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Treating tuberculosis (TB) is not the end of the disease because of the wide spectrum of post TB sequelae associated with the disease. There is insufficient data on post TB radiological sequelae. The aim of this study is to evaluate the post TB radiological sequelae on chest x-rays in patients who had completed the treatment for pulmory and pleural TB at a tertiary care hospital of a high TB burden country. This is a retrospective cross-sectiol study conducted on patients treated for pulmory and pleural TB. Adult patients (18 years or above) with a clinical or microbiological diagnosis of pulmory or pleural TB were included. Patients were classified on the basis of site of TB into pulmory and pleural TB. Post-treatment radiological sequelae on chest x-ray were evaluated and divided into three main types i.e. fibrosis, bronchiectasis and pleural thickening. During the study period a total of 321 patients were included with a mean age of 44(SD±19) years. Only 17.13% (n=55) patients had normal chest x-rays at the end of treatment and 82.87% (n=266) patients had post-TB radiological sequelae with fibrosis being the most common followed by pleural thickening. The post TB radiological sequelae were high in patients who had diabetes mellitus (78.94%), AFB smear-positive (90.19%), AFB culture-positive (89.84%), Xpert MTB/Rif positive (88.40%) and with drug-resistant TB (100%). As a clinician, one should be aware of all the post TB sequelae so that early diagnosis and magement can be facilitated.

Mycotoxins are toxic secondary metabolites that globally contaminate an estimated 25 % of cereal crops and thus exposure is frequent in many populations. Aflatoxins, fumonisins and deoxynivalenol are amongst those mycotoxins of particular concern from a human health perspective. A number of risks to health are suggested including cancer, growth faltering, immune suppression and neural tube defects; though only the demonstrated role for aflatoxin in the aetiology of liver cancer is widely recognised. The heterogeneous distribution of mycotoxins in food restricts the usefulness of food sampling and intake estimates; instead biomarkers provide better tools for informing epidemiological investigations. Validated exposure biomarkers for aflatoxin (urinary aflatoxin M1, aflatoxin–N7-guaunine, serum aflatoxin–albumin) were established almost 20 years ago and were critical in confirming aflatoxins as potent liver carcinogens. Validation has included demonstration of assay robustness, intake v. biomarker level, and stability of stored samples. More recently, aflatoxin exposure biomarkers are revealing concerns of growth faltering and immune suppression; importantly, they are being used to assess the effectiveness of intervention strategies. For fumonisins and deoxynivalenol these steps of development and validation have significantly advanced in recent years. Such biomarkers should better inform epidemiological studies and thus improve our understanding of their potential risk to human health.

Yersinia enterocolitica is a Gram-negative bacterium that typically causes self-limiting gastrointestinal infections but can sometimes lead to systemic complications, particularly in immunocompromised hosts. This report describes a rare case of a 60-year-old farmer who developed enteric bacteremia, renal impairment, and pulmonary manifestations, likely due to the consumption of undercooked pork. Despite lacking common predisposing factors, the patient presented with a sore throat, joint pain, abdominal discomfort, and a characteristic erythematous rash. Extensive diagnostic workup, including blood cultures and autoimmune screening, yielded negative results. However, stool culture eventually identified Y. enterocolitica as the causative agent. The patient experienced worsening kidney function, respiratory distress, and significant abdominal findings on imaging, prompting consultations across multiple specialties. Treatment with doxycycline and amoxicillin led to clinical improvement, and the patient's renal function returned to baseline. This case highlights the potential for Y. enterocolitica to cause rare and severe extra-intestinal manifestations, including pulmonary involvement, in an immunocompetent host, underscoring the importance of considering this pathogen in differential diagnoses of systemic infections.

