Undifferentiated Pleomorphic Sarcoma of the Descending Colon: An Infrequent Occurrence.

Undifferentiated pleomorphic sarcoma (UPS), formerly known as malignant fibrous histiocytoma (MFH), constitutes a significant subset of soft-tissue sarcomas. Despite its rarity, UPS poses substantial clinical challenges due to its aggressive behavior and propensity for distant metastasis. Here, we report a rare case of high-grade UPS located in the colon, a site exceptionally uncommon for this malignancy, in a 49-year-old woman. The case also underscores the importance of considering UPS in the differential diagnosis of colonic neoplasms. Understanding the clinical and pathological features of UPS in unusual locations like the large intestine is crucial for timely diagnosis and appropriate management strategies.

Binder-Free Anodes for Potassium-ion Batteries Comprising Antimony Nanoparticles on Carbon Nanotubes Obtained Using Electrophoretic Deposition.

Antimony has a high theoretical capacity and suitable alloying/dealloying potentials to make it a future anode for potassium-ion batteries (PIBs); however, substantial volumetric changes, severe pulverization, and active mass delamination from the Cu foil during potassiation/depotassiation need to be overcome. Herein, we present the use of electrophoretic deposition (EPD) to fabricate binder-free electrodes consisting of Sb nanoparticles (NPs) embedded in interconnected multiwalled carbon nanotubes (MWCNTs). The anode architecture allows volume changes to be accommodated and prevents Sb delamination within the binder-free electrodes. The Sb mass ratio of the Sb/CNT nanocomposites was varied, with the optimized Sb/CNT nanocomposite delivering a high reversible capacity of 341.30 mA h g-1 (∼90% of the initial charge capacity) after 300 cycles at C/5 and 185.69 mA h g-1 after 300 cycles at 1C. Postcycling investigations reveal that the stable performance is due to the unique Sb/CNT nanocomposite structure, which can be retained over extended cycling, protecting Sb NPs from volume changes and retaining the integrity of the electrode. Our findings not only suggest a facile fabrication method for high-performance alloy-based anodes in PIBs but also encourage the development of alloying-based anodes for next-generation PIBs.

A Comprehensive Analysis of Conventional Acupuncture and Pharmacological Approaches for Cardiac Arrhythmias: An Umbrella Review.

With a global incidence of approximately 3.4% and an annual mortality rate of 3.7 million, cardiac arrhythmias (CAs) are a pressing global health issue. Their increasing prevalence, especially among older people, is intensifying the challenge for health care systems worldwide. This study aims to compare the safety and effectiveness of acupuncture and pharmacological treatments for CAs, addressing critical gaps in understanding optimal therapeutic approaches. A search of PubMed, EMBASE, and the Cochrane database of systematic reviews was performed to identify data compiled through September 2023 for this umbrella review. Randomized controlled trials (RCTs) as the foundation for meta-analyses and peer-reviewed systematic reviews were the primary focus of the literature search. The Grading of Recommendations Assessment, Development, and Evaluation method was used to assess the overall certainty of the evidence, whereas AMSTAR 2 and the Cochrane Collaboration tool were used to evaluate the quality of the included reviews. Following a comprehensive review, three systematic analyses of 27 RCTs were integrated. Acupuncture led to a slightly greater reduction in the recurrence rate of paroxysmal supraventricular tachycardia (SVT) compared to standard pharmaceutical therapy (risk ratio [RR], 1.06; 95% confidence interval [CI], 0.88-1.27; I2 = 56%; P = .55), although the difference was not statistically significant. In contrast, acupuncture significantly outperformed pharmacological treatment in the context of ventricular premature beats (VPBs) (RR, 1.16; 95 CI, 1.08-1.25; I2 = 0%; P < .0001). The reduction in paroxysmal atrial fibrillation (AF)/atrial flutter was increased with acupuncture, albeit without statistical significance (RR, 1.12; 95% CI, 0.88-1.42; I2 = 0%; P = .36). Acupuncture also led to a greater reduction in heart rate (HR) compared to pharmaceutical treatment despite notable heterogeneity and a lack of statistical significance (mean difference, -1.55; 95% CI, -41.37 to 38.28; I2 = 99%; P = .94). Adverse events were effectively managed, affirming the favorable safety profile of acupuncture. Our study suggests that acupuncture leads to a greater reduction in the recurrence rates of VPBs, AF, and atrial flutter but not significantly so in paroxysmal SVT or post-treatment HR. While promising for specific arrhythmias, the varying effectiveness of acupuncture underscores the need for further research and clinical assessment to determine its precise role and suitability in managing particular cardiac conditions.

