EMPHYSEMATOUS GASTRITIS WITH INTESTINAL PNEUMATOSIS – A VASO-OCCLUSIVE PHENOMENON

Emphysematous gastritis secondary to vaso-occlusive disease is a surgical emergency with a mortality rate of 60-80%. Prompt treatment with broad-spectrum antibiotics and surgical revascularization has been reported to be “lifesaving” in several cases

Issues in Physics Practicals in an Open and Distance Learning Environment

This paper reviews the objectives of physics practicals in physics education in relation to the hilosophy of open and distance learning programme. The various issues that arise in the implementation of physics experiment based on an existing practical model are presented. Two major concerns are the effectiveness of the practical sessions and sustaining the fundamentals of the open and distance learning programme. A new practical physics model is then proposed, which enables students to experience physics experiments without violating the open and distance learning programme fundamentals. (Authors' abstract

MALIGNANT PHYLLODES WITH OSTEOSARCOMATOUS DIFFERENTIATION – A CASE REPORT

Introduction: Malignant phyllodes tumor is a rare and aggressive neoplasm, which presents as a breast lump and is detected on routine examination in premenopausal women. Heterologous differentiation is uncommon in these tumors. Owing to its rare occurrence, very few treatment protocols have been formulated for these cases posing a surgical dilemma. Presentation of Case: For a better understanding of the pathogenesis and prognosis of these tumors we discuss here the clinical profile of a 49-year-old lady with metastatic phyllodes tumor of the breast with osteosarcomatous differentiation. Discussion: Malignant phyllodes with osteosarcomatous differentiation are highly aggressive and extremely rare constituting 1.3% of all breast cancers. It has been hypothesized that malignant change of metaplastic stromal results in these neoplasms. Conclusion: To conclude, malignant phyllodes are a rare entity. Osteosarcomatous differentiation is almost unheard of and indicates an aggressive biological behavior. Accurate diagnosis and timely surgical management are essential to prevent the progression of the disease and improve survival

Does the Number of Hours Spent on Learning Affect Academic Achievement?

Examinations are measurement tools designed to assess learners’ achievement of course learning outcomes. Past studies have shown that factors such as motivation and study time play a part in enhancing learner achievement in assessment. The objective of this exploratory study is to develop a Regression Model that will be used to identify the possible relationship between the learners’ study time with their academic achievement. An online questionnaire survey was administered to 98 respondents of year 1 distance learners of the Principle of Management course in the January 2021 semester at Open University Malaysia. The data on the self-report of study time by the learners for the two variables were analysed. A regression analysis via Statistical Package for Social Sciences (SPSS) analysis tool was performed to study the relationship between the study time (for completing the assignment and preparing for the final examination) and academic achievement. The findings of this study suggest that a regression model can significantly predict academic achievement. However, based on this model, only the study time allocated for completing the assignment appears to be significantly correlated to the course assessment achievement. It is hoped that the findings gathered will lay the foundation for future research that take into consideration other relevant factors associated with study time and academic achievement

Mucosal microbiome is predictive of pediatric Crohn’s disease across geographic regions in North America [version 2; peer review: 2 approved]

Background: Patients with Crohn’s disease (CD) have an altered intestinal microbiome, which may facilitate novel diagnostic testing. However, accuracy of microbiome classification models across geographic regions may be limited. Therefore, we sought to examine geographic variation in the microbiome of patients with CD from North America and test the performance of a machine learning classification model across geographic regions. Methods: The RISK cohort included 447 pediatric patients with CD and 221 non-inflammatory bowel disease controls from across North America. Terminal ileum, rectal and fecal samples were obtained prior to treatment for microbiome analysis. We divided study sites into 3 geographic regions to examine regional microbiome differences. We trained and tested the performance of a machine learning classification model across these regions. Results: No differences were seen in the mucosal microbiome of patients with CD across regions or in either the fecal or mucosal microbiomes of controls. Machine learning classification algorithms for patients with CD performed well across regions (area under the receiver operating characteristic curve [AUROC] range of 0.85-0.91) with the best results from terminal ileum. Conclusions: This study demonstrated the feasibility of microbiome based diagnostic testing in pediatric patients with CD within North America, independently from regional influences

Controversies over Infective Endocarditis Prophylaxis and the need for National Guidelines

Infective endocarditis (IE) is a relatively rare but invariably fatal disease if left untreated. Over decades, individuals with certain congenital or acquired heart defects were given antibiotic prophylaxis before certain procedures to prevent IE. However, controversies on this regimen have begun to grow since 2002 and in 2007-2008, three major international health organizations, the American Heart Association (AHA), the European Society for Cardiology (ESC), and the National Institute for Health and Clinical Excellence (NICE), UK published have their revised guidelines where AHA and ESC markedly shortened the list of indications for IE prophylaxis and NICE abandoned the concept of IE prophylaxis altogether. This has literally divided not only the medical practitioners around the world but practitioners within countries who used to follow either AHA, ESC or NHS guidelines in absence of their own national guidelines. This chaotic situation has also affected the medical teaching in those countries because of contradictory teaching from teachers having different views and belongingness on this issue. Even follow up review five years after the introduction of revised guidelines has failed to resolve the controversies and it deems un resolvable in near future. In such circumstances, every country needs to have own guideline for uniform medical teaching and practice

Recovery of endoscopy services in the era of COVID-19: recommendations from an international Delphi consensus

The COVID-19 pandemic has had a profound impact on provision of endoscopy services globally as staff and real estate were repurposed. As we begin to recover from the pandemic, a cohesive international approach is needed, and guidance on how to resume endoscopy services safely to avoid unintended harm from diagnostic delays. The aim of these guidelines is to provide consensus recommendations that clinicians can use to facilitate the swift and safe resumption of endoscopy services. An evidence-based literature review was carried out on the various strategies used globally to manage endoscopy during the COVID-19 pandemic and control infection. A modified Delphi process involving international endoscopy experts was used to agree on the consensus statements. A threshold of 80% agreement was used to establish consensus for each statement. 27 of 30 statements achieved consensus after two rounds of voting by 34 experts. The statements were categorised as pre-endoscopy, during endoscopy and postendoscopy addressing relevant areas of practice, such as screening, personal protective equipment, appropriate environments for endoscopy and infection control precautions, particularly in areas of high disease prevalence. Recommendations for testing of patients and for healthcare workers, appropriate locations of donning and doffing areas and social distancing measures before endoscopy are unique and not dealt with by any other guidelines. This international consensus using a modified Delphi method to produce a series of best practice recommendations to aid the safe resumption of endoscopy services globally in the era of COVID-19.status: publishe