Ground-level falls are common among older adults and are the most frequent cause of traumatic intracranial bleeding. The aim of this study was to derive a clinical decision rule that safely excludes clinically important intracranial bleeding in older adults who present to the emergency department after a fall, without the need for a computed tomography (CT) scan of the head. This prospective cohort study in 11 emergency departments in Canada and the United States enrolled patients aged 65 years or older who presented after falling from standing on level ground, off a chair or toilet seat, or out of bed. We collected data on 17 potential predictor variables. The primary outcome was the diagnosis of clinically important intracranial bleeding within 42 days of the index emergency department visit. An independent adjudication committee, blinded to baseline data, determined the primary outcome. We derived a clinical decision rule using logistic regression. The cohort included 4308 participants, with a median age of 83 years; 2770 (64%) were female, 1119 (26%) took anticoagulant medication and 1567 (36%) took antiplatelet medication. Of the participants, 139 (3.2%) received a diagnosis of clinically important intracranial bleeding. We developed a decision rule indicating that no head CT is required if there is no history of head injury on falling; no amnesia of the fall; no new abnormality on neurologic examination; and the Clinical Frailty Scale score is less than 5. Rule sensitivity was 98.6% (95% confidence interval [CI] 94.9%–99.6%), specificity was 20.3% (95% CI 19.1%–21.5%) and negative predictive value was 99.8% (95% CI 99.2%–99.9%). We derived a Falls Decision Rule, which requires external validation, followed by clinical impact assessment. Trial registration: ClinicalTrials. gov, no. NCT03745755.

An accurate and dimensionally stable trial denture base is required for a successful denture. The aim of this in vitro study was to assess the dimensional stability of a light-activated urethane dimethacrylate (UDMA) visible light cure (VLC) denture base with three fabrication techniques and different curing cycles. Forty-five VLC denture base samples were divided evenly into three groups. Group A used a conventional fabrication technique with a curing cycle of 5 min. Group B used a modified fabrication technique with two 4-min curing cycles. Group C used a multi-step fabrication technique with three curing cycles (4 min, plus 4 min, plus 2 min). The samples were sectioned and observed under a stereomicroscope to measure the discrepancy between the sample and the master cast. The mean dimensional discrepancy (mm) at the molar region at mid-palate, after 24 h in Group A, B and C was 0.790 mm, 0.741 mm and 0.379 mm, respectively; at the right ridge crest, it was 0.567, 0.408 and 0.185, while at the left ridge crest it was 0.475, 0.331 and 0.125, respectively. Statistical analysis showed significantly different dimensional discrepancies among the groups at all three sites; right ridge crest (F = 93.54, p < 0.001), left ridge crest (F = 105.96, p < 0.001) and mid-palate (F = 125.53, p < 0.001). Within the limitations of this laboratory study, it can be concluded that the denture base using a multi-step fabrication technique with three curing cycles provides better adaptation than the conventional technique. The significance of the study is that clinicians should consider performing denture base fabrication using a multi-step technique to enhance adaptation and hence the stability of the dentures for patients.

Hyperimmunoglobulin E syndrome is a rare multisystem inherited disorder characterised by high serum IgE levels, skin disorder causing eczema, dermatitis, recurrent staphylococcal infections and pulmonary infections and various skeletal and connective tissue abnormalities. Common presentation is with recurrent skin and sinopulmonary infections. Several features unrelated to immune system such as characteristic facial features, hyperextensibility of joints, multiple bone fractures and craniosynostosis have been described in the literature. We describe a rare presentation of this disease with invasive aspergillosis presenting as mediastinal mass with extension to mediastinal structures and pulmonary vasculature.