A 5-year comprehensive evaluation of maxillofacial injuries in polytrauma patients at a tertiary hospital - an epidemiological study.

OBJECTIVES: To report and analyze the pattern of maxillofacial injuries in trauma victims and to define the role of a maxillofacial surgeon in an emergency trauma care team. MATERIALS AND METHODS: Trauma patients reported and reporting to the casualty of a tertiaryhospital with facial injuries and other suspected concomitant injuries in the body were included in this study. The complete medical and radiographic records of each patient were reviewed and data was collected in a standard proforma in this 5-year clinical study (3 year of retrospective and 2 year of prospective study). The complete data related to the facial injuries and associated systemic trauma was recorded and statistical analysis conducted. RESULTS: A total of 18,369 patients with trauma were admitted to the hospital from May 2018 to April 2023. Out of these, 11,277 (61.4%) were males and 7,092 (38.6%) were females. Seventy percent of the reported cases with trauma were in the age group of 14-40 years. The incidence of trauma during the monsoon season was highest (n = 7,927, 43%). The commonest etiological factor leading to trauma was road traffic accident (n = 4,510, 40%). Among facial injuries, the mandibular fractures (n = 1,821, 41%) were predominant. CONCLUSIONS: The management of polytrauma patients should be undertaken by a team of specialists which should include a maxillofacial surgeon as facial injuries were common. This data is essential in developing and assessing the preventative strategies aimed at decreasing the frequency of facial and other injuries.

Orbital Plasmacytoma in an Elderly Patient With Multiple Myeloma.

Orbital plasmacytomas are exceedingly rare neoplasms characterized by the proliferation of monoclonal plasma cells in the orbital soft tissues. Their presentation and clinical course can be diverse, making early diagnosis and management challenging. This case report sheds light on one such instance, emphasizing the diagnostic and therapeutic aspects of this uncommon condition. We present an 81-year-old patient with a prior diagnosis of multiple myeloma and bilateral orbital plasmacytomas, highlighting the importance of imaging in diagnosis and management.

Prevalence of obstructive sleep apnoea syndrome in oncological patients: A systematic review and meta-analysis.

BACKGROUND: Obstructive sleep apnoea syndrome (OSAS) has garnered increasing attention in recent years due to its potential association with cancer. This systematic review and meta-analysis aimed to assess the prevalence of OSAS in cancer patients through a comprehensive analysis of existing literature. METHODS: This systematic review and meta-analysis, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, aimed to evaluate the prevalence of OSAS in cancer patients. A comprehensive search of electronic databases was performed to identify relevant studies published up to September 2021. Eligible studies reporting on the prevalence of OSAS in cancer patients, encompassing various study designs, were included in the analysis. Pooled estimates of the odds ratios (OR) with 95% confidence intervals (CIs) were calculated using a random effects model. Heterogeneity among the studies was assessed using the I2 statistic. RESULTS: Seventeen studies fulfilled the inclusion criteria and were subsequently included in the review. The prevalence of OSAS in cancer patients was estimated to have an overall OR of 0.80 (95% CI: 0.75-0.85). In comparison with non-cancer patients, cancer patients had a statistically significant greater risk of OSAS, as indicated by the total estimated RR for the prevalence of OSAS in cancer patients, which was 0.89 (95% CI: 0.86-0.92). Nonetheless, there was a significant amount of heterogeneity (I2 = 96%) among the studies. CONCLUSION: The overall data analysed in this review indicates that patients with cancer had far reduced likelihood of developing OSAS than individuals without cancer. However, the significant variation across the included studies highlights the need for additional investigation to fully clarify the complex association between OSAS and cancer incidence. These results emphasise how critical it is to identify OSAS as a possible comorbidity in cancer patients, one that should be taken into account for clinical management and ongoing research.

