Ayersstallings1326

Over the past 50 years, endoscopic retrograde cholangiopancreatography (ERCP) has become the preferred minimally invasive method of treating a vast array of pancreatobiliary diseases. An initial sine qua non for ERCP success is selective ductal cannulation. Despite significant progress in the optimisation of ERCP methods and accessories, selective biliary cannulation using conventional techniques remains unsuccessful in approximately 15% of native papilla cases. Furthermore, difficult biliary cannulation has been associated with an increased risk of post-ERCP pancreatitis, among other adverse events. Here, in the first of a two-part series, the authors provide a primer on standard biliary cannulation techniques and discuss the definition, risk factors, and implications of difficult biliary cannulation. The second part of the series will provide an overview of the existing advanced techniques used in cases of difficult biliary cannulation as well as the approach to their selection.The remarkable success of taxonomic discovery, powered by culturomics, genomics and metagenomics, creates a pressing need for new bacterial names while holding a mirror up to the slow pace of change in bacterial nomenclature. Here, I take a fresh look at bacterial nomenclature, exploring how we might create a system fit for the age of genomics, playing to the strengths of current practice while minimizing difficulties. Adoption of linguistic pragmatism-obeying the rules while treating recommendations as merely optional-will make it easier to create names derived from descriptions, from people or places or even arbitrarily. Simpler protologues and a relaxed approach to recommendations will also remove much of the need for expert linguistic quality control. Automated computer-based approaches will allow names to be created en masse before they are needed while also relieving microbiologists of the need for competence in Latin. The result will be a system that is accessible, inclusive and digital, while also fully capable of naming the unnamed millions of bacteria.Mycobacterium tuberculosis (MTB) complex is comprising of pathogenic mycobacteria responsible for human and animal tuberculosis, a major public health problem in Niger. Although infected individuals are paramount sources of contamination, nevertheless alternative, neglected sources may play some role in minority forms of the infection. Accordingly, we investigated the presence of Mycobacterium tuberculosis complex in soil samples in Niger. A total of 103 soil samples were collected in six different areas in Niger in October and November 2018 and April and May 2020 from residential areas of tuberculosis patients. Screening PCR targeting M. tuberculosis complex CRISPR-Csm4 and Xpert MTB/RIF Ultra assay were applied to detect the M. tuberculosis complex. M. compound library chemical tuberculosis DNA was positively detected in five of 103 (5/103; 4.8%) soil samples (Dosso one sample, Zinder one sample and Niamey three samples) using the CRISPR-Csm4 system. CRISPR-Csm4 gene sequence identified four M. tuberculosis sensu stricto (may be lineages 1, 3 or 4) and one M. tuberculosis L2 lineage (Beijing). Moreover, the five positive samples were confirmed by Xpert MTB/RIF Ultra assay as rifampicin-susceptible M. tuberculosis complex strains. However, culture remained negative after 42 days. In this study, we announced for the first time the presence of M. tuberculosis sensu stricto in the soil of Niger. Moreover, these detected lineages were identical to the dominant M. tuberculosis lineages in patients. The presence of common lineages of M. tuberculosis between the soil and human highlight the risk of transmission from the soil to human.Cervical cancer is considered to be the fourth common cancer. It is assumed that numerous risk factors, especially infectious ones, can have a detrimental effect on cervical cancer. In this study, we evaluated the expression of Herv-K env, np9, rec and gag in cervical tissues. After RNA extraction and cDNA sensitizing of 12 cervical cancer tissues and CIN3, 51 CIN1,2 and 18 normal ones, Herv-K env, np9, rec and gag were assessed using quantitative real-time PCR analysis. There was a decrease in the level of HERV-K env expression in cervical cancer and CIN 1-3 in compression with normal tissues. Cervical cancer and CIN3 indicated the most increase in expression. Meanwhile, we observed an increase in gag and rec expression in CIN 1,2; although cervical cancer and CIN 3 had a decrease in rec and gag expression, we did not report any changes in np expression. In conclusion, given the relationship between HERV-associated genes and cervical cancer, our study suggests that these genes can be useful for cancer diagnosis. However, further investigations are needed to provide a better perspective about the effectiveness of these genes in the diagnostic strategies of gastrointestinal cancer. These results are just an observation that could open a wider investigation to test the correlation between the expression of these genes and cervical cancer.Background Antioxidants show nephroprotective effect against vancomycin associated nephrotoxicity (VAN) in animals. This study aimed to assess the ascorbic acid nephro-protective role against VAN clinically. Methods Forty-one critically ill patients were randomly assigned to one of two groups intervention group (vancomycin IV plus ascorbic acid, n=21) or control group (vancomycin IV only, n=20). Primary outcomes were the incidence of VAN and the absolute change in creatinine parameters, while mortality rate was the secondary outcome. Nephrotoxicity was defined as an increase in serum creatinine (S.cr) by at least 0.5 mg/dL or 50% of