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Background: Idiopathic intracranial hypertension (IIH or pseudotumor cerebri) has two major morbidities: papilledema with visual loss and disabling headache. Intracranial Venous Hypertension (IVH) is a fundamental mechanism of IIH. Although traditionally considered limiting to the central nervous system, evidence suggests IIH as a systemic disease associated with cardiorespiratory disorders, which has been far less comprehended. Case Report: A 60-year-old female with Chronic Obstructive Pulmonary Disease (COPD) was admitted for dyspnea and developed a coma with a pH of 7.01 and pCO2 of 158 mmHg. She was intubated and had persistent nuchal rigidity, a brief myoclonus episode with a negative electroencephalogram, and negative CT head studies. A Lumbar Puncture (LP) revealed elevated opening pressure (35 cmH2O) with normal Cerebral Spinal Fluid (CSF) studies. Her nuchal rigidity improved after the removal of 40 mL CSF. The ophthalmology examination the next day after her the large volume LP didn’t show visual loss or papilledema. The patient improved clinically and was extubated two days later. Her echocardiogram showed a dilated right ventricle with pulmonary hypertension. The patient was discharged home.Discussion: IIH is different from hypercapnic encephalopathy and characterized by increased intracranial pressure with papilledema, vision loss, and debilitating headache. Hypercapnia-induced increased intracranial venous flow and pulmonary hypertension-caused elevated central venous pressure with consequent outflow resistance lead to IVH. In hypercapnic encephalopathy, the presentation is mostly cognitive changes. In this case, nuchal rigidity with a negative CT head scan triggered the investigation of IIH. Conclusion: A deep understanding of the relationship between COPD and IIH is vital. There is insufficient evidence to recommend routine eye examinations in COPD patients for papilledema and to conduct a pulmonary function test for a newly diagnosed IIH patient. However, we highly suggest a timely ophthalmology exam prior to performing an LP in COPD patients with suspecting IIH to avoid unnecessary procedures and meanwhile improve clinical outcomes.

Nobody doubts that mathematics plays a crucial role in medical achievements. It is certain that is being mainly used in statistics and physics for biomedical problems [1]. For sure that we have already heard about how mathematics can improve the anticancer arsenal [2]. Quantitative genetics have triggered a giant potential in medical care [3,4]. And mathematical algorithms, provided by artificial intelligence, continuously boost new therapeutic paradigms [5,6]. Nonetheless, one cannot ignore the ability of mathematics for analyzing ideas.

Indole acetic acid (AIA) is the most important plant growth hormone since it intervenes in the mechanisms of cell growth and differentiation and is produced mostly in the meristematic zones of the plant for apical dominance or root growth. AIA is also produced in root nodules and plant galls. In the latter cases, its presence is associated with endophytic bacteria. Although it is a plant growth hormone, it is also produced by bacteria such as Azospirillum brasilense and Bradyrhizobium japonicum. These species live in the soil (rhizosphere) or can colonize the roots (endophytic) of their hosts. From these bacteria, there are also isolates that are nitrogen fixers, which in addition to providing growth factors to plants, contribute by releasing nitrogenous molecules that improve plant nutrition.

Acute cholecystitis is a common general surgery disease which may require hospital admission. Delayed or early cholecystectomy is the definitive treatment. Availability of theatre slots may postpone cholecystectomy for weeks. I am writing this letter to explain the importance of early cholecystectomy programme and the necessity of support such programme by hospital managers. I will rationalize the concept of such program and its clinical and economic benefits. There are many strong evidences that early laparoscopic cholecystectomy (ELC) is a better option than delayed laparoscopic cholecystectomy (DLC) for management of acute cholecystitis. For example, a meta-analysis study showed ELC as safe and effective as DLC and it is associated with lower hospital costs, fewer work delay lost and greater patient satisfaction [1]. Furthermore, US Medicare database that include 29818 elderly patients with acute cholecystitis found a higher risk for mortality over the following two years in patients who were discharged without surgery compared with patients who underwent cholecystectomy in the initial hospitalization [2]. The risk of hospital re-admission after first attack of acute cholecystitis has been studied in a population –based analysis of the clinical course of 10304 patients with acute cholecystitis who discharged without cholecystectomy. Such analysis showed that the probability of a gall stone –related A&E visit or admission within 6 weeks, 12 weeks and 1 year was 14%, 19% and 29% respectively [3]. This will increase the gall stone disease burden and decrease patients’ satisfaction. Per NICE guidelines we should offer ELC (to be carried out within 1 week of diagnosis) to patients with acute cholecystitis. Patients who had pancreatitis secondary to gallbladder stones should have laparoscopic cholecystectomy in the index admission [4]. NICE full health economy report showed that ELC burden is 2728.27 in compare to 3686.21 for DLC [5]. Furthermore, 2018/2019 NHS tariff for emergency laparoscopic cholecystectomy is between 6885 to 3872 pounds, while it is 3731 to 2080 pounds only for an elective case. To sum up, ELC is as safe as DLC with potential lower mortality risk in elderly patients. In addition to eliminate the risk of re–admission after first attack of cholecystitis and decrease health care burden of gall bladder stones disease.

Ironman Wales sept 14th 2014 Sea swim (2.4 mile), bike ride (112 mile) and Marathon (26 mile), all in one day! There are lessons that the 7.8 million UK Chronic Pain patients can learn from the world of endurance sports, and vice versa [1]. The training, psychological tools and strategies used by athletes to complete an endurance event, are equally relevant for those with chronic pain, who wish to regain some form of “normal” life if treatment therapies have failed [2,3]. This is my reflection of how, using some of the techniques involved in Pain Management Programs, I trained for an Ironman Triathlon in just over one year.

