Seroprevalence of Hepatitis-E Virus-Immunoglobulin G and its association with Chronic Liver Disease.

Background & Objective: Viral hepatitis is a major public health concern in low-middle income countries. Hepatitis-E infection (HEV) is found globally but most prevalent in low-income countries especially those with poor sanitation systems, access to clean drinking water and health services. Superinfection with HEV in patients with chronic liver disease (CLD) can cause severe hepatic decompensation leading to increased morbidity and mortality. To determine the frequency of seroprevalence of Hepatitis-E virus Immunoglobulin g (IgG) and its association with chronic liver disease. Methods: A cross-sectional study was conducted in Asian Institute of Medical Sciences, Hyderabad, Pakistan from January till May 2022. A total of 196 patients of aged ≥ 18 years, presenting in gastroenterology clinics were included in the study after informed consent. Result: Among 196 patients, one third of patient were male (73.5%). Out of which 162 (82.7%) had liver disease and 34 (17.3%) were without liver disease. The median age of patient was 45 (33-51) years. The overall seroprevalence of HEV IgG among study population was 69.4%. HEV IgG was present in 114 and 22 in CLD and non CLD patients respectively. Multivariable regression shows no association between seroprevalence of HEV in CLD and non-CLD patient (AOR 1.02, 95% CI 0.45-2.313). Conclusion: Our study showed high frequency of HEV seropositivity. No difference was observed in HEV seropositivity among CLD and non-CLD patients.

Anthropometry of Proximal Tibia in Patients Undergoing Total Knee Replacement at a Tertiary Care Hospital.

Introduction Total knee arthroplasty is the standard of care treatment for advanced knee osteoarthritis. However, patients frequently continue to have pain and disability after surgery, with one of the most common reasons being a bone-implant mismatch. Notably, there is a significant difference reported in proximal tibia morphometry between Asian and Caucasian populations, and the currently available implants do not account for the anthropometric variations observed across ethnicities. We aimed to evaluate the proximal tibia anthropometry in a Pakistani population. Materials and methods A study was conducted at The Indus Hospital, Karachi Campus, from August 2019 to July 2020. All consecutive patients fulfilling the eligibility criteria and undergoing knee replacement surgery were included in the study. Baseline characteristics and anthropometry of proximal tibia were recorded on a pre-designed proforma. Statistical analysis was done using SPSS version 24. Results  A total of 30 patients were enrolled in this study, which included 17 females (56.7%) and 13 males (43.3%). The mean age was 61.6± 7.9 years and the BMI was 33±5.7 kg/m2. There was a significant difference found in the anteroposterior and mediolateral dimensions in both genders. A significant association was noted with body mass index (p-value 0.01) and occupation (p-value=0.02). Conclusion The results indicated that the anatomical profile of the proximal tibia in the Pakistani population is distinct, thus stressing the fact that it requires developing prostheses specifically tailored to this population's sizing requirements.

High-Throughput Analysis of Leaf Chlorophyll Content in Aquaponically Grown Lettuce Using Hyperspectral Reflectance and RGB Images.

Chlorophyll content reflects plants' photosynthetic capacity, growth stage, and nitrogen status and is, therefore, of significant importance in precision agriculture. This study aims to develop a spectral and color vegetation indices-based model to estimate the chlorophyll content in aquaponically grown lettuce. A completely open-source automated machine learning (AutoML) framework (EvalML) was employed to develop the prediction models. The performance of AutoML along with four other standard machine learning models (back-propagation neural network (BPNN), partial least squares regression (PLSR), random forest (RF), and support vector machine (SVM) was compared. The most sensitive spectral (SVIs) and color vegetation indices (CVIs) for chlorophyll content were extracted and evaluated as reliable estimators of chlorophyll content. Using an ASD FieldSpec 4 Hi-Res spectroradiometer and a portable red, green, and blue (RGB) camera, 3600 hyperspectral reflectance measurements and 800 RGB images were acquired from lettuce grown across a gradient of nutrient levels. Ground measurements of leaf chlorophyll were acquired using an SPAD-502 m calibrated via laboratory chemical analyses. The results revealed a strong relationship between chlorophyll content and SPAD-502 readings, with an R2 of 0.95 and a correlation coefficient (r) of 0.975. The developed AutoML models outperformed all traditional models, yielding the highest values of the coefficient of determination in prediction (Rp2) for all vegetation indices (VIs). The combination of SVIs and CVIs achieved the best prediction accuracy with the highest Rp2 values ranging from 0.89 to 0.98, respectively. This study demonstrated the feasibility of spectral and color vegetation indices as estimators of chlorophyll content. Furthermore, the developed AutoML models can be integrated into embedded devices to control nutrient cycles in aquaponics systems.

