Delayed Presentation of a Post-infarction Ventricular Septal Rupture.

Ventricular septal rupture, a formidable complication of acute myocardial infarction (AMI), is linked to significant morbidity and mortality. The clinical manifestation typically involves pronounced hemodynamic compromise necessitating prompt surgical intervention. This report outlines the case of a 60-year-old male presenting with acute heart failure 3 weeks post a presumed AMI. On evaluation, a substantial ventricular septal defect with left-to-right shunt was observed. The patient, although hemodynamically stable with mild symptoms, underwent surgical closure of the defect and coronary artery bypass graft for multivessel coronary artery disease. This case contributes to the literature on the delayed presentation of post-myocardial infarction (MI) ventricular septal rupture, a scenario deviating from the anticipated severe hemodynamic instability given the timing of the MI and the extent of the septal defect.

Titania-Graphene Oxide Nanocomposite-Based Philadelphia-Positive Leukemia Therapy.

Philadelphia-positive (Ph+) leukemia is a type of blood cancer also known as acute lymphoblastic leukemia (ALL), affecting 20-30% of adults diagnosed worldwide and having an engraved prognosis as compared to other types of leukemia. The current treatment regimens mainly rely on tyrosine kinase inhibitors (TKIs) and bone marrow transplants. To date, several generations of TKIs have been developed due to associated resistance and frequent relapse, with cardiovascular system anomalies being the most devastating complication. Nanotechnology has the potential to address these limitations by the targeted drug delivery and controlled release of TKIs. This study focused on the titanium dioxide (TiO2) and graphene oxide (GO) nanocomposite employment to load nilotinib and ponatinib TKIs for therapy of Ph+ leukemia cell line (K562) and Ba/F3 cells engineered to express BCR-ABL oncogene. Meanwhile, after treatment, the oncogene expressing fibroblast cells (Rat-1 P185) were evaluated for their colony formation ability under 3D conditions. To validate the nanocomposite formation, the TiO2-GO nanocomposites were characterized by scanning electron microscope, DLS, XRD, FTIR, zeta potential, EDX, and element mapping. The TKI-loaded TiO2-GO was not inferior to the free drugs after evaluating their effects by a cell viability assay (XTT), apoptosis induction, and colony formation inhibition. The cell signaling pathways of the mammalian target of rapamycin (mTOR), signal transducers and activators of transcription 5 (STAT5), and extracellular signal-regulated kinase (Erk1/2) were also investigated by Western blot. These signaling pathways were significantly downregulated in the TKI-loaded TiO2-GO-treated groups. Based on the findings above, we can conclude that TiO2-GO exhibited excellent drug delivery potential that can be used for Ph+ leukemia therapy in the future, subject to further investigations.

Effect of vigorous-intensity physical activity on incident cognitive impairment in high-risk hypertension.

INTRODUCTION: We investigated the effect vigorous physical activity (VPA) on the risk of incident mild cognitive impairment (MCI) and probable dementia among individuals with high-risk hypertension. METHODS: Baseline self-reported frequency of VPA was categorized into low VPA (<1 session/week), and high VPA (≥1 session/week). We used multivariate Cox regression analysis to examine the association of VPA categories with incident MCI and probable dementia events. RESULTS: Participants in the high VPA category, compared with low VPA, experienced lower events rates (per 1000 person-years) of MCI (13.9 vs 19.7), probable dementia (6.3 vs 9.0), and MCI/probable dementia (18.5 vs 25.8). In the multivariate Cox regression model, high VPA, compared with low VPA, was associated with lower risk of MCI, probable dementia, and MCI/probable dementia (HR [95% CI]: 0.81 [0.68-0.97], 0.80 [0.63-1.03], and 0.82 [0.70-0.96]), respectively. DISCUSSION: This study provides evidence that VPA may preserve cognitive function in high-risk patients with hypertension. HIGHLIGHTS: Hypertension is associated with an increased risk of cognitive impairment Physical activity (PA) is associated with a lower risk of decline in cognition The effect of ≥1 sessions of vigorous-intensity PA (VPA) per week was assessed This analysis included SPRINT MIND trial participants with high-risk hypertension ≥1 VPA sessions/week was associated with lower risk of future cognitive impairment.

Experiment and Analysis of Variance for Stabilizing Fine-Grained Soils with Cement and Sawdust Ash as Liner Materials.

