bluuebunny/crossref_metadata_2025 huggingface dataset:
Verification of RNN-Based Neural Agent-Environment Systems
Authors: Akintunde Michael E. , Kevorchian Andreea , Lomuscio Alessio , Pirovano Edoardo
Published: August 2019

We introduce agent-environment systems where the agent is stateful and executing a ReLU recurrent neural network. We define and study their verification problem by providing equivalences of recurrent and feed-forward neural networks on bounded execution traces. We give a sound and complete procedure for their verification against properties specified in a simplified version of LTL on bounded executions. We present an implementation and discuss the experimental results obtained.
Consensus in Opinion Formation Processes in Fully Evolving Environments
Authors: Auletta Vincenzo , Fanelli Angelo , Ferraioli Diodato
Published: August 2019

Friedkin and Johnsen (1990) modeled opinion formation in social networks as a dynamic process which evolves in rounds: at each round each agent updates her expressed opinion to a weighted average of her innate belief and the opinions expressed in the previous round by her social neighbors. The stubbornness level of an agent represents the tendency of the agent to express an opinion close to her innate belief.

Motivated by the observation that innate beliefs, stubbornness levels and even social relations can co-evolve together with the expressed opinions, we present a new model of opinion formation where the dynamics runs in a co-evolving environment. We assume that agents’ stubbornness and social relations can vary arbitrarily, while their innate beliefs slowly change as a function of the opinions they expressed in the past. We prove that, in our model, the opinion formation dynamics converges to a consensus if reasonable conditions on the structure of the social relationships and on how the personal beliefs can change are satisfied. Moreover, we discuss how this result applies in several simpler (but realistic) settings.
Successor Features Based Multi-Agent RL for Event-Based Decentralized MDPs
Authors: Gupta Tarun , Kumar Akshat , Paruchuri Praveen
Published: August 2019

Decentralized MDPs (Dec-MDPs) provide a rigorous framework for collaborative multi-agent sequential decisionmaking under uncertainty. However, their computational complexity limits the practical impact. To address this, we focus on a class of Dec-MDPs consisting of independent collaborating agents that are tied together through a global reward function that depends upon their entire histories of states and actions to accomplish joint tasks. To overcome scalability barrier, our main contributions are: (a) We propose a new actor-critic based Reinforcement Learning (RL) approach for event-based Dec-MDPs using successor features (SF) which is a value function representation that decouples the dynamics of the environment from the rewards; (b) We then present Dec-ESR (Decentralized Event based Successor Representation) which generalizes learning for event-based Dec-MDPs using SF within an end-to-end deep RL framework; (c) We also show that Dec-ESR allows useful transfer of information on related but different tasks, hence bootstraps the learning for faster convergence on new tasks; (d) For validation purposes, we test our approach on a large multi-agent coverage problem which models schedule coordination of agents in a real urban subway network and achieves better quality solutions than previous best approaches.
IPOMDP-Net: A Deep Neural Network for Partially Observable Multi-Agent Planning Using Interactive POMDPs
Authors: Han Yanlin , Gmytrasiewicz Piotr
Published: August 2019

This paper introduces the IPOMDP-net, a neural network architecture for multi-agent planning under partial observability. It embeds an interactive partially observable Markov decision process (I-POMDP) model and a QMDP planning algorithm that solves the model in a neural network architecture. The IPOMDP-net is fully differentiable and allows for end-to-end training. In the learning phase, we train an IPOMDP-net on various fixed and randomly generated environments in a reinforcement learning setting, assuming observable reinforcements and unknown (randomly initialized) model functions. In the planning phase, we test the trained network on new, unseen variants of the environments under the planning setting, using the trained model to plan without reinforcements. Empirical results show that our model-based IPOMDP-net outperforms the other state-of-the-art modelfree network and generalizes better to larger, unseen environments. Our approach provides a general neural computing architecture for multi-agent planning using I-POMDPs. It suggests that, in a multi-agent setting, having a model of other agents benefits our decision-making, resulting in a policy of higher quality and better generalizability.
General Robustness Evaluation of Incentive Mechanism against Bounded Rationality Using Continuum-Armed Bandits
Authors: Hu Zehong , Zhang Jie , Li Zhao
Published: August 2019

Incentive mechanisms that assume agents to be fully rational, may fail due to the bounded rationality of agents in practice. It is thus crucial to evaluate to what extent mechanisms can resist agents’ bounded rationality, termed robustness. In this paper, we propose a general empirical framework for robustness evaluation. One novelty of our framework is to develop a robustness formulation that is generally applicable to different types of incentive mechanisms and bounded rationality models. This formulation considers not only the incentives to agents but also the performance of mechanisms. The other novelty lies in converting the empirical robustness computation into a continuum-armed bandit problem, and then developing an efficient solver that has theoretically guaranteed error rate upper bound. We also conduct extensive experiments using various mechanisms to verify the advantages and practicability of our robustness evaluation framework.
Message-Dropout: An Efficient Training Method for Multi-Agent Deep Reinforcement Learning
Authors: Kim Woojun , Cho Myungsik , Sung Youngchul
Published: August 2019