Can sub-cutaneous drain safely counter debilitating surgical emphysema? A retrospective study in quest for an answer.

Literature evidence on sub-cutaneous drain insertion in severe surgical emphysema (SE) is lacking. We retrospectively reviewed the clinical notes of 5 patients who underwent insertion of sub-cutaneous drains to manage SE of various aetiologies between September 2022 to August 2023 in a single district general hospital in the UK. Case history, outcome following sub-cutaneous drain insertion, and side effects due to the procedure were collected. Clinical decompression were noticed within an hour of drain insertion in all patients. Radiological resolution ranged between 2 and 10 days with a median 3 days and mean of 4.8 days. Patients with uni-lateral sub-cutaneous drain required more time for radiological improvement than patients on bi-lateral drains (median 6.5 vs. 2, mean 6.5 vs. 3.6). Maximum duration for resolution was 10 days for patients receiving uni-lateral sub-cutaneous drain versus 7 days in patients having bi-lateral drains. Only one patient had no prior lung disease making it difficult to comment if having healthy lungs affects outcomes. Sub-cutaneous drain insertion is a safe procedure which can accelerate recovery in severe SE.

A comparative analysis of postoperative visual outcomes following cataract surgery with different brands of Monofocal Intraocular Lenses.

Objective: To compare visual outcomes after cataract surgery using three intraocular lenses (IOL) of different prices but similar properties. Methods: A comparative study with retrospective data of patients operated for phacoemulsification with monofocal IOL implants was carried out at Al-Ibrahim Eye Hospital (AIEH) from April 2021 to Feb 2022. Patients with diabetes, any preoperative ocular morbidity and unclear diagnosis were excluded from the study. Pre and post-operative best corrected visual acuity (BCVA) on 1st day, 7th day and 4-6 weeks were analyzed. IOLs were categorized on the basis of price into economical, standard and premium lenses. To minimize surgical bias, data was further stratified on the basis of surgical expertise. Results: Data of 3237 patients was analyzed. Economical lens (A) was implanted in 2647, standard (B) in 254 and premium (C) in 336 patients. On average BCVA (6/6 to 6/12) was achieved in 88.2% of patients. No significant difference was found at third follow up among BCVA of three IOls operated by senior surgeon, χ2(2) = 3.216, p = 0.20, with median (IQR) is 0.2(0.2) logMAR for Group-A, 0.1(0.2) logMAR for Group-B and 0.2(0.1) logMAR for Group-C. When results of the rest of the surgeons was considered, significant difference was found among BCVA at 3rd follow-up, χ2(2) = 6.661, p = 0.036, with median (IQR) is 0.3(0.2) logMAR for Group-A, 0.2(0.1) logMAR for Group-B and 0.2(0.3) logMAR for Group-C. Conclusion: When surgical factors mainly, surgeon bias is removed, all three types of monofocal IOL had similar visual outcomes.

Effectiveness of Chitosan versus Natural Aloe Vera on Candida Adherence in Denture Soft Lining Material.

Background: Soft denture lining materials act as a cushion between the denture base and tissues. Alongside having many advantages, its main problem is candida growth due to its rubbery and porous texture. Many interventions have been performed to halt the growth of candida within soft lining materials such as the use of antifungal therapy and strict oral and denture hygiene but there are consequences such as recurrence, drug resistance, and toxicity related to these interventions. Since natural agents such as aloe vera and chitosan have been proven to have antibacterial and antifungal properties with minimum adverse effects, this study aimed to study the effectiveness of chitosan and aloe vera powders incorporated within denture soft lining materials against candida adherence. Methodology. A total of 60 soft-lining material samples were prepared that were equally divided into three groups, viz., group 1 (chitosan incorporation), group 2 (aloe vera incorporation), and group 3 (control). Candida was obtained from the microbiology lab to form a candidal suspension, diluted in 0.9% NaCl to match the McFarland standard bacteriologic solution. Samples were incubated at 37°C for 24 hours in test tubes containing 100 mL of the candidal suspension and 9.9 mL of the previously prepared Sabouraud dextrose agar. Crystal violet stain was used to stain the adhering cells by fixing them with methanol 80%. For each sample, the adhering candida cells were counted on three standard fields by using an inverted light microscope, and the mean of those fields was recorded. Results: The mean value for samples containing aloe vera was 41.15, while the mean values for samples containing chitosan and the control group were 16.05 and 79.1, respectively. Of all the three groups, aloe vera powder had a significant efficacy against candida growth as compared to the chitosan and control groups (P value = 0.001). Conclusion: Both herbal agents were effective against candida growth. In comparison, aloe vera was more effective against candida growth compared to chitosan.