Binder-free germanium nanoparticle decorated multi-wall carbon nanotube anodes prepared via two-step electrophoretic deposition for high capacity Li-ion batteries.

Germanium (Ge) has a high theoretical specific capacity (1384 mA h g-1) and fast lithium-ion diffusivity, which makes it an attractive anode material for lithium-ion batteries (LIBs). However, large volume changes during lithiation can lead to poor capacity retention and rate capability. Here, electrophoretic deposition (EPD) is used as a facile strategy to prepare Ge nanoparticle carbon-nanotube (Ge/CNT) electrodes. The Ge and CNT mass ratio in the Ge/CNT nanocomposites can be controlled by varying the deposition time, voltage, and concentration of the Ge NP dispersion in the EPD process. The optimized Ge/CNT nanocomposite exhibited long-term cyclic stability, with a capacity of 819 mA h g-1 after 1000 cycles at C/5 and a reversible capacity of 686 mA h g-1 after 350 cycles (with a minuscule capacity loss of 0.07% per cycle) at 1C. The Ge/CNT nanocomposite electrodes delivered dramatically improved cycling stability compared to control Ge nanoparticles. This can be attributed to the synergistic effects of implanting Ge into a 3D interconnected CNT network which acts as a buffer layer to accommodate the volume expansion of Ge NPs during lithiation/delithiation, limiting cracking and/or crumbling, to retain the integrity of the Ge/CNT nanocomposite electrodes.

Treating Pulmonary Arterial Hypertension With Sotatercept: A Meta-Analysis.

Pulmonary arterial hypertension (PAH) results from proliferative remodeling and narrowing of the pulmonary vasculature. Sotatercept is a first-in-class fusion protein that has recently garnered attention for showing improvements in patients with PAH. This meta-analysis of randomized controlled trials (RCTs) assesses the overall efficacy of Sotatercept in treating PAH. PubMed, Google Scholar, and Clinicaltrials.gov were searched using relevant keywords and MeSH terms. Studies were included if RCTs compared Sotatercept with placebo in patients with PAH. Our comprehensive literature search yielded 3,127 results, of which two RCTs with 429 patients were included in this meta-analysis. The patients were on background therapy for PAH. Results of the meta-analysis show that when compared with placebo, Sotatercept improved the six-minute walk distance (mean difference [MD] 34.99; 95% confidence interval [CI] 19.02-50.95; P < 0.0001), the World Health Organization (WHO) functional class (odds ratio [OR] 2.50; 95% CI 1.50-4.15; P = 0.0004), and pulmonary vascular resistance (PVR, MD -253.90; 95% CI -356.05 to -151.75; P < 0.00001). However, reduction in N-terminal pro-B-type natriuretic peptide (NT-proBNP, MD -1563.14; 95% CI -3271.93 to 145.65; P = 0.07) was not statistically significant in the Sotatercept group versus placebo. In conclusion, Sotatercept improves the six-minute walk distance, WHO functional class, and PVR in patients with PAH receiving background therapy. However, the effect on NT-proBNP levels was not statistically significant. More research is needed to assess the clinical relevance of these findings.

Epidemiology and Clinical Outcomes of Fusobacterium Infections: A Six-Year Retrospective Study.