In this paper, we propose a new learning technique named message-dropout to improve the performance for multi-agent deep reinforcement learning under two application scenarios: 1) classical multi-agent reinforcement learning with direct message communication among agents and 2) centralized training with decentralized execution. In the first application scenario of multi-agent systems in which direct message communication among agents is allowed, the messagedropout technique drops out the received messages from other agents in a block-wise manner with a certain probability in the training phase and compensates for this effect by multiplying the weights of the dropped-out block units with a correction probability. The applied message-dropout technique effectively handles the increased input dimension in multi-agent reinforcement learning with communication and makes learning robust against communication errors in the execution phase. In the second application scenario of centralized training with decentralized execution, we particularly consider the application of the proposed messagedropout to Multi-Agent Deep Deterministic Policy Gradient (MADDPG), which uses a centralized critic to train a decentralized actor for each agent. We evaluate the proposed message-dropout technique for several games, and numerical results show that the proposed message-dropout technique with proper dropout rate improves the reinforcement learning performance significantly in terms of the training speed and the steady-state performance in the execution phase.
Symmetry-Breaking Constraints for Grid-Based Multi-Agent Path Finding
Authors: Li Jiaoyang , Harabor Daniel , Stuckey Peter J. , Ma Hang , Koenig Sven
Published: August 2019

We describe a new way of reasoning about symmetric collisions for Multi-Agent Path Finding (MAPF) on 4-neighbor grids. We also introduce a symmetry-breaking constraint to resolve these conflicts. This specialized technique allows us to identify and eliminate, in a single step, all permutations of two currently assigned but incompatible paths. Each such permutation has exactly the same cost as a current path, and each one results in a new collision between the same two agents. We show that the addition of symmetry-breaking techniques can lead to an exponential reduction in the size of the search space of CBS, a popular framework for MAPF, and report significant improvements in both runtime and success rate versus CBSH and EPEA* – two recent and state-of-the-art MAPF algorithms.
Multi-Agent Discussion Mechanism for Natural Language Generation
Authors: Li Xu , Sun Mingming , Li Ping
Published: August 2019

We introduce the discussion mechanism into the multiagent communicating encoder-decoder architecture for Natural Language Generation (NLG) tasks and prove that by applying the discussion mechanism, the communication between agents becomes more effective. Generally speaking, an encoder-decoder architecture predicts target-sequence word by word in several time steps. At each time step of prediction, agents with the discussion mechanism predict the target word after several discussion steps. In the first step of discussion, agents make their choice independently and express their decision to other agents. In the next discussion step, agents collect other agents’ decision to update their own decisions, then express the updated decisions to others again. After several iterations, the agents make their final decision based on a well-communicated situation. The benefit of the discussion mechanism is that multiple encoders can be designed as different structures to fit the specified input or to fetch different representations of inputs.We train and evaluate the discussion mechanism on Table to Text Generation, Text Summarization and Image Caption tasks, respectively. Our empirical results demonstrate that the proposed multi-agent discussion mechanism is helpful for maximizing the utility of the communication between agents.
Single-Cell Transcriptomic Map of the Human and Mouse Bladders
Authors: Yu Zhenyuan , Liao Jinling , Chen Yang , Zou Chunlin , Zhang Haiying , Cheng Jiwen , Liu Deyun , Li Tianyu , Zhang Qingyun , Li Jiaping , Yang Xiaobo , Ye Yu , Huang Zhiguang , Long Xinyang , Yang Rirong , Mo Zengnan
Published: August 2019

Significance Statement

Previous studies of bladder cell classification mostly relied on the cell’s morphology, location, electrophysiology, and function. However, it is difficult to classify bladder cells accurately and comprehensively using these methods. The authors created a single-cell transcriptomic map of human bladder cells using single-cell RNA sequencing. They also created a more detailed single-cell sequencing RNA map of the mouse bladder than what was previously available. Using these tools, the authors compare the similarities and differences between human and mouse bladder cells and found many cell types that are highly similar across the two. Additionally, the authors discovered two new types of human bladder cells. One may play a role in allergic reactions and nerve conduction, whereas the other may play a role in bladder emptying. The results may assist scientists studying the relationship between bladder cell types and diseases.

Background

Having a comprehensive map of the cellular anatomy of the normal human bladder is vital to understanding the cellular origins of benign bladder disease and bladder cancer.

Methods

We used single-cell RNA sequencing (scRNA-seq) of 12,423 cells from healthy human bladder tissue samples taken from patients with bladder cancer and 12,884 cells from mouse bladders to classify bladder cell types and their underlying functions.

Results

We created a single-cell transcriptomic map of human and mouse bladders, including 16 clusters of human bladder cells and 15 clusters of mouse bladder cells. The homology and heterogeneity of human and mouse bladder cell types were compared and both conservative and heterogeneous aspects of human and mouse bladder evolution were identified. We also discovered two novel types of human bladder cells. One type is ADRA2A
+ and HRH2
+ interstitial cells which may be associated with nerve conduction and allergic reactions. The other type is TNNT1
+ epithelial cells that may be involved with bladder emptying. We verify these TNNT1
+ epithelial cells also occur in rat and mouse bladders.