Life cycle assessment of coal mines of diverse scales over time in China.

Coal mining has important detrimental effects on the environment and human health. By the end of 2022, China mined more than 4 billion tons of raw coal, and coal mining contributed to adverse environmental impacts. The objective of this work is to evaluate the environmental impacts emanated from coal mines in different periods (construction period, production period and closing period) and to find the relationship between coal mine scale and ecological impacts. This study uses coal mines that produce 0.45 Mt/a (considered a medium sized mine), 3 Mt/a and 8 Mt/a (both classified as large mines in this study) and a 12 Mt/a extra-large coal mine. Based on the time dimension, the mine life cycle was classified into construction, production and closing period, and the life cycle assessment method was used to conduct environmental assessment. The main influencing substances and key processes were tracked. The results indicated that mining engineering and gangue are the main factors affecting the construction and production periods of coal mines. Freshwater ecotoxicity, marine ecotoxicity, and human toxicity are the main environmental effects of coal produce, and they are mostly brought up by the release of hazardous elements like copper, chromium, zinc, nickel, and copper. Furan, formaldehyde, and chromium emissions during mine closure can be effectively reduced through environmental compensation, however coal mines' environmental compensation during mine closure is minimal. The environmental impact of coal mines producing 3 Mt and 8 Mt annually is minimal. The environmental impact of 0.45 Mt/a and 3 Mt/a coal mines is more prominent in the construction period. The pollutant discharge throughout the production phase, particularly the metal leaching discharge from gangue, needs to receive more attention from the 8 Mt/a and 12 Mt/a coal mines. Additionally, the larger the scale of coal mine production, the greater the proportion of the total environmental impact in the production stage.

Manipulating Surface Band Bending of III-Nitride Nanowires with Ambipolar Charge-Transfer Characteristics: A Pathway Toward Advanced Photoswitching Logic Gates and Encrypted Optical Communication.

The operational principle of semiconductor devices critically relies on the band structures that ultimately govern their charge-transfer characteristics. Indeed, the precise orchestration of band structure within semiconductor devices, notably at the semiconductor surface and corresponding interface, continues to pose a perennial conundrum. Herein, for the first time, this work reports a novel postepitaxy method: thickness-tunable carbon layer decoration to continuously manipulate the surface band bending of III-nitride semiconductors. Specifically, the surface band bending of p-type aluminum-gallium-nitride (p-AlGaN) nanowires grown on n-Si can be precisely controlled by depositing different carbon layers as guided by theoretical calculations, which eventually regulate the ambipolar charge-transfer behavior between the p-AlGaN/electrolyte and p-AlGaN/n-Si interface in an electrolyte environment. Enabled by the accurate modulation of the thickness of carbon layers, a spectrally distinctive bipolar photoresponse with a controllable polarity-switching-point over a wide spectrum range can be achieved, further demonstrating reprogrammable photoswitching logic gates "XOR", "NAND", "OR", and "NOT" in a single device. Finally, this work constructs a secured image transmission system where the optical signals are encrypted through the "XOR" logic operations. The proposed continuous surface band tuning strategy provides an effective avenue for the development of multifunctional integrated-photonics systems implemented with nanophotonics.

Highly Responsive Switchable Broadband DUV-NIR Photodetector and Tunable Emitter Enabled by Uniform and Vertically Grown III-V Nanowire on Silicon Substrate for Integrated Photonics.