Background and Objectives: Anaerobic bacteria like Fusobacterium can lead to severe and life-threatening infections. The inherent complexities in the isolation of these bacteria may result in diagnostic and therapeutic delays, thereby escalating both morbidity and mortality rates. We aimed to examine data from patients with infections due to Fusobacterium to gain insights into the epidemiology and clinical outcomes of patients with these infections. Methods and Results: We conducted a retrospective analysis of clinical data from a cohort of patients with cultures positive for Fusobacterium species at a tertiary care medical center in the United States. Between 2009 and 2015, we identified 96 patients with cultures positive for Fusobacterium. Patients could be categorized into three groups based on the site of primary infection. Patients with head and neck infections constituted 37% (n 36). Patients with infections of other soft tissue sites accounted for 38.5% (n 37). Patients with anaerobic bacteremia due to Fusobacterium formed 24% (n 23) of the cohort. Surgical intervention coupled with antibiotic therapy emerged as cornerstones of management for patients with head and neck or other soft tissue infections, who generally exhibited more favorable outcomes. Patients with bacteremia were older, more likely to have malignancy, and had a high mortality rate. When speciation was available, Fusobacterium necrophorum was the most frequently isolated species. Conclusions: Our retrospective analysis of epidemiology and clinical outcomes of Fusobacterium infections revealed three distinct cohorts. Patients with head, neck, or soft tissue infections had better outcomes than those with bacteremia. Our findings highlight the importance of employing management strategies based on infection site and underlying comorbidities in patients with Fusobacterium infections. Further research is needed to investigate the optimal therapeutic strategies and identify prognostic indicators to improve clinical outcomes for these complex infections.

Effect of experimental boundary conditions and treatment-time on the electro-desalination of soils.

This study investigates the effect of boundary conditions and treatment-time on the electro-desalination of artificially-contaminated soil. The effect of ion exchange membranes (IEM), calcium chloride (CaCl2), and ethylenediaminetetraacetic acid (EDTA) on the removal of salt (i.e., Na+, Cl-, and Ca2+) and metal (i.e., Co2+ and Fe2+) ions from the soil by electrokinetic (EK) was studied. The outcomes demonstrate that an increase in treatment-time decreases the electroosmosis and ion removal rate, which might be attributed to the formation of acid-base fronts in soil, except in the IEM case. Because a high pH jump and electroosmotic flow (EOF) of water were not observed within the soil specimen due to the IEM, the removal of ions was only by diffusion and electromigration. The collision of acid-base fronts produced a large voltage gradient in a narrow soil region with a reduced electric field (EF) in its remaining parts, causing a decrease in EOF and ion transport by electromigration. The results showed that higher electroosmosis was observed by using CaCl2 and EDTA; thus, the removal rate of Co2+, Na+, and Ca2+ was greater than Cl- due to higher EOF. However, for relatively low EOF, the removal of Cl- exceeded that of Co2+, Na+, and Ca2+, possibly due to a lack of EOF. In addition, the adsorption of Fe2+ in soil increased with treatment-time due to the corrosion of the anode during all EK experiments except in the case of IEM, where an anion exchange membrane (AEM) was introduced at the anode-soil interface.

Novel Developments in the Treatment of Multiple Myeloma-Associated Bone Disease.

Osteolytic bone disease is present in about 80% of patients with multiple myeloma at the time of diagnosis. Managing bone disease in patients with multiple myeloma is a challenge and requires a multi-faceted treatment approach with medication, surgery, and radiation. The established treatments with intravenous or subcutaneous antiresorptives can cause debilitating adverse events for patients, mainly osteonecrosis of the jaw, which, traditionally, has been difficult to manage. Now, oral surgery is recommended and proven successful in 60-85% of patients. Patients with spinal involvement may benefit from surgery in the form of vertebroplasty and kyphoplasty for pain relief, improved mobility, and reestablished sagittal balance, as well as the restoration of vertebral height. These procedures are considered safe, but the full therapeutic impact needs to be investigated further. Ixazomib, the first oral proteasome inhibitor, increases osteoblast differentiation, and recently published preliminary results in patients treated with Ixazomib maintenance have promisingly shown increased trabecular volume caused by prolonged bone formation activity. Other novel potential treatment strategies are discussed as well.

What You See Is Not What You Get: Frontal Sinus Metastasis From the Renal Cell Carcinoma.

Metastatic neoplasms occurring in the nasal and paranasal sinuses are infrequent occurrences. In this study, we present one such case of a 61-year-old male patient with a known clear cell renal carcinoma presenting to us with signs and symptoms of acute sinusitis. The patient subsequently underwent CT and MRI examinations, which revealed a neoplastic mass in the right frontal sinus, which was surgically resected and was later confirmed histologically as a metastatic deposit from clear cell renal carcinoma. The patient is currently being treated with chemotherapy and radiotherapy and is doing well.

