Introduction: Chronic hepatitis C (CHC) infection is an important cause of chronic and end stage liver disease. Treatment response has improved with combination therapy. We review our experience with combination therapy in CHC patients. Materials and Methods: All patients who had completed at least one course of combination therapy (> 6 months) and had longer than 6 months of follow-up were retrospectively reviewed. Results: There were 28 (22 males, mean age 40.7 ± 9.9 years old) patients who completed one course of treatment. Intravenous drug use (IDU) accounted for 61% of the aetiology. The end of treatment biochemical response was 92.6%. The overall sustained viral response (SVR) was 64.3%. Comparing IDU to the others (non-IDU), there was no difference in treatment SVR (64.7% vs. 63.6%, p = 0.954). Responders had significantly higher pretreatment serum alanine aminotransferase (p = 0.018). Overall treatment side effects were observed in 64% (flu-like symptoms 58.3%, haematological 50% and depressive mood 8%). Conclusions: Our response rates are comparable to published data. There was no difference in treatment response rate between the IDU and non-IDU. CHC infected IDU should be offered treatment.

This cross sectional study investigated the clinical and radiographic status of crowned teeth with and without root canal treatment. The study used secondary data from records of patients who received crown treatment at the Faculty of Dentistry, University of Malaya before 2015 and walk-in patients attending the primary care clinic between July - December 2016. The inclusion criterion was crown fitted for more than 12 months. Once identified, the patients were assessed for clinical and radiographic status. Data were entered into and analysed using SPSS Version 20 software. A total of 66 crowns [35 root canal treated (RCT) and 31 non-root canal treated (n-RCT)] were identified. Chi-square test was carried out to determine the health of crowned teeth and for its longevity in the oral cavity. There were 43 crowns (46.5% RCT; 53.5% n-RCT) with plaque accumulation, 15 (66.7% RCT; 33.3% n-RCT) with gingival swelling/recession, 17 (46.5% RCT; 53.5% n-RCT) with widening of the periodontal ligament, 13 (53.8% RCT; 46.2% n-RCT) with bone loss and 5 (60% RCT; 40% n-RCT) crowns with periapical lesion. There was no statistically significant difference except for poorer alveolar bone condition for crowns that have been in the mouth for >10 years. Based on the study, no significant adverse pulpal involvement between crown with RCT and crown without RCT was observed.

OBJECTIVETo assess the correlation between five anthropometric parameters and the distance from tibial tuberosity to medial malleolus in 100 volunteers.

METHODSSix anthropometric parameters were measured in 50 male and 50 female medical students using a metallic scale: medial knee joint line to ankle joint line (K-A), medial knee joint line to medial malleolus (K-MM), tibial tuberosity to ankle joint (TT-A), tibial tuberosity to medial malleolus (TT- MM), olecranon to 5th metacarpal head (O-MH) and body height (BH). Nail size predicted based upon TT-MM measurement was chosen as ideal nail size. A constant was derived for each of the six anthropometric parameters which was either added or subtracted to each measurement to derive nail size. A regression equation was applied to BH measurements. Nail sizes calculated were compared with that obtained from TT-MM measurement and accuracy was evaluated. Accuracy of O-MH and BH regression equations recommended by other authors were calculated in our data.

RESULTSAdding 11 mm to TT-A distance had highest accuracy (81%) and correlation (0.966) in predicting nails correctly. Subtracting 33 mm from K-MM measurement and 25 mm from K-A distance derived accurate sizes in 69% and 76% respectively. Adding 6 mm to O-MH distance had a poor accuracy of 51%. Nail size prediction based upon body height regression equation derived correct nail sizes in only 34% of the cases. Regression equation analysis by other authors based on O-MH and BH distances yielded correct sizes in 11% and 5% of the cases respectively.

CONCLUSIONTT-A, K-A and K-MM measurements can be used simultaneously to increase accuracy of nail size prediction. This method would be helpful in determining nail size preoperatively especially when one anatomic landmark is difficult to palpate.