Low-dimensional semiconductor nanostructures, particularly in the form of nanowire configurations with large surface-to-volume-ratio, offer intriguing optoelectronic properties for the advancement of integrated photonic technologies. Here, a bias-controlled, superior dual-functional broadband light detecting/emitting diode enabled by constructing the aluminum-gallium-nitride-based nanowire on the silicon-platform is reported. Strikingly, the diode exhibits a stable and high responsivity (R) of over 200 mAW-1 covering an extremely wide operation band under reverse bias conditions, ranging from deep ultraviolet (DUV: 254 nm) to near-infrared (NIR: 1000 nm) spectrum region. While at zero bias, it still possesses superior DUV light selectivity with a high off-rejection ratio of 106. When it comes to the operation of the light-emitting mode under forward bias, it can achieve large spectral changes from UV to red simply by coating colloid quantum dots on the nanowires. Based on the multifunctional features of the diodes, this study further employs them in various optoelectronic systems, demonstrating outstanding applications in multicolor imaging, filterless color discrimination, and DUV/NIR visualization. Such highly responsive broadband photodetector with a tunable emitter enabled by III-V nanowire on silicon provides a new avenue toward the realization of integrated photonics and holds great promise for future applications in communication, sensing, imaging, and visualization.

Infarcts of a Cardioembolic Source Mimicking Lacunar Infarcts: Case Series With Clinical and Radiological Correlation.

Lacunar strokes are the hallmark of cerebral small vessel disease. There are several well-established mechanisms for the pathogenesis of lacunar stroke, but the cardioembolic mechanism is not well-established. Three cases of acute ischemic stroke following elective cardiac and cerebral catheterization are reported. These cases had typical lacunar-looking infarcts on neuroimaging despite strong evidence of an embolic source with temporal correlation. Awareness of such findings and pathogenesis may help investigational workup and management of these patients.

Ocular Complications Associated With Diabetes And The Risk Of Sustainable Blindness; A Real World Analysis.

OBJECTIVE: To evaluate the frequencies of ocular comorbidities among patients with type II diabetes, and the association with multiple systemic factors. METHODS: The retrospective, cross-sectional study was conducted at the Al Ibrahim Eye Hospital, Karachi, and comprised diabetic eye clinic data from April 2014 to February 2022. Demographic, biochemical and ophthalmic findings of the patients were recorded. Ocular findings analysed were best-corrected visual acuity, lens status, corneal changes, optic disc assessment, intraocular pressure and signs of retinopathy and its grading. Data was analysed using SPSS 22. RESULTS: Of the 43,723 subjects, 22,677(51.86%) were males and 21,046(48.13%). The overall mean age was 54.14±10.68 years. There were 21,680(49.58%) patients with diabetes duration 5-10 years. Overall, 33,876(77.5%), had some ocular morbidity, while 9,847(22.5%) had no such complaints. The commonest morbidity was cataract12,607(28.8%), followed by refractive errors 8,508(19.5%), vision-threatening diabetic retinopathy 2,553(5.83%) and suspected glaucoma 1,211(2.76%). Vision 28 threatening diabetic retinopathy and suspected glaucoma represented sustained blindness risk 3,764(8.6%). Increasing levels of low-density lipoprotein were significantly associated with advanced diabetic eye disease and clinically significant macular oedema (p<0.05), while glycated haemoglobin >6.4 was associated significantly with diabetic retinopathy and suspected glaucoma (p<0.05). CONCLUSIONS: Diabetes caused some or the other ocular morbidity that needed intervention. Poor control of biochemical parameters was seen to increase frequency of ocular complications.

Novel technique of stent placement via gateway balloon in intracranial atherosclerosis-associated large vessel occlusion.