Solution processable Si/Ge heterostructure NWs enabling anode mass reduction for practical full-cell Li-ion batteries.

Here, we report the solution phase synthesis of axial heterostructure Si and Ge (hSG) nanowires (NWs). The NWs were grown in a high boiling point solvent from a low-cost Sn powder to achieve a powder form product which represents an attractive route from lab-scale to commercial application. Slurry processed anodes of the NWs were investigated in half-cell (versus Li-foil) and full-cell (versus NMC811) configurations of a lithium ion battery (LIB). The hSG NW anodes yielded capacities of 1040 mA h g-1 after 150 cycles which corresponds to a 2.8 times increase compared to a standard graphite (372 mA h g-1) anode. Given the impressive specific and areal capacities of the hSG anodes, a full-cell test against a high areal capacity NMC811 cathode was examined. In full-cell configuration, use of the hSG anode resulted in a massive anode mass reduction of 50.7% compared to a standard graphite anode. The structural evolution of the hSG NW anodes into an alloyed SiGe porous mesh network was also investigated using STEM, EDX and Raman spectroscopy as a function of cycle number to fully elucidate the lithiation/delithiation mechanism of the promising anode material.

IoT empowered smart cybersecurity framework for intrusion detection in internet of drones.

The emergence of drone-based innovative cyber security solutions integrated with the Internet of Things (IoT) has revolutionized navigational technologies with robust data communication services across multiple platforms. This advancement leverages machine learning and deep learning methods for future progress. In recent years, there has been a significant increase in the utilization of IoT-enabled drone data management technology. Industries ranging from industrial applications to agricultural advancements, as well as the implementation of smart cities for intelligent and efficient monitoring. However, these latest trends and drone-enabled IoT technology developments have also opened doors to malicious exploitation of existing IoT infrastructures. This raises concerns regarding the vulnerability of drone networks and security risks due to inherent design flaws and the lack of cybersecurity solutions and standards. The main objective of this study is to examine the latest privacy and security challenges impacting the network of drones (NoD). The research underscores the significance of establishing a secure and fortified drone network to mitigate interception and intrusion risks. The proposed system effectively detects cyber-attacks in drone networks by leveraging deep learning and machine learning techniques. Furthermore, the model's performance was evaluated using well-known drones' CICIDS2017, and KDDCup 99 datasets. We have tested the multiple hyperparameter parameters for optimal performance and classify data instances and maximum efficacy in the NoD framework. The model achieved exceptional efficiency and robustness in NoD, specifically while applying B-LSTM and LSTM. The system attains precision values of 89.10% and 90.16%, accuracy rates up to 91.00-91.36%, recall values of 81.13% and 90.11%, and F-measure values of 88.11% and 90.19% for the respective evaluation metrics.

Simulating aortic root replacement for a surgical wet laboratory in a resource-limited setting: an economical innovation.

Traditional cardiac surgery residency programs rely mainly on teaching surgical skills in the operating room. The increasing complexity of cardiac surgical operations on high-risk patients and the time constraints placed on residents in this surgical discipline negatively impact the learning opportunities for those residents. Simulation models, though efficient, are very expensive. In Third World Countries, they are unavailable for trainees due to financial constraints. We have introduced an innovative and cost-effective way of simulating aortic root replacement in a wet laboratory by applying a hand-made valve conduit or 'pencil conduit' to a bovine heart. It is reproducible, easy to assemble, cost-effective and simple to use. It can help develop and enhance the surgical skills of residents and junior surgeons for this advanced operation, which requires a meticulous surgical technique performed within a limited time frame.

Therapeutic Approach for Trigeminal Neuralgia: A Systematic Review.