Conclusions

This transcriptomic map provides a resource for studying bladder cell types, specific cell markers, signaling receptors, and genes that will help us to learn more about the relationship between bladder cell types and diseases.
THE INFLUENCE OF GEOLOGICAL HETEROGENEITY OF LAYERS ON THE WORK OF UNDERGROUND GAS STORAGE FACILITIES
Authors: Dubei N.
Published: August 2019

As a result of the analysis of studies in the field of the creation and operation of underground gas storage facilities (PSG) in the conditions of heterogeneous reservoirs, the lack of a comprehensive method for incorporating the heterogeneity factor at the stage of their design is established. As a result, there is a significant overestimation of project indicators comparing to actual and a decrease in the efficiency of the operation of the subsystem.

In this article, the author presents methodological developments for the account of the heterogeneity of the reservoir at the design stage of the UGS, which contains specific proposals for the refinement of initial stocks and gas-saturated reservoir volume by reinterpreting the dependence of reduced reservoir pressure on the total amount of gas in underground gas storage.

The purpose of this work is to assess the impact of geological and industrial factors on the technological performance of the PSG, created in exhausted gas deposits, by comparing the characteristics of the work of Oparsky and Bogorodchansky UGS. To achieve this goal, the geologicalindustrial features of the Oparsky and Bogorodchansky UGS have been investigated; the methodology for studying geological heterogeneity has been developed; the influence of geological factors on the technological parameters of the operation of the UHF is investigated.

The results of the study are of practical importance. The use of the methodology for studying the nature of the heterogeneity of reservoir layers is necessary in the design of new gas storage facilities and in the adjustment of technological projects on gas-fired power stations that are in operation and created in non-uniform collectors.
Effect of Split N-Fertilizer Application on Soil Quality and Maize Yield of Tropical Alfisol
Authors: Dayo-Olagbende G. Olufemi
Published: August 2019

A field experiment was conducted to determine the effect of split application of nitrogen fertilizer on soil properties and maize yield. Two sites at Apatapiti layout, South gate of the Federal University of Technology Akure were used as the experimental sites. The experiment was designed in a randomized-complete-block design arrangement with three replications. The treatments consisted of urea applied at four levels of split application (0kgha-1, 60kgha-1 basal application, 30kgha-1 basal application+ 30kgha-1 applied at 15 days after planting, 30kgha-1basal application + 20kgha-1applied at 15 days after planting + 10kgha-1applied at 30 days after planting). The plot size was 2 m x 2 m with 1 m space between plots and blocks. Maize (Zea mays L. var. TZB-SR) was planted at 75 cm by 25 cm spacing and 10 were sampled per unit for yield parameters. Split application of urea (30kgha-1basal application + 20kgha-1applied at 15 days after planting + 10kgha-1applied at 30 days after planting) significantly (p>0.05) increased N content of the soil. There was no significant (p>0.05) difference with regard to other nutrients. Soil pH was significantly (p>0.05) reduced as a result of urea application in all treatments. Split urea fertilizer application retained a considerable amount of nitrogen in soil even after the harvest of maize. Exchangeable cations were not significantly different from one another as well as CEC. Split application of urea (30kgha-1basal application + 20kgha-1applied at 15 days after planting + 10kgha-1applied at 30 days after planting) gave the highest grain yield of maize for both sites. Also, plant biomass of both split application were better than the basal application and control.
CRISPR-Cas Genome Editing Tool: Mechanisms of Pathogen Resistance Plants – Review
Authors: Kalidoss Karthik
Published: August 2019

In recent years, the CRISPR-Cas system is most familiar and advance genome editing tool in modern biological research. The genome editing tool used in various biological researchers worldwide in past years has witnessed exposure site-directed mutagenesis modification methods zinc finger nucleases (ZFNs), transcription activator-like effector nucleases (TALENs), Meganucleases and CRISPR-Cas9(associated proteins 9). CRISPR-Cas genome editing technology to ease design and implement, more flexible and less expensive. Plants are affected two types of stresses like biotic and abiotic. Abiotic occurs naturally temperature or wind, sunlight depend upon on the environmental conditions. Biotic stress is caused by pathogens of virus, fungi, bacteria, etc. This review to focus on the recent advance of plant protection use CRISPR-Cas system mechanism of disease resistant plants in past and current trends of research. A short overview of the experimental methodology for Beet Curly Top Virus (BCTV) disease and Magnaporthe oryzae fungus infection cause rice blast disease resistance mechanisms will be discussed. Furthermore, the need developments of this genome editing tool in future.
Perception of second professional undergraduate medical students and teachers about pharmacy practical classes in pharmacology curriculum
Authors: Karmakar Anindya , Mandal Ananya , Mandal Sonai , Gangopadhyay Tanmoy , Naser Syed Mohammad
Published: August 2019

Background: The practice and teaching in the MBBS curriculum has changed over the last few decades and most of it caters to the making of the Indian Medical Graduate (IMG) and the first contact physician of the community. The most notable change in pharmacy in modern times has been the virtual disappearance of the preparation and compounding of medicines. Pharmacy practical classes still form a part of the MCI curriculum in Pharmacology undergraduate teaching in many states of India including West Bengal. This study was undertaken to assess the attitude of students as well as teachers towards continuation of these practical classes in the curriculum and possible alternatives.Methods: Second year pharmacology students were included in the study (n=143). Along with this 10 faculty members were provided a structured and pre-tested questionnaire to be answered anonymously.Results: It was seen that 89 percent students and 100 percent faculty members wanted these practical classes to be discontinued. The most popular alternative to these classes were ADR reporting from the faculty members (90%) and demonstration of clinical effects of drugs and dosage calculation (86%) among the students.Conclusions: Given the lessening importance and relevance of the pharmacy practical classes in today’s day to day practice, a change in curriculum and examination system in Pharmacology must be considered.
Evaluation of eye prescriptions for appropriateness and rationality in indoor patients: an observational prospective study
Authors: Mark Andrew , Desai Sagun
Published: August 2019