In this research paper, the results of the numerical investigations on combined surface radiation and natural convection heat transfer in a square enclosure with partition are presented. The vertical walls of the square enclosure are differentially heated, with the left wall at a higher temperature and the right wall at a lower temperature. The partition is placed parallel to these isothermal vertical walls while the horizontal walls are adiabatic. The simulation is done for a Rayleigh Number ranging between 10 3 and 10 6 , Prandtl number of 0.7 (air). In this research work, the numerical simulation is carried out using the software ANSYS FLUENT 2022R1 in which the governing equations of fluid flow and heat transfer with surface radiation are solved using finite volume-based solver and coupled algorithm. Discrete Ordinate (DO) is used as the radiation model. The thickness of the partitioned is fixed and is equal to one twentieth of the length of the square enclosure. An analysis from the obtained streamlines, temperature contours and Nusselt number values shows the significant influence of surface radiation on natural convection heat transfer. It has been observed that increasing the length of partition reduces the Nusselt number, when the height of partition is varied from h = L to L/4, the value of Nusselt number increases to 7.2% for Ra 10 3 and 30.3% for Ra 10 6 . It is also established that increasing the distance of partition from hot wall increases the Nusselt number. Likewise, an increase in emissivity leads to an increase in total Nusselt number which can be noted that when emissivity is changed from 0.25 to 1, the increase in total Nusselt number is found to be 24.9% and 97.1% respectively when compared with pure convection for Ra = 10 3 . For Rayleigh number 10 6 the increase in Nusselt number is 32.6% and 170.9% sequentially when compared with pure convection.

Insufficient knowledge of medical chemicals and their improper use have destructive effects. Accidental exposure to chemicals on facial tissue may result in large facial defect. For ages the tradition of piercing nose is common but improper use of unknown chemical for piercing has deleterious effect. Mostly rhinectomy defects are acquired caused by trauma or malignant diseases. Prosthetic rehabilitation is the preferred treatment of choice for any large rhinectomy defects as medical and surgical interventions are ineffective in developing esthetics. Main concern with the prosthesis for such defects is retention. This article describes rehabilitation of a patient with large size nasal defect created by chemical burn in childhood during piercing. Implant retained customized silicone nasal prosthesis was fabricated using simple O-ring attachments and innovative modified polyamide acrylic resin substructure acting as skeleton.

Objectives The population is aging and falls are a common reason for emergency department visits. Appropriate imaging in this population is important. The objectives of this study were to estimate the prevalence of cervical spine injury and identify factors associated with cervical spine injuries in adults ≥ 65 years after low-level falls. Methods This was a pre-specified sub-study of a prospective observational cohort study of intracranial bleeding in emergency patients ≥ 65 years presenting after low-level falls. The primary outcome was cervical spine injury. The risk factors of interest were Glasgow coma scale (GCS) < 15, head injury, neck pain, age, and frailty defined as Clinical Frailty Scale ≥ 5. Multivariable logistic regression was used to measure the strength of association between risk factors and cervical spine injury. A descriptive analysis of absence of significant risk factors was performed to determine patients who may not require imaging. Results There were 4308 adults ≥ 65 who sustained low-level falls with mean age of 82.0 (standard deviation ± 8.8) years and 1538 (35.7%) were male; 23 [0.5% (95% confidence interval (CI) 0.3–0.8%)] were diagnosed with cervical spine injuries. The adjusted odds ratios and 95% CIs were 1.3 (0.5–3.2) for GCS < 15, 5.3 (1.7–26.7) for head injury, 13.0 (5.7–31.2) for new neck pain, 1.4 (1.0–1.8) for 5-year increase in age, and 1.1 (0.4–2.9) for frailty. Head injury or neck pain identified all 23 cervical spine injuries. Management was a rigid collar in 19/23 (82.6%) patients and none had surgery. Conclusions In emergency patients ≥ 65 years presenting after a low-level fall, head injury, neck pain, and older age were associated with the diagnosis of cervical spine injury. There were no cervical spine injuries in those without head injury or neck pain. Patients with no head injury or neck pain may not require cervical spine imaging.

In this era of digitalization, the glamorous world of dentistry has already made significant strides. Fabrication of inlays, crowns, fixed partial dentures, implant abutment, prosthesis via CAD/CAM technology have proven to be advantageous to both practitioners and patients. With the advent of CAD/CAM, it will be possible to fabricate digital dentures through which impressions, inter-occlusal records and tooth selection can be completed in a single appointment. Added advantages include reduced clinical chair time, ease of fabricating a replacement denture, elimination of polymerization shrinkage, less porosity and less C.Albicans adherence.