Due to volume change and low strength, fine-grained soils are problematic in construction. Stabilization with cement and sawdust ash (SDA) by-products can improve engineering properties. This study aimed to investigate the effectiveness of cement and sawdust ash (SDA) in stabilizing fine-grained soils for liner applications. Varying proportions of cement (0-9%) and SDA (0-10%) were added to soil samples (n = 24). Specimens were tested for unconfined compressive strength (UCS), hydraulic conductivity (HC), and volumetric shrinkage strain (VSS). Two-way ANOVA analyzed stabilization effects. Optimal stabilization occurred with 6% cement and 6% SDA, resulting in significant increases in UCS (51 to 375 kN/m2) and decreases in HC (1.7 × 10-8 to 4.7 × 10-10 m/s) and VSS (12.8 to 3.51%) compared to untreated soil. ANOVA indicated that both cement and SDA had statistically significant (p < 0.05) effects on improving all three engineering properties. The addition of 6% cement and 6% SDA significantly improved the expansive soil's strength, hydraulic conductivity, and volume change properties. ANOVA confirmed the quantitative improvements and the significance of both stabilizers. Stabilization using the by-product SDA has the potential to be a sustainable soil improvement method.

Optimization of switching charge and recoverable energy density mediated by structural transformation in Sr-substituted BaNiO3 perovskites.

Because of their distinctive characteristics, ferroelectric perovskites are considered among the most potent and auspicious candidates for energy storage and pulsed power devices. But their energy storage properties and switching capabilities need to be further enhanced which can be done by substitutions of appropriate cations. Hence, a series of lead-free Ba1-xSrxNiO3 (x = 0.00, 0.33, 0.67, and 1.00) ceramics was fabricated using a sol-gel auto combustion technique. Rietveld's refinement of X-ray diffraction plots verified the complete development of the required hexagonal perovskite structure. Scanning electron microscopy images revealed a gradual increase in average grain sizes and agglomeration with the increase in Sr-content. Moreover, the existence of all the constituent elements exactly in proportion to their stoichiometric ratios was verified by energy dispersive X-ray spectroscopy. The characteristic parameters of ferroelectric materials such as ferroelectric response, electrical conductivity, and switching charge density were also determined. The P-E loops indicated that with the increase in Sr-content, the coercive field, remanent polarization, and maximum polarization all decreased gradually, but the recoverable energy density (Wrec) increased as the loops became slimmer. The maximum value of Wrec was found in the Ba0.33Sr0.67NiO3 sample. Moreover, SrNiO3 exhibited minimum energy loss with the highest efficiency of ∼47.21%. The existence of a current barrier in all the samples was proved from the low leakage current values (∼10-7 A). In addition, the pure SrNiO3 showed a low electrical conductivity and minimum value of switching charge density. All these findings make SrNiO3 a promising candidate for fast switching and energy storage applications.

Saraiki language characters dataset (SLCD).

About 26 million people worldwide use the Saraiki language [1]. In the southern part of Punjab and Sindh, Saraiki language is extensively spoken. One of the most important Saraiki cultural hubs is Dera Ghazi Khan. In Dera Ghazi Khan, the Saraiki language is spoken by over 90 % of the population. Calligraphers use a sophisticated script to write this language. Despite the vast body of Optical Character Recognition (OCR) literature and research dedicated to other languages, a fully functional OCR system is still needed for Saraiki language [2,3]. This work presents a genuine dataset of Saraiki handwritten characters, consisting of 50,000 scanned photos, and makes it accessible to the public for use. All of the photographs include handwritten text contributed by teachers and students from Pak-Austria Fachhochschule for Applied Sciences and Technology, Pakistan. Around 1000 people, roughly half men and half women, contributed in writing this text. For scientific research, the dataset will be made accessible to the general public.

Surgical outcome of angular deformity correction of lower limbs in rickets: a cross-sectional study.

PURPOSE: This study aims to compare the functional and radiological outcomes following both guided growth surgery (GGS) and acute corrective osteotomy (ACO) correction of angular deformities in children with rickets. METHODS: A total of 8 and 7 children who had gradual GGS and ACO correction, respectively, for angular deformities due to rickets from 2002 to 2022 were recalled for follow-up. Demographic data, types of rickets, data on pharmacological treatment, biochemical parameters, recurrence of angular deformity and postoperative complications were obtained from the medical records. A radiographic evaluation of the leg was performed to determine the tibiofemoral angle. For functional evaluation, the Active Scale for Kids (ASK) and Lower Extremity Functional Scale (LEFS) instruments were used for children below and above 15 years old, respectively. RESULTS: In terms of the tibiofemoral angle, the GGS group documented greater angle changes compared to the ACO group, but the difference was not significant. In terms of functional outcomes, the overall score percentage of both groups was comparable with the GGS group showing a trend of higher score percentage compared to the ACO group. The GGS group presented no complication while 2 neurovascular injuries and 1 implant failure were recorded in the ACO group. CONCLUSION: Both GGS and ACO procedures resulted in similar radiographic and functional outcomes for the treatment of rickets in children. GGS may be advantageous in terms of reducing complications of surgery. Nevertheless, the choice of surgical intervention should be made based on the patient's circumstances and the surgeon's preference.