Adult ; Anthropometry ; Body Height ; Bone Nails ; Female ; Fracture Fixation, Intramedullary ; instrumentation ; Humans ; Male ; Preoperative Care ; Tibial Fractures ; surgery

In the last three decades, significant advances have been made in the care of children requiring renal replacement therapy (RRT). The move from the use of only hemodialysis and peritoneal dialysis to continuous venovenous hemofiltration with or without dialysis (continuous renal replacement therapy, CRRT) has become a mainstay in many intensive care units. The move to CRRT is the result of greater clinical experience as well as advances in equipment, solutions, vascular access, and anticoagulation. CRRT is the mainstay of dialysis in pediatric intensive care unit (PICU) for critically ill children who often have hemodynamic compromise. The advantages of this modality include the ability to promote both solute and fluid clearance in a slow continuous manner. Though data exist suggesting that approximately 25% of children in any PICU may have some degree of renal insufficiency, the true need for RRT is approximately 4% of PICU admissions. This article will review the history as well as the progress being made in the provision of this care in children.
Child ; Critical Illness ; Dialysis ; Hemodynamics ; Hemofiltration ; Humans ; Intensive Care Units ; Pediatrics ; Peritoneal Dialysis ; Renal Dialysis ; Renal Insufficiency ; Renal Replacement Therapy

Background: This is a rare and challenging case of Wolff–Parkinson–White syndrome due to a posteroseptal acces‑ sory pathway located in the coronary sinus diverticulum. It is often difficult to precisely locate this type of accessory pathway, and the ablation procedure could be associated with collateral damage to the neighbouring coronary arteries.Case Presentation: The patient was a 49-year-old female with Wolff–Parkinson–White syndrome who was referred for catheter ablation. She had had a previous unsuccessful attempt at ablation and had remained symptomatic despite drug therapy. The pre-procedural cardiac computed tomography scan revealed the presence of a diverticu‑ lum in the proximal coronary sinus. Using an advanced three-dimensional cardiac mapping system, the electroana‑ tomic map of the diverticulum was created. The accessory pathway potential was identified within the diverticulum preceding the ventricular insertion. The accessory pathway was then successfully ablated using radiofrequency energy. Conclusion We have demonstrated that the advanced three-dimensional cardiac mapping system plays a very important role in guiding clinicians in order to precisely locate and safely ablate this type of challenging accessory pathway.

Objective: To systematically review studies on canine agenesis prevalence in different populations and continents, based on the jaw, sex, location, and associated dental anomalies. Methods: Electronic and hand searches of English literature in PubMed, Web of Science, Scopus, OpenGrey, and Science Direct were conducted, and the authors were contacted when necessary. Observational studies (population-based, hospital/clinic-based, and cross-sectional) were included. For study appraisal and synthesis, duplicate selection was performed independently by two reviewers. Study quality was assessed using a modified Strengthening the Reporting of Observational Studies in Epidemiology checklist, with main outcome of prevalence of canine agenesis. Results: The global population prevalence of canine agenesis was 0.30% (0.0−4.7%), highest in Asia (0.54%), followed by Africa (0.33%), and the least in Europe and South America (0.19% in both continents). Canine agenesis was more common in the maxilla (88.57%), followed by both maxilla and mandible (8.57%), and the least common was mandible-only presentation (2.86%). The condition was more common in females (female:male ratio = 1.23), except in Asia (female:male ratio = 0.88) and Africa (female:male ratio = 1). In Asia, unilateral agenesis was almost twice as prevalent as bilateral, but in Europe, the bilateral form was more common. Conclusions The overall prevalence of canine agenesis is 0.30%, with the highest prevalence in Asia, followed by Africa, Europe, and South America.The condition is more common in the maxilla than the mandible, and in females than males (except in Asia and Africa), with unilateral agenesis being more common in Asia and the bilateral form showing a greater prevalence in Europe.

Objective: To systematically review studies on canine agenesis prevalence in different populations and continents, based on the jaw, sex, location, and associated dental anomalies. Methods: Electronic and hand searches of English literature in PubMed, Web of Science, Scopus, OpenGrey, and Science Direct were conducted, and the authors were contacted when necessary. Observational studies (population-based, hospital/clinic-based, and cross-sectional) were included. For study appraisal and synthesis, duplicate selection was performed independently by two reviewers. Study quality was assessed using a modified Strengthening the Reporting of Observational Studies in Epidemiology checklist, with main outcome of prevalence of canine agenesis. Results: The global population prevalence of canine agenesis was 0.30% (0.0−4.7%), highest in Asia (0.54%), followed by Africa (0.33%), and the least in Europe and South America (0.19% in both continents). Canine agenesis was more common in the maxilla (88.57%), followed by both maxilla and mandible (8.57%), and the least common was mandible-only presentation (2.86%). The condition was more common in females (female:male ratio = 1.23), except in Asia (female:male ratio = 0.88) and Africa (female:male ratio = 1). In Asia, unilateral agenesis was almost twice as prevalent as bilateral, but in Europe, the bilateral form was more common. Conclusions The overall prevalence of canine agenesis is 0.30%, with the highest prevalence in Asia, followed by Africa, Europe, and South America.The condition is more common in the maxilla than the mandible, and in females than males (except in Asia and Africa), with unilateral agenesis being more common in Asia and the bilateral form showing a greater prevalence in Europe.