Background: In the branch of ophthalmology, there have been many developments of new ocular therapeutic agents. Indiscriminate use of topical drugs can lead to various unwanted effects. In order to improve drugs therapeutic efficacy, minimize adverse effects, and delay development of resistance, drug utilization trends and patterns need to be evaluated periodically. The objective of the study was to evaluate drug utilization pattern, appropriateness of use and rationality in indoor patients attending ophthalmology department.Methods: A prospective, observational study was conducted over a period of 15 months in the Ophthalmology Department of Tertiary care teaching Hospital after obtaining permission from IEC. Information of patients collected included age, sex, duration of stay, diagnosis, income per capita per month, information about drugs given- their dose, frequency, route and duration were recorded from the day of admission till discharge.Results: A total of 150 patients were enrolled in the study with M:F was 1.43:1. Mean hospitalization was 3.00±1.17 days. Most common disease were cataract (108, 72%) followed by pterygium (15, 10%). Mean of 16.35±4.25 medicines were prescribed. On most occasions (2274, 92.70%) the medicines were prescribed using brand names. Injection gentamicin 147 (98%) and flurbiprofen eye drops 145 (96.67%) were the most common drugs used. Majority (83.20%) of medicines were rational. Out of 125 medicines, 35 (28%) were FDC and 90 (72%) were single ingredient. All 100% medicine uses were appropriate with respect to dosage form, route of administration, dosage, frequency of administration and duration of therapy.Conclusions: Polypharmacy is common practice in eye department which increases inappropriateness and irrational use.
Drug utilization pattern and analysis of quality of life in Indian patients of Parkinson’s disease
Authors: Shah Jugal , Joshi Pranav , Sood Shikha V. , Rana Devang , Malhotra Supriya D.
Published: August 2019

Background: Parkinson's disease (PD) is a highly debilitating disease characterized by tremors, bradykinesia and rigidity. It leads to lowered self-esteem and psychological consequences which affect quality of life. The aim of this study is to study the drug utilization pattern and assess the quality of life in patients of Parkinson’s Disease.Methods: 40 patients of PD at least 1 month duration and 20 age-based controls were analyzed for quality of life using Parkinson’s Disease Questionnaire-39 (PDQ-39). Drug prescriptions were analyzed.Results: Mean number of anti-Parkinson drugs prescribed is 2.65±1.21. Of 106 anti-Parkinson drugs prescribed, 45% were levodopa and carbidopa combinations, followed by dopamine agonists (18%), anticholinergic drugs (15%), amantadine (12%), MAO inhibitors (5%) and COMT inhibitors (5%). There were significant problems in speech, performance of daily chores and daytime somnolence (p<0.0001). Depression, isolation, cognitive decline and memory loss were noteworthy in the patients as compared to controls (p<0.05). 25% patients felt embarrassed due to their disease; 59% felt affected by others’ opinion, 60% felt difficulty in communicating with others (p<0.05). Almost 2/3rd patients needed help in personal care as compared to the control group (p<0.0001).Conclusions: Quality of life of parkinsonian patients is severely affected in spite of them receiving a large number of drugs. This may be both due to disease progression as well as medication. Levodopa-carbidopa combination is the most prescribed medication. Use of levodopa and carbidopa combination must be evaluated properly. Newer guidelines and interventions are the need of the hour which may provide a better outcome on the quality of life of parkinsonian patients.
A comparative study for efficacy and safety of low doses of clonidine for hemodynamic stability in patients undergoing laparoscopic cholecystectomy
Authors: Choudhary Ruchi , Singh Preeti , Gupta Surabhi , Khosla P. P. , Matreja Prithpal S. , Singh Upmanyu
Published: August 2019

Background: This randomized prospective double-blind study was designed to evaluate the efficacy and side effects of low doses clonidine for perioperative haemodynamic stability and postoperative recovery.Methods: Patient’s with ASA grade I–II undergoing laparoscopic cholecystectomy were randomized into three groups of 30 patients each. All patients received either normal saline 10 ml (Group I) or 0.8 µg/kg (Group II) or 1 µg/kg (Group III) over duration of 180 seconds, 10 min prior to laryngoscopy and intubation. Anaesthesia was induced with 1% propofol (2 mg/kg) and maintained with nitrous oxide 60% in oxygen and isoflurane. The parameters assessed at various time intervals were heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure and sedation score.Results: Both doses of clonidine proved to be effective in perioperative haemodynamic stability. Clonidine 0.8 mcg/kg was as effectve and safer to Clonidine 1 mcg/kg for attenuatíon of the hemodynamíc responses to laparoscopy. There were no significant differences in the parameters of recovery between groups.Conclusions: Significant hemodynamic derangements can occur during laproscopic cholecystectomy at intubation, pneumoperitoneum and extubation. These were effectively attenuated by premedication with 0.8 mcg/kg and 1 mcg/kg of intravenous clonidine. Dose of 1 mcg/kg though found to be effective but produced adverse effects in form of hypotension and bradycardia.
A study on the knowledge, attitude and practice on adverse drug reactions and pharmacovigilance among post graduate residents in Gandhi Medical College, Bhopal
Authors: Hindoliya Mukesh , Chitapure Faizan
Published: August 2019