Advancing brain tumor detection: harnessing the Swin Transformer's power for accurate classification and performance analysis.

The accurate detection of brain tumors through medical imaging is paramount for precise diagnoses and effective treatment strategies. In this study, we introduce an innovative and robust methodology that capitalizes on the transformative potential of the Swin Transformer architecture for meticulous brain tumor image classification. Our approach handles the classification of brain tumors across four distinct categories: glioma, meningioma, non-tumor, and pituitary, leveraging a dataset comprising 2,870 images. Employing the Swin Transformer architecture, our method intricately integrates a multifaceted pipeline encompassing sophisticated preprocessing, intricate feature extraction mechanisms, and a highly nuanced classification framework. Utilizing 21 matrices for performance evaluation across all four classes, these matrices provide a detailed insight into the model's behavior throughout the learning process, furthermore showcasing a graphical representation of confusion matrix, training and validation loss and accuracy. The standout performance parameter, accuracy, stands at an impressive 97%. This achievement outperforms established models like CNN, DCNN, ViT, and their variants in brain tumor classification. Our methodology's robustness and exceptional accuracy showcase its potential as a pioneering model in this domain, promising substantial advancements in accurate tumor identification and classification, thereby contributing significantly to the landscape of medical image analysis.

Toward robust and privacy-enhanced facial recognition: A decentralized blockchain-based approach with GANs and deep learning.

In recent years, the extensive use of facial recognition technology has raised concerns about data privacy and security for various applications, such as improving security and streamlining attendance systems and smartphone access. In this study, a blockchain-based decentralized facial recognition system (DFRS) that has been designed to overcome the complexities of technology. The DFRS takes a trailblazing approach, focusing on finding a critical balance between the benefits of facial recognition and the protection of individuals' private rights in an era of increasing monitoring. First, the facial traits are segmented into separate clusters which are maintained by the specialized node that maintains the data privacy and security. After that, the data obfuscation is done by using generative adversarial networks. To ensure the security and authenticity of the data, the facial data is encoded and stored in the blockchain. The proposed system achieves significant results on the CelebA dataset, which shows the effectiveness of the proposed approach. The proposed model has demonstrated enhanced efficacy over existing methods, attaining 99.80% accuracy on the dataset. The study's results emphasize the system's efficacy, especially in biometrics and privacy-focused applications, demonstrating outstanding precision and efficiency during its implementation. This research provides a complete and novel solution for secure facial recognition and data security for privacy protection.

Incidence, clinical features, and outcomes of posterior circulation ischemic stroke: insights from a large multiethnic stroke database.

Background: Posterior cerebral circulation ischemic stroke (PCS) comprises up to 25% of all strokes. It is characterized by variable presentation, leading to misdiagnosis and morbidity and mortality. We aim to describe PCS in large multiethnic cohorts. Methods: A retrospective review of a large national stroke database from its inception on the 1st of January 2014 till 31 December 2020. Incidence per 100,000 adult population/year, demographics, clinical features, stroke location, and outcomes were retrieved. We divided the cohort into patients from MENA (Middle East and North Africa) and others. Results: In total, 1,571 patients were identified. The incidence of PCS was observed to be rising and ranged from 6.3 to 13.2/100,000 adult population over the study period. Men were 82.4% of the total. The mean age was 54.9 ± 12.7 years (median 54 years, IQR 46, 63). MENA patients comprised 616 (39.2%) while others were 954 (60.7%); of these, the majority (80.5%) were from South Asia. Vascular risk factors were prevalent with 1,230 (78.3%) having hypertension, 970 (61.7%) with diabetes, and 872 (55.5%) having dyslipidemia. Weakness (944, 58.8%), dizziness (801, 50.5%), and slurred speech (584, 36.2%) were the most commonly presenting symptoms. The mean National Institute of Health Stroke Score (NIHSS) score was 3.8 ± 4.6 (median 3, IQR 1, 5). The overall most frequent stroke location was the distal location (568, 36.2%). The non-MENA cohort was younger, less vascularly burdened, and had more frequent proximal stroke location (p < 0.05). Dependency or death at discharge was seen in 39.5% and was associated with increasing age, and proximal and multilocation involvement; while at 90 days it was 27.4% and was associated with age, male sex, and having a MENA nationality (p < 0.05). Conclusion: In a multiethnic cohort of posterior circulation stroke patients from the MENA region and South Asia, we noted a rising incidence over time, high prevalence of vascular risk factors, and poor outcomes in older men from the MENA region. We also uncovered considerable disparities between the MENA and non-MENA groups in stroke location and outcome. These disparities are crucial factors to consider when tailoring individualized patient care plans. Further research is needed to thoroughly investigate the underlying reasons for these variations.