This umbrella review aimed to determine the various drugs used to treat trigeminal neuralgia (TN) and to evaluate their efficacies as well as side effects by surveying previously published reviews. An online search was conducted using PubMed, CRD, EBSCO, Web of Science, Scopus, and the Cochrane Library with no limits on publication date or patients' gender, age, and ethnicity. Reviews and meta-analyses of randomized controlled trials pertaining to drug therapy for TN, and other relevant review articles added from their reference lists, were evaluated. Rapid reviews, reviews published in languages other than English, and reviews of laboratory studies, case reports, and series were excluded. A total of 588 articles were initially collected; 127 full-text articles were evaluated after removing the duplicates and screening the titles and abstracts, and 11 articles were finally included in this study. Except for carbamazepine, most of the drugs had been inadequately studied. Carbamazepine and oxcarbazepine continue to be the first choice for medication for classical TN. Lamotrigine and baclofen can be regarded as second-line drugs to treat patients not responding to first-line medication or for patients having intolerable side effects from carbamazepine. Drug combinations using carbamazepine, baclofen, gabapentin, ropivacaine, tizanidine, and pimozide can yield satisfactory results and improve the tolerance to the treatment. Intravenous lidocaine can be used to treat acute exaggerations and botulinum toxin-A can be used in refractory cases. Proparacaine, dextromethorphan, and tocainide were reported to be inappropriate for treating TN. Anticonvulsants are successful in managing trigeminal neuralgia; nevertheless, there have been few studies with high levels of proof, making it challenging to compare or even combine their results in a statistically useful way. New research on other drugs, combination therapies, and newer formulations, such as vixotrigine, is awaited. There is conclusive evidence for the efficacy of pharmacological drugs in the treatment of TN.

A rare case of diffuse ectasia in the coronary arteries and proximal aneurysm in the left anterior descending artery: A case report.

INTRODUCTION: Coronary artery aneurysm is defined as dilatation of a segment of coronary artery, greater than 1.5 times the diameter of the largest normal coronary artery of the patient. Major cause of coronary artery aneurysm is coronary artery disease. Coronary artery aneurysm maybe an incidental finding during coronary angiography or it may present with symptoms including chest pain, myocardial infarction or even death. CASE PRESENTATION: We present a rare case of a 59-year-old gentleman, who had, previously, underwent multiple left heart catheterizations and percutaneous coronary interventions. He presented to us with symptomatic diffuse ectasia of the coronary arteries with proximal aneurysm in the Left Anterior Descending Artery. DISCUSSION: Coronary artery aneurysms are very rare with an incidence of about 0.02 %-0.04 % and a prevalence of 0.3 %-12 %. Right Coronary Artery is the principal site coronary artery aneurysms with a predominance of 83.8 %. The occurrence of multiple aneurysms is a very rare finding. About 73 % patients present with single aneurysms while only 27 % present with multiple aneurysms. Coronary artery aneurysms predispose to various complications including compression of the chambers, thrombosis and rupture. CONCLUSION: From the presented case it can be concluded that even though, conservative management is available, surgical repair is the gold standard treatment, especially in the presence of multiple, symptomatic and large aneurysms in order to avoid fatal ischemic complications.

Dental amalgam teaching phase-out - a step too soon? Foundation trainees' experience of amalgam use in dental school compared to practice: a mixed-methods survey.

Aim This study aimed to explore disparities in experience of UK dental foundation trainees in amalgam use at dental school compared to their first year in dental practice.Methods A modified version of the 'survey of Yorkshire dentists' targeted the dental foundation trainees. A mixed-method of quantitative and thematic content analysis was undertaken for the close-ended and free-text responses, respectively.Results Only 35% of participants described their confidence level as 'satisfactory' in placing dental amalgam before starting their dental foundation training and 51% scored the level of teaching between 'very poor' and 'satisfactory'. In total, 63% of respondents were in favour of receiving additional support in placing amalgam restorations during their undergraduate training. Participants indicated that the consequences of amalgam phase-out are increased appointment times and decreased quality of care due to patient and health service unaffordability of amalgam alternatives.Conclusion These findings raise concerns regarding newly qualified undergraduates' confidence, experience and skill in placing amalgams. This suggests the need to increase undergraduate education and training to improve undergraduates' skills and confidence in amalgam procedures to reduce the gap between the dental schools and real-world practice.