Background: This is a rare and challenging case of Wolff–Parkinson–White syndrome due to a posteroseptal acces‑ sory pathway located in the coronary sinus diverticulum. It is often difficult to precisely locate this type of accessory pathway, and the ablation procedure could be associated with collateral damage to the neighbouring coronary arteries.Case Presentation: The patient was a 49-year-old female with Wolff–Parkinson–White syndrome who was referred for catheter ablation. She had had a previous unsuccessful attempt at ablation and had remained symptomatic despite drug therapy. The pre-procedural cardiac computed tomography scan revealed the presence of a diverticu‑ lum in the proximal coronary sinus. Using an advanced three-dimensional cardiac mapping system, the electroana‑ tomic map of the diverticulum was created. The accessory pathway potential was identified within the diverticulum preceding the ventricular insertion. The accessory pathway was then successfully ablated using radiofrequency energy. Conclusion We have demonstrated that the advanced three-dimensional cardiac mapping system plays a very important role in guiding clinicians in order to precisely locate and safely ablate this type of challenging accessory pathway.

Background/Aims: This study aimed to develop a diagnostic tool using machine learning to apply functional luminal imaging probe (FLIP) panometry data to determine the probability of esophagogastric junction (EGJ) obstruction as determined using the Chicago Classification version 4.0 (CCv4.0) and high-resolution manometry (HRM). Methods: Five hundred and fifty-seven adult patients that completed FLIP and HRM (with a conclusive CCv4.0 assessment of EGJ outflow) and 35 asymptomatic volunteers (“controls”) were included. EGJ opening was evaluated with 16-cm FLIP performed during sedated endoscopy via EGJ-distensibility index and maximum EGJ diameter. HRM was classified according to the CCv4.0 as conclusive disorders of EGJ outflow or normal EGJ outflow (timed barium esophagram applied when required and available). The probability tool utilized Bayesian additive regression treesBART, which were evaluated using a leave-one-out approach and a holdout test set. Results: Per HRM and CCv4.0, 243 patients had a conclusive disorder of EGJ outflow while 314 patients (and all 35 controls) had normal EGJ outflow. The model accuracy to predict EGJ obstruction (based on leave-one-out/holdout test set, respectively) was 89%/90%, with 87%/85% sensitivity, 92%/97% specificity, and an area under the receiver operating characteristic curve of 0.95/0.97. A free, opensource tool to calculate probability for EGJ obstruction using FLIP metrics is available at https://www.wklytics.commgi/prob_flip.html. Conclusions Application of FLIP metrics utilizing a probabilistic approach incorporates the diagnostic confidence (or uncertainty) into the clinical interpretation of EGJ obstruction. This tool can provide clinical decision support during application of FLIP Panometry for evaluation of esophageal motility disorders.

In this work, we describe the development of Polar Gini Curve, a method for characterizing cluster markers by analyzing single-cell RNA sequencing (scRNA-seq) data. Polar Gini Curve combines the gene expression and the 2D coordinates ("spatial") information to detect patterns of uniformity in any clustered cells from scRNA-seq data. We demonstrate that Polar Gini Curve can help users characterize the shape and density distribution of cells in a particular cluster, which can be generated during routine scRNA-seq data analysis. To quantify the extent to which a gene is uniformly distributed in a cell cluster space, we combine two polar Gini curves (PGCs)-one drawn upon the cell-points expressing the gene (the "foreground curve") and the other drawn upon all cell-points in the cluster (the "background curve"). We show that genes with highly dissimilar foreground and background curves tend not to uniformly distributed in the cell cluster-thus having spatially divergent gene expression patterns within the cluster. Genes with similar foreground and background curves tend to uniformly distributed in the cell cluster-thus having uniform gene expression patterns within the cluster. Such quantitative attributes of PGCs can be applied to sensitively discover biomarkers across clusters from scRNA-seq data. We demonstrate the performance of the Polar Gini Curve framework in several simulation case studies. Using this framework to analyze a real-world neonatal mouse heart cell dataset, the detected biomarkers may characterize novel subtypes of cardiac muscle cells. The source code and data for Polar Gini Curve could be found at http://discovery.informatics.uab.edu/PGC/ or https://figshare.com/projects/Polar_Gini_Curve/76749.