baseline for at least two successive measurements. This study is registered at Clinicaltrials.gov (NCT03921099), April 2019. Results Mean absolute S.cr increase was significant when compared between both groups, P-value = 0.036, where S.cr increased by 0.05(0.12) and 0.34(0.55) mg/dL in the intervention and control groups, respectively. Mean absolute Cr.cl decline was significant when compared between both groups, P-value = 0.04, where Cr.cl was decreased by 5.9(17.8) and 22.3(30.4) ml/min in the intervention and control groups, respectively. Incidence of VAN was 1/21(4.7%) versus 5/20(25%) in the intervention and control groups, respectively (RR 0.19; CI 0.024-1.49; P-value = 0.093). Mortality was higher in the control group; however, it was not statistically significant, P-value = 0.141. Conclusion Co-administration of ascorbic acid with vancomycin preserved renal function and reduced the absolute risk of VAN by 20.3%, however, the reduction in VAN incidence didn't reach statistical significance level. Further large multicenter prospective trials are recommended.Non-pharmaceutical interventions for veterans living with post-traumatic stress disorder are becoming a more popular way to address some of the social and personal needs identified by this group. Horticultural therapy or growing and eating food together provides several ways to increase mood, improve nutritional status, reduce loneliness and reduce the physical health impacts of mental illnesses such as post-traumatic stress disorder. In this paper we will discuss some of the issues people living with post-traumatic stress disorder might face. We will also provide an overview of the therapeutic effects of these approaches and how they will be applied in a locally identified group.Background An e-wallet is a digital equivalent of a physical wallet which plays an essential role in payment system transformation. To embrace the concept of a cashless society, the Malaysian Government and central bank have taken various steps to encourage the adoption of e-wallets. Despite the seamless services offered by the e-wallet, it is yet to reach high-scale adoption in Malaysia. This study aims to investigate Malaysians' readiness towards the e-wallet and their perceptions of it by employing the UTAUT2 model. Methods A total of 309 valid data were gathered and analysed with partial least squares structural equation modelling (PLS-SEM). Results The findings revealed that the respondents were confident about the new technology and tended to believe that e-wallet was somehow useful for them. The results also disclosed that e-wallet adoption intention was significantly influenced by performance expectancy, price value, facilitating conditions, and followed closely by social influence. Nonetheless, insecurity did not present significant impact on both performance expectancy and effort expectancy of e-wallet. Conclusions This study provides a substantial contribution to the knowledge domain by combining system-specific and individual-specific models in an e-wallet context. The outcomes of this study would also benefit e-wallet service providers and policymakers by delivering holistic insight into Malaysians' readiness and adoption behaviour of the e-wallet.Background COVID-19 causes a critical occupational risk to frontline healthcare workers (HCWs) who respond to the pandemic, as they are placed in environments with an increased risk of infection exposure. It is a public health priority to understand how transmission occurs to protect this vulnerable group of HCWs. This study was conducted to estimate the incidence of self-reported COVID-19 infection among physicians and its possible associated factors. Methods An online national survey using Survey Monkey was initiated to collect sociodemographic e.g. age and sex, occupational e.g. place and duration of work, and clinical data e.g. COVID symptoms and laboratory investigations, and to describe affected physicians' diagnoses. Results The self-reported incidence of COVID-19 infection was found to be 65.4% among studied physicians. The significant independent predictors of COVID-19 infection were smoking, working as a frontline physician, having contact with a COVID-19 case, and working for less than ten years [ARR (95% CI) 3.0(1.6-5.7), 2.3(1.4-3.8), 2.1(1.2-3.6), and 1.8(1.2-2.9); respectively]. Conclusions The incidence of COVID-19 infection among Egyptian physicians is relatively high. Smoking, being a frontline physician, having contact with a COVID-19 case, and working for less than 10 years are all factors associated with an increased risk of infection. There should be strict application of preventive measures, periodic screening for COVID-19 for early detection and isolation of infected HCWs together with effective vaccination.Mixed infections with two or more species of Plasmodium are frequently reported due to vector factors, parasite factors (formation of hypnozoites) and host factors (residing in endemic areas, travel to endemic areas, inadequately treated previous infection, lack of compliance to therapy). Here we report a case of a 33-year-old Saudi female who had a significant travel history, and a peripheral blood smear (PBS) revealed mixed infection with P. falciparum and P. vivax. The case was successfully treated with a combination therapy of artemisinin and primaquine with follow up testing at three, seven, 14, and 28 days. Mixed malaria infections are especially reported in travelers to endemic areas. Hence, adequate diagnosis and appropriate treatment of the cases contributes majorly to preventing relapse and controlling the disease. Travel consultations should be given to all travelers before their trips to endemic countries.