Point of Care Ultrasonographic Life Support in Emergency (PULSE)-a quasi-experimental study.

BACKGROUND: Many physicians use point-of-care ultrasound (PoCUS) in their clinical practice to improve their diagnostic capabilities, accuracy, and timeliness. Over the last two decades, the use of PoCUS in the emergency room has dramatically increased. This study aimed to determine emergency physicians' retention of knowledge and skills after a brief training workshop on a focused ultrasound-guided approach to a patient presenting with undifferentiated shock, shortness of breath, and cardiac arrest in the emergency department of a tertiary care hospital. The secondary aim was to deliver the PoCUS-guided algorithmic approach to manage a patient presenting with undifferentiated shock, respiratory distress, and cardiac arrest in the emergency department. METHODS: A quasi-experimental study was conducted with a single-day Point of Care Ultrasonographic Life Support in Emergency (PULSE) training workshop in October 2021 at the Aga Khan University Hospital, Karachi, Pakistan. A total of 32 participants attended the course, including twenty-one junior residents (PGY 1 and 2) and medical officers with experience of fewer than two years working in different emergency departments of urban tertiary care hospitals across Karachi, Pakistan. Pre- and post-assessment tools comprised a written examination, evaluating participants' knowledge and skills in ultrasound image acquisition and interpretation. Cronbach's alpha was used to calculate the validity of the tool. Results obtained before and after the training session were compared by the McNemar's test. A p value of ≤ 0.05 was considered significant. RESULTS: There was a significant improvement in response to each question pre to post-test after completion of the course (Table 1). The significant change can be seen in questions 7, 8, 13, and 15, with a percentage change of 33.3, 80.9, 42.9, and 47.7. There was a significant improvement in the understanding and knowledge of participants after the training. The scores in the post-test were high compared to the pre-test in each category, i.e., respiratory distress (p < 0.017), cardiac arrest (p < 0.041), basic ultrasound knowledge (p < 0.001), and undifferentiated shock (p < 0.001). CONCLUSION: All participants showed improvement in their knowledge and confidence regarding using PoCUS in life-threatening conditions. Through this study, we have also developed an algorithmic approach to managing undifferentiated shock, respiratory failure, and cardiac arrest. Future studies must assess the effectiveness and feasibility of incorporating these algorithms into clinical practice.

Effect of peri-operative intra-aortic balloon pump in patients undergoing coronary artery bypass grafting on outcomes in a resource limited setting.

INTRODUCTION: Intra-aortic balloon pump (IABP) insertion for diminished myocardial function is standard of care in cardiac surgery. Previous studies have suggested a possible benefit to IABP support before surgery with regards to outcomes and complications. However, there are conflicts with other studies suggesting no significant benefit. Optimal time of insertion, whether preoperative or perioperative (intra-operative and post-operative), has yet to be defined. METHODOLOGY: A retrospective, hospital records-based chart review was conducted for patients admitted to our center from January 2015 to December 2019 for coronary bypass surgery necessitating IABP insertion. Cases were stratified according to the timing of insertion and analyzed according to surgical outcomes and complication rates. RESULTS: Out of 97 patients, 84.5% underwent preoperative IABP insertion while 15.5% of patients received perioperative (Intra-operative or post-operative) insertion. In-hospital mortality was significantly higher in patients with perioperative IABP insertion as compared to the preoperative group (60% vs 20.7%, p = 0.003). However, there were no significant differences between 30-day readmission rates in the two groups (9.8% vs 6.7%, p = 1.000). Length of stay was also higher in patients with preoperative insertion of IABP (p = 0.032), with no significant difference in ICU stay (p = 0.107). Perioperative IABP patients had higher rates of arrhythmias (46.7%, p = 0.042) and reopening of patient (33.3%, p = 0.028). CONCLUSION: Our study shows improved mortality in patients with preoperatively inserted IABP. This may be beneficial for high-risk patients undergoing CABG surgery. Expanding the use of IABP before CABG in third world countries such as Pakistan may improve overall survival for patients.