Background: Resident doctors should consider adverse drug reaction (ADR) reporting as their professional obligation and should be aware of the existing pharmacovigilance mechanisms in their countries. In India, pharmacovigilance implementation is essential due to the absence of a vibrant ADR monitoring system. The present study primary objective was to evaluate the knowledge, attitude and practices (KAP) of the postgraduate students towards pharmacovigilance and ADR reporting in GMC, Bhopal as they observe and attend to the patients round the clock while the patient is admitted in the hospital.Methods: A cross-sectional-observational study was carried out using a pretested questionnaire having 17 questions in all. Data was compiled, entered in Microsoft Excel sheet and analysed by descriptive statistics.Results: A total of 127 duly filled responses were analysed. Study shows ADR is necessary and Pharmacovigilance should be taught in detail to postgraduate students is an important finding from our study. In this study there was also a wide gap between the ADR experienced in professional practice (71%) and ADR reported (23%).Conclusions: In our present study, the average knowledge score was 64% in contrast to 32% residents who didn’t answered correctly. Though majority (87%) of the residents had a positive attitude towards awareness about Pharmacovigilance and ADR reporting, however in clinical scenario even as ADR reporting was considered to be important by a large majority of the participants, the actual practices of ADR reporting was very low.
Study of vitamins in pulmonary Tuberculosis
Authors: Dalvi Shubhangi M. , Patil Vinayak W. , Ramraje Nagsen N. , Yeram Neelam , Meshram Priti
Published: August 2019

Background: In recent years, progress in Tuberculosis (TB) control and eradication has been threatened by the emergence of drug resistant strains of Mycobacterium tuberculosis (MTB). Several studies describe micronutrient malnutrition in TB. This study focuses on the effect of drug resistance and disease progression on levels of various vitamins.Methods: The case control study comprised of 50 normal healthy human volunteers (Control), 50 newly diagnosed TB patients (CAT I) and 50 TB patients showing multi drug resistance (MDR). Recruited subjects were of both genders in age group of 18- 60 years and from different socioeconomic status. Blood serum samples analysed for levels of Vitamin A, Vitamin D, Vitamin E, Vitamin C, Vitamin B12 and Folic acid by using Spectrophotometer, ELISA and Chemiluminescence instruments. Statistical evaluation was done for correlation among variables.Results: The levels of vitamins in TB patients were significantly reduced when compared with controls. Also, MDR-TB patients showed severe malnourished state in comparison to those who were newly diagnosed for the disease.Conclusions: There is a need to provide vitamin supplements in proper sufficient dosage with anti-TB drugs during treatment, which will help fight against the disease and ensure rapid recovery of the patients.
Utility of Papanicolaou’s smears in the diagnosis of premalignant and malignant lesions of the cervix in a tertiary care centre of South Gujarat, India
Authors: Gandhi Shivangi S. , Shah Pinal C.
Published: August 2019

Background: "Preventable but not prevented", this is the reality of cervical cancer today, at least in developing countries. 80% of all the cases of cervical cancer occur in these developing countries. In India, cervical cancer is the leading cause of cancer related deaths in women. The Papanicolaou test is simple, quick, and painless. It is capable of detecting cervical cancer at an early stage and is used widely in developed countries, where it has decreased both the incidence and mortality of cervical cancer. Objective of the study was conducted to determine the importance of conventional Pap smears for the diagnosis of inflammatory, premalignant and malignant lesions of the cervix.Methods: This cross-sectional study was conducted from January 2017 to June 2018 on 2000 women coming for a Pap smear examination in Government Medical College attached to New Civil Hospital, Surat. After doing Pap stain, all cases were reported as per the 2014 Bethesda system.Results: A total of 2000 cases of Pap smears were received out of which 1914(95.7%) cases were satisfactory for evaluation, 86(4.3%) cases were unsatisfactory. The frequency of epithelial abnormalities was 3.66%. The age group of 51-60 years showed the highest epithelial abnormalities. The frequency of epithelial abnormalities in asymptomatic women was 2.3%. Out of the 1844 cases, 103(5.6%) showed changes of atrophy, 1011(54.8%) cases showed inflammatory/reactive changes, whereas organisms were seen in 558(30.3%) cases.Conclusions: Pap smear happens to be an economical, safe and pragmatic diagnostic tool for early detection of cervical cancer.
Pattern of regional metastasis in papillary thyroid cancer: our experience of 86 cases
Authors: Das Rajjyoti , Sharma Jagannath D. , Kataki Amal Ch , Kalita Chandi R. , Baishya Nizara
Published: August 2019

