. Once acute respiratory distress syndrome (ARDS) occurs as a secondary condition, treatment is extremely difficult and the mortality rate is very high. Case presentation The patient was a 49-year-old. He was admitted to the hospital because he had experienced a fever and cough for 4 days. Hemorrhage, respiratory failure, ARDS and other symptoms appeared soon after admission. Due to severe pulmonary hemorrhage secondary to ARDS, mechanical ventilation was performed through tracheal intubation. During intubation, the patient suffered cardiac arrest, and the patient’s condition worsened. He was confirmed to have leptospirosis through second-generation sequencing of the alveolar lavage fluid. Finally, we successfully treated the patient with penicillin as an anti-infective medication and venous-venous extracorporeal membrane oxygenation (v-vECMO). To the best of our knowledge, this report is the first to describe the successful application of ECMO in mainland China. Conclusions Leptospirosis can induce serious but transient ARDS with a better prognosis than other causes of ARDS. Our patient was successfully treated with V-vECMO.

Coexistence of pancreatic adenocarcinoma and a pseudocyst in cat

Exocrine pancreatic tumors in cats and dogs are very uncommon, with exocrine pancreatic adenocarcinoma described as a particularly rare, malignant tumor in a small animals. It is usually derived from pancreatic ducts, as well as glandular tissue. Very often the disease has a subclinical course and is diagnosed only during post – mortem examination. Adenocarcinoma metastasize to both the surrounding and distant organs. The etiology of the cancer progress in the pancreas remains unknown.Pancreatic pseudocyst (pseudocystis pancreatis) is a very rare disease in domestic animals. Only a few cases of pancreatic pseudocyst in dogs and cats are described in the available literature. On the other hand, in humans it is a common complication of pancreatitis. The pancreatic pseudocyst can be a result of pancreatitis, as well as be a secondary condition to acute pancreatitis, trauma or chronic inflammation. It is a capsule made of fibrous or granulation tissue, containing sterile pancreatic juice. The pathogenesis of pancreatic pseudocyst is still unknown. Clinical signs are not specific and may resemble symptoms of pancreatitis. The ultrasound examination shows a cyst in the pancreas.This paper describes the case of pancreatic adenocarcinoma in a cat that occurred simultaneously with the pancreatic pseudocyst. Currently, literature indicates the necessity to differentiate the above cancer from cystic lesion. Due to the simultaneous occurrence of both pathologies, extremely rare diagnosis and spectacular picture of changes, it was decided to present this case.

Hypertriglyceridemic pancreatitis: epidemiology, pathophysiology and clinical management

Hypertriglyceridemic pancreatitis (HTGP) typically occurs in patients with an underlying dyslipidemia (such as type I, IV or V dyslipidemia) and in the presence of a secondary condition, such as inadequately controlled diabetes, excess alcohol consumption or medication use. Although the symptoms of HTGP are similar to those of acute pancreatitis from other etiologies, HTGP is often associated with greater clinical severity and rate of complications. Therefore, accurate diagnosis of HTGP is essential so that patients receive the appropriate treatment. Novel therapies that aim to reduce the incidence of pancreatitis in this patient population are now available or in development. Understanding the etiology, pathophysiology and clinical characteristics of HTGP will enable future development of therapeutic agents to treat HTGP.

Smooth Non-increasing Square Spatial Extents of Filters in Convolutional Layers of CNNs for Image Classification Problems

The present paper considers an open problem of setting hyperparameters for convolutional neural networks aimed at image classification. Since selecting filter spatial extents for convolutional layers is a topical problem, it is approximately solved by accumulating statistics of the neural network performance. The network architecture is taken on the basis of the MNIST database experience. The eight-layered architecture having four convolutional layers is nearly best suitable for classifying small and medium size images. Image databases are formed of grayscale images whose size range is 28 × 28 to 64 × 64 by step 2. Except for the filter spatial extents, the rest of those eight layer hyperparameters are unalterable, and they are chosen scrupulously based on rules of thumb. A sequence of possible filter spatial extents is generated for each size. Then sets of four filter spatial extents producing the best performance are extracted. The rule of this extraction that allows selecting the best filter spatial extents is formalized with two conditions. Mainly, difference between maximal and minimal extents must be as minimal as possible. No unit filter spatial extent is recommended. The secondary condition is that the filter spatial extents should constitute a non-increasing set. Validation on MNIST and CIFAR- 10 databases justifies such a solution, which can be extended for building convolutional neural network classifiers of colour and larger images.

Acute acalculous cholecystitis: from common to rare causes

Diagnostic and therapeutic approaches of acute calculous cholecystitis are well defined. Cholecystectomy is among the most frequently performed surgical interventions. In contrast, acute acalculous cholecystitis is a secondary condition; its cause may be difficult to determine and indication for surgical intervention has not been clearly established. The authors summarize the primary causes of acute acalculous cholecystitis and discuss ultrasonographic features which may help the decision to perform cholecystectomy in patients with acalculous cholecystitis. Orv. Hetil., 2014, 155(3), 89–91.

Symptomatic Secondary Selective IgM Immunodeficiency in Adult Man with Undiagnosed Celiac Disease

Selective IgM immunodeficiency (SIgMID) is a heterogeneous disorder with no known genetic background and may occur as a primary or a secondary condition. Celiac disease has been reported in association with several humeral immunodeficiencies, including isolated severe selective IgA deficiency, panhypogammaglobulinemia, and isolated combined IgA and IgM deficiency. There are only few reported cases of pediatric and adult patients with SIgMID and celiac disease. In this paper, we describe an adult patient with a symptomatic secondary SIgMID associated with undiagnosed celiac disease, with a resolution of clinical symptoms of immunodeficiency and serum IgM normalization following a gluten-free diet.