BACKGROUND AND PURPOSE: Neuroform Atlas stent can be deployed directly via gateway balloon for angioplasty and stent placement without the need for exchange maneuver required for Wingspan stent use. We present our initial experience of this strategy in intracranial atherosclerosis-associated large vessel occlusions. METHODS: Patients were identified through mechanical thrombectomy (MT) database from January 2020 to June 2022 at our institutions. Due to reocclusion or impending occlusion, rescue angioplasty with stent placement was performed after initial standard MT. Primary outcomes were good angiographic recanalization with modified thrombolysis in cerebral infarction (mTICI) score of 2b-3, rate of intracranial hemorrhage (ICH), and favorable functional outcome at 3 months, that is, modified Rankin Scale (mRS) score of 0-3. RESULTS: We identified 22 patients treated using this technique. Among those, 11 were females with their average age at 66 years (range: 52-85). Initial median National Institute of Health Stroke Scale score was 11 (range: 5-30) and all patients received loading doses of aspirin and P2Y12 inhibitor. After performing submaximal angioplasty and Neuroform Atlas stent deployment through the gateway balloon, we achieved final mTICI of 2b-3 in 20 (90%) patients. One patient had ICH post-op that was asymptomatic. Eight (36%) patients had mRS of 0-3 at 90 days. CONCLUSION: Our preliminary experience suggests possible safety and feasibility of deploying Neuroform Atlas stent through a compatible Gateway balloon microcatheter without the need for ICH-associated microcatheter exchange. Further studies with long-term clinical and angiographic follow-up are warranted to corroborate our initial findings.

Assessing Risk Factors for Prolonged Intensive Care Unit Stay After Surgery for Adult Congenital Heart Disease: A Study From a Lower-Middle-Income Country.

Background Prolonged post-surgery intensive care unit (ICU) stay for congenital heart disease (CHD) has been explored in the pediatric population. However, there is limited data for adult CHD (ACHD), also called grown-up congenital heart (GUCH) disease, especially in low-resource countries where intensive care beds are scarce. This study identifies factors associated with prolonged ICU stay following surgery for ACHD in Pakistan, a lower-middle-income country (LMIC). Methods This retrospective study included all adult patients (⩾18 years) who underwent cardiac surgery with cardiopulmonary bypass for their CHD from 2011-2016 at a tertiary-care private hospital in Pakistan. Prolonged ICU stay was defined as stay >6 days (75th percentile). Regression analysis was used to explore risk factors of prolonged ICU stay. Results A total of 166 patients (53.6% males) with a mean age of 32.05 ± 12.11 years were included. Atrial septal defect repair was the most common surgery (42.2%). Most patients were categorized as Risk Adjustment for Congenital Heart Surgery 1 (RACHS-1) Category 1 (51.8%) and Category 2 (30.1%). Forty-three of 166 patients (25.9%) experienced prolonged ICU stay. Complications occurred in 38.6% of patients postoperatively, with the most common being acute kidney injury (29.5%). On multivariable logistic regression adjusted for age, gender, and RACHS-1 categories, intraoperative inotrope score, cardiopulmonary bypass time, aortic cross-clamp time duration of mechanical ventilation, and postoperative acute kidney injury (AKI) were associated with prolonged ICU stay. Conclusion Surgeons managing ACHD in LMICs must strive for shorter operative durations and the judicious use of intraoperative inotropes in addition to anticipating and promptly managing postoperative complications such as AKI, to minimize ICU stay in countries where intensive care beds are a scarce resource.

Light-Induced Bipolar Photoresponse with Amplified Photocurrents in an Electrolyte-Assisted Bipolar p-n Junction.

The p-n junction with bipolar characteristics sets the fundamental unit to build electronics while its unique rectification behavior constrains the degree of carrier tunability for expanded functionalities. Herein, a bipolar-junction photoelectrode employed with a gallium nitride (GaN) p-n homojunction nanowire array that operates in electrolyte is reported, demonstrating bipolar photoresponse controlled by different wavelengths of light. Significantly, with rational decoration of a ruthenium oxides (RuOx ) layer on nanowires guided by theoretical modeling, the resulting RuOx /p-n GaN photoelectrode exhibits unambiguously boosted bipolar photoresponse by an enhancement of 775% and 3000% for positive and negative photocurrents, respectively, compared to the pristine nanowires. The loading of the RuOx layer on nanowire surface optimizes surface band bending, which facilitates charge transfer across the GaN/electrolyte interface, meanwhile promoting the efficiency of redox reaction for both hydrogen evolution reaction and oxygen evolution reaction which corresponds to the negative and positive photocurrents, respectively. Finally, a dual-channel optical communication system incorporated with such photoelectrode is constructed with using only one photoelectrode to decode dual-band signals with encrypted property. The proposed bipolar device architecture presents a viable route to manipulate the carrier dynamics for the development of a plethora of multifunctional optoelectronic devices for future sensing, communication, and imaging systems.

Differential Treatment Responses in Pakistani Schizophrenia Samples: Correlation with Sociodemographic Parameters, Drug Addiction, Attitude to the Treatment and Antipsychotic Agents.