Background: Papillary thyroid cancer (PTC) have a high propensity for regional metastasis which ranges from 30- 80%. The objective of the study is to assess the pattern of lymph node metastasis and to plan the extent of neck dissection accordingly. Though central neck dissection (CND) is routinely done in PTC but the indication of extent of  neck dissection is still controversial.Methods: The medical records of   86 patients with PTC  who underwent total thyroidectomy (TT) and neck dissection at Dr. B. Borooah Cancer Institute(BBCI) from January 2010 to  December 2014 were retrospectively reviewed.Results: Out of 86 patients 22 were males and 64 were females. The median age of presentation was 40.0 years. 43 out of 86 patients (50%) had cervical lymph node metastasis. Ipsilateral nodal metastasis was found in 37 patients (43.0%) and contralateral metastasis was found in only 6 patients (7.0%).Tumors with size more than 3cm had ipsilateral nodal metastasis in 21(56.7%) patients which is statistically significant (p 0.03).A strong association was found between level VI and the ipsilateral group of lymph nodes involving level II,III,IV and V.Conclusions: Majority of patients present with multiple level nodal metastasis, with the central compartment commonly involved. In view of the high incidence of metastatic lymph nodes in levels II, III, IV and level VI ,our study  supports the recommendation  for posterolateral  and anterior  neck dissection in patients with clinically positive neck  nodes and tumor with aggressive criteria.
A study of cardiovascular sympathetic function tests during different phases of menstrual cycle in young females
Authors: Das Shampa , Panja Sumana , Samajdar Kaushik
Published: August 2019

Background:  Menstrual cycle is a regular coordinated physiological change in non-pregnant women. The variation of hormonal concentrations during different phases of the menstrual cycle has a profound influence on autonomic and metabolic activities. The present study was designed to assess the cardiovascular sympathetic functions during different phases of menstrual cycle in normal healthy eumenorrheic females.Methods:  Fifty females in the age group of 18-25 years were selected for the study. Non-invasive cardiovascular sympathetic function tests were performed during different phases of the menstrual cycle using RMS Polyrite D.Results: Results were analyzed using paired ‘t’ test. Resting blood pressure, blood pressure response to isometric handgrip test and cold pressor test were statistically significant higher (p-value <0.05), in the secretory phase as compared to menstrual and proliferative phase. Blood pressure response to orthostatic test was statistically significant between the proliferative and secretory phase and between menstrual and secretory phase (p-value <0.05).Conclusion: Our study shows that sympathetic activity is highest during the secretory phase of the menstrual cycle and lowest in the proliferative phase as compared to the menstrual phase. This higher sympathetic activity may be correlated with higher estrogen and progesterone levels during the secretory phase of the menstrual cycle. The study also emphasizes the complex relationship between ovarian hormones and autonomic regulatory systems.
A study on the lipid ratios and inflammatory markers in pre-diabetic and diabetic patients
Authors: Shrestha Shailaza , Sharma Preeti , Kumar Pradeep , Prasad Mahendra
Published: August 2019

Background: One of the leading causes of diabetic mortality is cardiovascular disease. Diabetes progression is preceded by pre-diabetic phase which is also at higher cardiovascular risk. Both hyperglycemia and atherosclerotic processes are inflammatory phenomenon. Keeping this in view, it was aimed to evaluate atherogenic indices and correlate them with inflammatory mediators.Methods: This study included 80 controls, 80 pre-diabetic and 80 diabetic patients. Anthropometric parameters (BMI, WHR) and blood parameters like fasting glucose, HbA1c, lipid profile (cholesterol, HDL, LDL TG, VLDL), adiponectin, IL-6, CRP, fibrinogen and uric acid were analysed.Results: Significantly high atherogenic indices were observed in pre-diabetic and diabetic subjects compared to healthy controls. The indices were also significantly correlated with BMI, fasting sugar, HbA1c, cholesterol, HDL, TG and LDL. The correlation with HDL was negative and with other parameters, the correlation was positive. In pre-diabetic patients, adiponectin showed significant negative correlation while fibrinogen and CRP showed significant positive correlation with cardiac risk indices. IL-6 was positively correlated only with AIP while correlation of uric acid with these indices was insignificant. In case of diabetic patients, the cardiac risk indices were significantly correlated with adiponectin, IL-6, CRP, fibrinogen and uric acid. The correlation with adiponectin was negative.Conclusions: The altered atherogenic indices and their significant association with inflammatory markers signify the direct association of inflammation with CVD risks. Thus, there is requirement of novel approaches that can retard inflammatory responses and arrest unwanted cardiac health outcomes.
A rare presentation of snake bite
Authors: Goswami Sourabh , Keswani Prakash , Sharma Shrikant
Published: August 2019

In India, doctor’s in casualty frequently get confronted with snake bite. A wide range of complications occur in snake bite. Intracerebral haemorrhage (ICH) is an unusual presentation following snake bite. Here authors discuss a patient presents with ICH after snake bite. Venom induced consumption coagulopathy is the most accepted theory behind intracerebral haemorrhage.
A rare case report of oral prednisolone dependence in a middle aged man
Authors: A. Chamelee , L. Lavanya , D. Vijayanand , S. Chandraleka G.
Published: August 2019

Dependence is an uncommon, but potentially sinister complication of corticosteroid therapy. prednisolone was the most frequently implicated corticosteroid in steroid dependence. Here we report a rare case of oral prednisolone dependence in middle aged man  who had chronic asthma.
Postoperative complications after total thyroidectomy for benign thyroid diseases
Authors: Nassar Mohammed Nazeeh Shaker , Algammal Ahmed Sabry
Published: August 2019

