We present the clinical scenario of acute abdominal pain in a 27-year-old man with recent-onset type 1 diabetes mellitus. Evaluation of the patient revealed elevated levels of serum amylase, lipase, and transaminase without any biliary obstruction. He had elevated serum IgG4 levels, and his computed tomography scan showed features consistent with autoimmune pancreatitis. Further evaluation revealed celiac disease. He was treated as a patient with autoimmune pancreatitis and was started on steroids in addition to a gluten-free diet. His liver function improved in 6 weeks. He gained weight and his glycemic control also improved. Magnetic resonance cholangiopancreatography after 3 months revealed complete resolution of pancreatic enlargement. The patient is being followed up in our clinic since the past 3 years. To the best of our knowledge and according to the Medline search, this is the first case report of celiac disease as an association of autoimmune pancreatitis.
While address space layout randomization (ASLR) has been extensively studied for user-space programs, the corresponding OS kernel's KASLR support remains very limited, making the kernel vulnerable to just-in-time (JIT) return-oriented programming (ROP) attacks. Furthermore, commodity OSs such as Linux restrict their KASLR range to 32 bits due to architectural constraints (e.g., x86-64 only supports 32-bit immediate operands for most instructions), which makes them vulnerable to even unsophisticated brute-force ROP attacks due to low entropy. Most in-kernel pointers remain static, exacerbating the problem when pointers are leaked.Adelie, our kernel defense mechanism, overcomes KASLR limitations, increases KASLR entropy, and makes successful ROP attacks on the Linux kernel much harder to achieve. First, Adelie enables the position-independent code (PIC) model so that the kernel and its modules can be placed anywhere in the 64-bit virtual address space, at any distance apart from each other. Second, Adelie implements stack re-randomization and address encryption on modules. Finally, Adelie enables efficient continuous KASLR for modules by using the PIC model to make it (almost) impossible to inject ROP gadgets through these modules regardless of gadget's origin.Since device drivers (typically compiled as modules) are often developed by third parties and are typically less tested than core OS parts, they are also often more vulnerable. By fully re-randomizing device drivers, the last two contributions together prevent most JIT ROP attacks since vulnerable modules are very likely to be a starting point of an attack. Furthermore, some OS instances in virtualized environments are specifically designated to run device drivers, where drivers are the primary target of JIT ROP attacks. Using a GCC plugin that we developed, we automatically modify different kinds of kernel modules. Since the prior art tackles only user-space programs, we solve many challenges unique to the kernel code. Our evaluation shows high efficiency of Adelie's * Most of the work was done while the author worked at Virginia Tech.
AimsThe increasing burden of mental disorders coupled with the social stigmatization in Pakistan is an immense barrier in combating the emerging mental health crisis. The low number of qualified psychiatrists and poor intake in post-graduate psychiatry training programs in the region further complicates the problem. Thus, our study aims to assess the attitudes of Pakistani medical students towards psychiatry. Furthermore, we also aim to evaluate how experience and different levels of exposure to psychiatry among students affect their attitudes towards psychiatry as a career choice.MethodThis cross-sectional study was conducted via an online survey made on Google Forms. A total of 831 medical students studying across various private and public medical institutions of Pakistan responded to the survey. The questionnaire comprised of demographical details (gender, age, institution, and academic year) exposure to psychiatry, duration of psychiatry rotation, and personal experience with mental illness. The attitudes of medical students towards psychiatry were evaluated using the English version of the 30-item Attitudes Towards Psychiatry (ATP-30) scale. Chi-square test and multiple regression with backward method were used to analyze the data.ResultThe Cronbach's alpha value of the ATP-30 scale was 0.830. The participants in our study had a mean score of 107.6 ± 12 on ATP-30. Overall, most participants had a positive attitude towards psychiatry. Multiple regression analysis revealed a significant model pertaining to predictors of attitude toward psychiatry (F (df) = 11.28 (830), P < 0.001). However, the predictors included in the model accounted for only 5.8% of the variation in ATP-30 scores. According to it, those students had a more positive attitude toward psychiatry who identified as female, older and having any sort of exposure toward psychiatric specialty, direct involvement in psychiatric patient care, and reporting personal experience of mental illnesses.ConclusionOur study showed that medical students had a positive attitude towards psychiatry but female medical students, students with previous exposure to psychiatry, and students with longer psychiatry rotations tend to view psychiatry more positively. The generally positive trend towards psychiatry in Pakistan indicates the need to sustain improvements through proactive measures. We recommend longer placements for medical students in mental health settings for at least 4 weeks or longer. Medical schools should also promote research, discussions, and seminars on different psychiatric illnesses in order to enhance awareness among the students.
The cephalometric appraisal of mandibular incisor teeth in relation to the mandibular basal bone had its origin in the clinical outcomes that Tweed observed in his treated cases. Although was an admirer of Angle's philosophy, failure to achieve functional and aesthetic harmony in some of the orthodontically treated cases prompted Tweed to introspect his methodology and revisit the records of his patients. Consequently, based on his clinical annotations and cephalometric aid, a Diagnostic Facial Triangle was framed to assess the severity and difficulty in treating various degrees of malocclusions in routine orthodontic practice. Furthermore, a simple and effective method in the form of Headplate/Cephalogram Correction was also developed to quantify the extent of space requirements for rectifying prognathic dentures.
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