Schizophrenia patients demonstrate variations in response to different therapies that are currently being used for the treatment of disorders, such as augmentation therapy (ECT or mood stabilizer) and combination therapy (with antipsychotics). These therapies are also used to treat schizophrenia patients in Pakistan; however, patients show poor overall response. Therefore, this study was conducted to investigate the association between the patients' response to treatment and the use of antipsychotic agents, with variability in overall response, within different groups of patients. Methods: We conducted a retrospective study that included schizophrenia subjects (N = 200) belonging to different age groups, ethnicities, and regions from different outpatient and inpatient departments in psychiatric institutes located in different cities of Pakistan. These patients were assessed for their response to treatment therapies and categorized into four groups (non-responders (N-R), slow response (S-R), patients with relapse, and completely recovered patients (C-R)) according to their responses. Results: The final analysis included 200 subjects, of which 73.5% were males. Mean age was 34 ± 10 years. Percentage of N-R was 5%, S-R was 42%, patients with relapse were 24%, and C-R was 1.5%. The generalized linear regression model shows a significant association between medication response and age (p = 0.0231), age of onset (p = 0.0086), gender (p = 0.005), and marital status (p = 0.00169). Variability within the medication responses was a result of the treatment regime followed. Antipsychotic agents were significantly associated with the treatment response (p = 0.00258, F = 4.981) of the patients. Significant variation was also observed in the treatment response (p = 0.00128) of the patients that were given augmentation therapy as well as combination therapy. Conclusion: The data suggests proper monitoring of patients' behavior in response to treatment therapies to implement tailored interventions. Despite several genetic studies supporting the heritability of schizophrenia, an insignificant association between characteristic features and family history might have been due to the limited sample size, suggesting collaborative work with massive sample sizes.

Prevalence of low back pain among medical doctors of the teaching hospitals in Karachi, Pakistan: A cross-sectional survey.

Objective: Our goal was to deduce the prevalence of low back pain among medical doctors in the teaching hospitals of Karachi, Pakistan, along with its associated variables and the functional disability accompanying it. Methods: This cross-sectional study was conducted among medical doctors from Creek General Hospital and United Hospital, affiliated with United Medical and Dental College, Karachi, Pakistan. A sample of 80 participants was included in this study, and a non-probability convenient sampling with randomization was utilized. Using a three-part questionnaire that included the Oswestry Disability Index, all participants were scrutinized for low back pain with its characteristics, associated risk factors, and functional disability. Results: Seventy percent of medical doctors included in this study suffered from the problem of low back pain, with 68% experiencing it over the last 3 months to 1 year. Furthermore, 89% and 11% suffered from minimal and moderate disability, respectively, affecting day-to-day and work life. Moreover, this study also found a significantly positive association (p value < 0.05*) of low back pain with age and work-related characteristics and was more common in those with work experience between 1 and 10 years, >8 working hours, >4 standing hours, and belonging to the surgery and medicine specialties. The association was significantly positive according to the chi-square/Fischer exact test. Conclusion: Our study addressed the evidence that low back pain is prevalent among medical doctors in teaching hospitals in Karachi, Pakistan, potentially affecting patient treatment and student education and accentuating the need for further intervention and research among doctors worldwide.

Meta-Analysis Evaluating Risk of Hyperkalemia Stratified by Baseline MRA Usage in Patients with Heart Failure Receiving SGLT2 Inhibitors.