Background: The thyroid gland is normally impalpable, once enlarged it is called goiter which may be simple, toxic, inflammatory or neoplastic. Autoimmune thyroid disease (ATD) includes goiters associated with antigen antibody reaction that initiates a series of inflammatory reactions. Due to these inflammatory reactions surgeries become more difficult with a tendency to develop postoperative complications.Methods: This is a prospective study on 207 patients with thyroid disorders who were treated with total thyroidectomy in general surgery department, Menoufia university hospital between October 2015 and December 2018. Patients were divided into two groups based on postoperative histopathological findings group A included 73 patients with autoimmune thyroid disease while group B included 134 patients with non-autoimmune thyroid disease. All patients were followed up for 6 months postoperatively to evaluate vocal cord palsy and hypoparathyroidism.Results: In our study, the rate of temporary and permanent vocal cord palsies were 4.1% and 1.4% in ATD group respectively while in non-ATD group were 1.5% and 0.7% respectively with no statistically significant difference between both groups, whereas the rate of temporary and permanent hypoparathyroidism were 9.5% and 4.1% in ATD group respectively while in non-ATD group were 2.9% and 0.7% respectively with significantly higher rate in ATD group.Conclusions: Surgery for ATD is a challenging procedure but safe with a low incidence of general complications and vocal cord palsy when compared with surgery for non-ATD. However, postoperative hypoparathyroidism is significantly higher due to dense adhesions which obscure the surgical field so a special attention should be paid to the parathyroid glands during total thyroidectomy.
Primary hepatic tuberculosis mimicking malignancy
Authors: Akıcı Murat , Bozkurt Erhan , Özdemir Çiğdem , Kaya Furkan
Published: August 2019

Background: One of the most serious health issues in developing regions is tuberculosis (TB), which has high prevalence worldwide. We aimed to investigate 6 cases of primary hepatic tuberculosis that mimics malignancy and to emphasize that differential diagnosis should be considered in Turkey, which is still an endemic region for tuberculosis.Methods: Data of 14 patients who were diagnosed with primary hepatic tuberculosis between January 2008 and January 2018 were retrospectively evaluated.Results: There were 11 females and 3 males among the cases with an average age of 51.3 years old. The most frequent presentations were the upper right quadrant pain and weight loss. Although laboratory values of 12 patients were normal, isolated gamma-glutamyl transferase (GGT) height was found in 2 patients. Granulomatous inflammation was diagnosed with applying percutaneous needle biopsy in 12 patients and laparoscopic liver biopsy in 2 patients. Tissue culture was positive in 2 patients. No recurrence was detected in any of the patients after medical treatment.Conclusions: When abdominal pain, fever, weight loss complaints, and malignancy-like masses in liver are detected during the differential diagnosis of patients who live in endemic areas such as Turkey; hepatic tuberculosis should be considered as a diagnosis.
Breast cancer in North-Central Nigeria: challenges to good management outcome
Authors: Umoke Ifeanyi Charles , Garba Ekundayo Stephen
Published: August 2019

Background: Breast cancer is a major health burden globally. Now ranked the number one cancer in females, and the leading cause of cancer deaths in females in our environment, outcome indices have remained poor in developing countries. The aim of this study was to ascertain the major challenges to good management outcome of breast cancer patients in our centre.Methods: The case notes of all histologically confirmed cases of breast cancer presenting to our centre from January 2016 to December 2017 were reviewed. Information on the variables of interest were extracted using a proforma.Results: Fifty-five (55) patients’ case notes were reviewed. All were females. 30.9% of the patients had early disease versus 67.3% with advanced disease. 76.4% had invasive ductal carcinoma. More lesions occurred on the left and the upper outer quadrants. 46% of the 37 patients with advanced disease who required chemotherapy completed the prescribed six courses. None of the patients who required radiotherapy received it. Only 1.8% of those who required hormonal therapy were still taking them at two years follow-up. 3.6%, 11%, and 0% used alcohol, oral contraceptives and tobacco respectively. 81.8% had been lost to follow-up at two years while 14.5% had died while on admission.Conclusions: This study identified late presentation with advanced disease; poor compliance and adherence to treatment strategies, and poor access to adjuvant therapy as the major challenges to good outcome for this disease.
Incidence of triple negative breast cancer at Rajendra Institute of Medical Sciences, Ranchi
Authors: Kumari Priyanka , Bhaskar Sumit , Ranjan Rajiv , Sinha Dipendra Kumar
Published: August 2019