Type 2 diabetes is a common disease in these days and day by day it is arising. The main focus of the study was to investigate association of packed cell volume (PCV), Mean Corpuscular Volume (MPV), Mean Corpuscular Hemoglobin Concentration (MCHC), Red Cell Distribution Width (RDW) with glycemic marker HbA1c. So that PCV, MPV, MCHC, RDW could be used as a predictor of glucoregulation in type 2 diabetes instead of HbA1c value. This study included 87 DMT2 patients, which divided into two groups, A (n=41, presence in diabetics≤6.5-6.9%) and B (n=46, target in diabetes≥7.0%), according to HbA1c values. Spearsman correlation co-efficients were calculated to evaluate the relationship between RBC count, MCHC, RDW with random blood sugar (RBS) and PCV, MCV, MCHC with HbA1c value. Binominal logistic regression analysis was performed to estimate the relationship between glycemic control, as dichotomous outcome of MCHC, RDW, PCV, and MCV as the main prognosticator. MCHC and RDW were significantly higher in the group B compared to the group A. RDW and MCHC may be applied as the auxiliary indicators of deterioration of glucoregulation.

The incidence of recurrent vulvovaginal candidiasis (RVVC) is extremely high. RVVC is likely to have a greater impact on patients. The aim of the study was to explore the risk factors of recurrent vulvovaginal candidiasis (RVVC) in the tropical coastal area. In this case-control study, a questionnaire survey was conducted in patients with VVC in the Sanya area from July 2014 to December 2016. The data included demographic characteristics, host factors, and behavioural characteristics. According to the maximum number of symptomatic episodes per year, the participants were classified into a non-recurrent VVC (NRVVC; < 4 episodes/year, including the current one) group or a RVVC group (≥ 4 episodes/year, including the current one). Crude odds ratios were calculated for potential risk factors and were adjusted using logistic regression. All vaginal secretions of patients with RVVC were cultured. Of the 728 cases of VVC, 69.0% (502/728) were NRVVC, and 31.0% (226/728) were RVVC. Previous antibiotic treatment (adjusted OR: 4.41, p < 0.01), repeat abortion (p < 0.05), and vaginal lavage (adjusted OR: 1.62, p < 0.05) were significantly associated with RVVC. A total of 230 yeasts isolates were obtained from 226 patients. C. albicans were the predominant Candida species (194 strains) in all patients of VVC. Our results demonstrate that in the tropical coastal area, a significant association was found between previous antibiotic treatment and incident RVVC. Host factors may be the most important factors in the occurrence of RVVC.

Purpose: The benefits of Physical Activity (PA) considered as a major supportive care in cancer patients, on survival, and recurrence risk is largely disseminated in public communication. However, these data must be taken with caution. The main objectives were to review the evidence and limits of studies reported regarding the post-diagnosis PA role on cancer survival and recurrence risk to secondly discuss of research perspectives on PA programs. Method: The narrative review included all published or ongoing studies in English during the last 20 years related to PA, survival and recurrence risk with a systematic search on main databases. Results and discussion: The current evidences regarding the PA role on survival and recurrence risk were only based on cohort studies, mainly in breast cancer. The major methodological limits identified as the lack of PA change assessment, PA level assessed largely by self-reported methods and the significant inter- but also intra- variability make the interpretation of data very. Beyond the use of rigorous RCT, the major issue is to develop adapted and personalized interventions to progressively increase PA level overtime in cancer survivors. Conclusion: Despite the lack of causal relationship between post-diagnosis PA, survival and recurrence risk, the review underlines several interesting research perspectives. The future PA interventions, using innovative tools and integrated to the “real-life” will argued for the potential antitumoral PA role growing in literature.

Introduction: Chronic kidney disease is a costly and burdensome public health concern. Delayed recognition and treatment of CKD may predispose patients to unfavorable future outcomes and burden the healthcare services. The early detection of disease via screening programs is widely recommended. The present study is a hospital camp-based screening for detecting patients with chronic kidney disease in Varanasi from 2014-18. Methods: The study subjects constituted 436 apparently healthy adults (age ≥18 years) of Varanasi. Information on socio-demographic profile, personal characteristics and clinical investigations were recorded. Stepwise binary logistic regression analysis was applied to find the significant predictors of chronic kidney disease. Results: Median age of the study subjects was 40.5 years. There were 39.7% males and 60.3% females. Chronic kidney disease was found in 23.9% subjects. Underweight, diabetes mellitus, hypertension, smoking status and higher creatinine levels came out as significant predictors of chronic kidney disease. Conclusion: We screened apparently healthy individuals and found very high percentages of chronic kidney disease and its predictors. Henceforth, understanding the preventable and modifiable risk factors of chronic kidney disease becomes a prerequisite to intervene before risk populations reaches to irreversible stages of adverse future outcomes.

Poultry industry is a domineering section of agriculture sector in the world as it provides meat, income and employment. Of the poultry industry, broiler chicken is dominating, as US export was more than 41 billion pounds of chicken (about 16.5 percent of production) in 2017 [1]. In Pakistan, the poultry industry contributes around 1.4 percent to the GDP and 31 percent to total meat production [2]. The global demand for this meat is rising in developing world including Pakistan. To meet the needs, rearing of poultry at both domestic and commercial levels is imperative [3]. However, the industry faces a lot of constraints, preventing it from reaching its maximal potential.