BACKGROUND: Both mineralocorticoid receptor antagonists (MRAs) and sodium-glucose co-transporter type 2 inhibitors (SGLT2is) have demonstrated beneficial reductions in cardiovascular outcomes. However, the risk of precipitating hyperkalemia with their concomitant usage remains unclear. METHODS: MEDLINE and Cochrane were searched from inception through March 2022. Randomized controlled trials on patients with heart failure (HF) evaluating the effect of SGLT2is on clinical outcomes between MRA users and non-users were considered for inclusion. Outcomes of interest were mild and moderate/severe hyperkalemia, for which hazard ratios (HR) were pooled using a random effects model. RESULTS: From the 972 articles retrieved from the initial search, three RCTs (n = 14,462 patients) were included in our meta-analysis. Pooled analysis demonstrated no significant difference in the incidence of mild hyperkalemia between MRA users (HR 0.82 [0.70-0.97]) and non-users (HR 0.95 [0.77-1.17]) (P-interaction = 0.28). The risk of severe hyperkalemia was significantly decreased in MRA users (HR 0.59 [0.44-0.78]; p = 0.0002; I2 = 0%) but not in non-users (HR 0.76 [0.56-1.02]; p = 0.07; I2 = 0%) (P-interaction = 0.22). Sensitivity analysis including patients with HF with reduced ejection fraction (HFrEF) revealed similar results across all subgroups, but no significant reduction in the incidence of mild hyperkalemia (HR 0.89 [0.76-1.04] was noted in MRA users with HFrEF. CONCLUSION: MRAs reduced the risk of mild or moderate/severe hyperkalemia, when added to SGLT2is. Future clinical trials should target scrupulous assessment of the risk of mild and moderate/severe hyperkalemia when used concomitantly with MRAs.

Achieving Record-High Photoelectrochemical Photoresponse Characteristics by Employing Co3O4 Nanoclusters as Hole Charging Layer for Underwater Optical Communication.

The physicochemical properties of a semiconductor surface, especially in low-dimensional nanostructures, determine the electrical and optical behavior of the devices. Thereby, the precise control of surface properties is a prerequisite for not only preserving the intrinsic material quality but also manipulating carrier transport behavior for promoting device characteristics. Here, we report a facile approach to suppress the photocorrosion effect while boosting the photoresponse performance of n-GaN nanowires in a constructed photoelectrochemical-type photodetector by employing Co3O4 nanoclusters as a hole charging layer. Essentially, the Co3O4 nanoclusters not only alleviate nanowires from corrosion by optimizing the oxygen evolution reaction kinetics at the nanowire/electrolyte interface but also facilitate an efficient photogenerated carrier separation, migration, and collection process, leading to a significant ease of photocurrent attenuation (improved by nearly 867% after Co3O4 decoration). Strikingly, a record-high responsivity of 217.2 mA W-1 with an ultrafast response/recovery time of 0.03/0.02 ms can also be achieved, demonstrating one of the best performances among the reported photoelectrochemical-type photodetectors, that ultimately allowed us to build an underwater optical communication system based on the proposed nanowire array for practical applications. This work provides a perspective for the rational design of stable nanostructures for various applications in photo- and biosensing or energy-harvesting nanosystems.

Recurrent mitral regurgitation and left atrial aneurysm in a pediatric patent: A complex case of infective endocarditis.

A 6-year-old boy with a history of infective endocarditis (IE) presented with recurrent disease manifesting as left hip arthritis and severe mitral regurgitation. He developed a rare complication - a left atrial pseudoaneurysm. Despite the absence of classic fever and systemic symptoms, imaging revealed the recurrence and guided surgical repair. This case highlights the complexities of recurrent IE in children and underscores the importance of high clinical suspicion and imaging modalities like echocardiography for diagnosis and management.

Caroli's Syndrome: A Case Report and Literature Review.

Synonymous with congenital non-obstructive saccular or fusiform intra-hepatic duct dilatation and congenital communicating cavernous ectasia of the intra-hepatic biliary tract, Caroli's syndrome (CS) is an extremely rare fibro-polycystic liver disorder characterized by ductal plate malformation and consequent peri-portal fibrosis due to segmental intra-hepatic duct dilatation. No more than 200 cases of the syndrome have been reported since 1958. CS may affect one or both lobes of the liver, but more commonly it affects the left hepatic lobe. We describe a rare case of CS localized to the right hepatic lobe in a 21-year-old male, who presented with complaints of upper gastrointestinal (GI) bleeding without any signs or stigmata of chronic liver disease. Personal as well as family history was non-significant except positive for consanguineous parental marriage. General physical examination was unremarkable except for pallor, and upper GI endoscopy revealed columns of bandable esophageal varices which led us to a line of investigations to identify the cause of portal hypertension. Blood tests were non-specific, though imaging studies chiefly abdominal ultrasound, CT abdomen and pelvis with contrast, and magnetic resonance cholangiopancreatography (MRCP) led us to confirmation of the diagnosis of CS in the right hepatic lobe with manifestations of portal hypertension as the predominant feature. Diagnosis was confirmed on liver biopsy which showed right-sided cystic dilations with congenital hepatic fibrosis.