Background: Breast carcinoma is the second most common carcinoma in women and accounts for 22% of all female cancer, which is more than twice the prevalence of cancer in women at any other site. Triple negative breast cancer, i.e., negative expression of oestrogen and progesterone receptors and HER2/neu receptors and accounts for approximately 10-17% of all breast carcinomas, is biologically aggressive, resistant to conventional cytotoxic chemotherapy treatment, and is associated with reduced survival compared to other subtypes of breast cancer.Methods: History, local examination, Various investigations like: FNAC of breast lump and axillary lymph node, USG of breasts and axilla, USG of whole abdomen and pelvis, Chest X-ray PA View etc, ER/PR and HER-2/neu status on the specimen sent for HPE were done. The prognostic implications on ER, PR and HER-2/neu receptors were assessed indirectly with the help of Nottingham prognostic index (NPI)).Results: A statistically significant correlation of ER/PR receptor status was found with tumour size, no. of lymph nodes, tumour grade and NPI, whereas HER2/neu receptor status had a statistically significant correlation with tumour size and no. of lymph node involved. Incidence of triple negative breast cancer in this Institute is 20%.Conclusions: ER, PR and HER2/neu receptor status is highly important predictor in cases of carcinoma breast which necessitates routine evaluation of these receptor statuses for better management of disease.
Study of incidence and cause of delay for treatment of long bone fractures of the lower limb in tertiary care hospital
Authors: Sada Elizabeth C. , Bhot Firdaus , Kanishetty Rohit
Published: August 2019

Background: Musculoskeletal trauma represents a considerable global health burden. Lower limb long bone fractures are seen as a serious concern at the individual and population level. So the purpose of the study was to find incidence and cause of delay for treatment of long bone fractures of the lower limb in tertiary care hospital.Methods: All adult patients (more than 18 years) reporting to Emergency Medicine Department of a tertiary care hospital with long bone fractures of lower limb were included in the study. Effects on the final outcome on the lifestyle of the patients were evaluated against the interventions and management at all stages of the course of the illness. Delay of surgery: in our study delay of surgery means if surgery occurs after one day (24 hours) of admission. The entire data is statistically analysed using SPSS software. P values less than 0.05 are considered to be statistically significant.Results: 74 operated cases. 60 cases (81.10%) had delayed surgery, 14 cases (18.9.0%) did not have delayed surgery. 33 cases (55%) had medical reason for delay, 19 cases (31.7%) had financial reason for delay, 5 cases (14.3%) had infrastructure issues (unit system/non availability of implant), 3 cases (5.0%) had plan of surgery as causes of delay.Conclusions: These factors have an effect in the final outcome of the cases. The final outcome is dependent on multiple factors. Adequate attention to each and every one of them was long way to get the patient to the pre-incident stage.
Colonoscopy: an inquiry into indications, findings and their correlation at a tertiary care hospital
Authors: M. N. Raghuveer , Shetty Harshavardhan , K. Madhusudhan
Published: August 2019

Background: Though colonoscopy is widely performed, the statistical data regarding its indications, findings, and the diagnostic yield are not widely documented especially in developing countries. This study is an attempt to determine such data in a group of patients who underwent colonoscopy at our hospital.Methods: This was a hospital‑based retrospective study carried out at the Department of General Surgery, MMC&RI, Mysore. The subjects were a total of 286 patients who underwent colonoscopies in the year 2017. The relevant data from colonoscopy register were recorded and tabulated.Results: The major indications in our study group were bleeding per rectum (25%), unexplained diarrhoea or dysentery (16%), pain abdomen (15%) and suspected malignancy (13%). Other indications included suspected inflammatory bowel disease (IBD), subacute intestinal obstruction, anaemia, mass per abdomen and suspected irritable bowel syndrome (IBS). More than one third (35%) had normal colonoscopic studies. The most common pathology found was malignancy (24%) followed by the spectrum of proctocolitis (20%). The indications which produced high diagnostic yields included suspected carcinoma (97%), bleeding per rectum (82%) and suspected IBD (80%). Significant number of patients with per rectal bleeding was diagnosed with malignancy (21%). The indications which produced low yields included subacute intestinal obstruction (31%), anaemia (45%), non-specific pain abdomen (50%) and suspected irritable bowel syndrome (18%).Conclusions: Colonoscopy is highly rewarding among patients who are being evaluated for suspected malignancies, lower gastrointestinal bleeding and suspected IBD. As such, certain indications produce a higher diagnostic yield than others, suggesting that a stricter patient selection criterion may be employed for performing colonoscopy especially in resource poor settings.
Study of risk, incidence and mortality associated with postoperative pulmonary complications using assess respiratory risk in surgical patients in catalonia score
Authors: Tilak Kedar M. , Litake Manjusha M. , Shingada Krupa V.
Published: August 2019

Background: Postoperative pulmonary complications (PPCs) are one of the major complications that are seen in patients undergoing surgeries and are also a significant cause of increased duration of hospital stay and mortality. Owing to their high incidence the present study was done to assess the risk and incidence of PPCs using the assess respiratory risk in surgical patients in catalonia (ARISCAT) score and to observe the mortality related to PPCS.Methods: The study was done at a tertiary care center over a period of three month and 150 patients were involved. The patients were the categorized into three risk groups and were observed for development of any PPCs.Results: Out of the 150 patients that were studied, 29 developed some form of PPC. 21 out of these 29 (72.41%) patients were from the high-risk category. 11 out of the 29 patients died in a span of 30 days. Pneumonia was seen to be the most common PPC.Conclusions: ARISCAT score can be useful as a preoperative evaluation tool to classify patients into risk groups and predict the development of PPC in the high-risk groups and to take measures to reduce the risk of PPCs. We conclude from our study that anemia, emergency surgery and surgery with duration of more than 3 hours were significant factors contributing to both the incidence and mortality of PPCs irrespective of the risk group.