Analgesic efficacy and safety of erector spinae versus serratus anterior plane block in thoracic surgery: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Erector spinae plane block (ESPB) and serratus anterior plane block (SAPB) are regional anesthesia techniques that have shown favorable results in pain management following thoracic surgeries; however, their relative superiority is unclear. This review (PROSPERO: CRD42023443018) aims to compare the analgesic efficacy of ESPB and SAPB in patients undergoing thoracic surgeries through the pooled analysis of co-primary outcomes: postoperative oral-morphine-equivalent (mg) consumption in 24 h and pain scores (static) at 24 h. METHODS: A literature search was conducted across PubMed, Cochrane Library, and Google Scholar to identify randomized controlled trials (RCTs) from inception to May 2023, comparing ESPB and SAPB in thoracic surgeries. Statistical pooling was done using Review Manager 5.4.1. Bias assessment employed the Cochrane Collaboration Risk-of-Bias 2.0 tool. The strength of evidence was assessed using the guidelines from the GRADE working group. RESULTS: Nine RCTs (485 patients) were included in the study. Postoperative pain scores (static) at 24 h (mean difference (MD) = - 0.31 [- 0.57, 0.05], p = 0.02) and postoperative oral-morphine-equivalent (mg) consumption in 24 h (MD = - 19.73 [- 25.65, - 13.80], p < 0.00001) were significantly lower in the ESBP group. However, the MDs did not exceed the set threshold for clinical importance. No significant differences were observed in the opioid-related adverse effects and block-related complications. CONCLUSION: Our statistically significant results imply that ESPB has superior analgesic efficacy compared to SAPB; however, this difference is clinically unimportant. The safety profile of the two blocks is comparable; hence, current evidence cannot define the relative superiority of one block over the other. Our findings warrant further research with standardized methodologies and a longer duration of analgesic efficacy assessment to yield robust evidence for better clinical applications.

Exploring soil radon (Rn) concentrations and their connection to geological and meteorological factors.

The relationship between soil radon and meteorological parameters in a region can provide insight into natural processes occurring between the lithosphere and the atmosphere. Understanding this relationship can help models establish more realistic results, rather than depending on theoretical consequences. Radon variation can be complicated to model due to the various physical variables which can affect it, posing a limitation in atmospheric studies. To predict Rn variation from meteorological parameters, a hybrid mod el called multiANN, which is a combination of multi-regression and artificial neural network (ANN) models, is established. The model was trained with 70% of the data and tested on the remaining 30%, and its robustness was tested using the Monte-Carlo method. The regions with low performance are identified and possibly related to seismic events. This model can be a good candidate for predicting Rn concentrations from meteorological parameters and establishing the lower boundary conditions in seismo-ionospheric coupling models.

Non-Coding RNA-Mediated Gene Regulation in Cardiovascular Disorders: Current Insights and Future Directions.

Cardiovascular diseases (CVDs) pose a significant burden on global health. Developing effective diagnostic, therapeutic, and prognostic indicators for CVDs is critical. This narrative review explores the role of select non-coding RNAs (ncRNAs) and provides an in-depth exploration of the roles of miRNAs, lncRNAs, and circRNAs in different aspects of CVDs, offering insights into their mechanisms and potential clinical implications. The review also sheds light on the diverse functions of ncRNAs, including their modulation of gene expression, epigenetic modifications, and signaling pathways. It comprehensively analyzes the interplay between ncRNAs and cardiovascular health, paving the way for potential novel interventions. Finally, the review provides insights into the methodologies used to investigate ncRNA-mediated gene regulation in CVDs, as well as the implications and challenges associated with translating ncRNA research into clinical applications. Considering the broader implications, this research opens avenues for interdisciplinary collaborations, enhancing our understanding of CVDs across scientific disciplines.

Malignant Pheochromocytoma With Intravascular Extension to the Heart.

Background: Malignant pheochromocytomas are rare and aggressive tumors that arise from the adrenal medulla and secrete catecholamines. Patients exhibit episodic symptoms of hypertension, headaches, sweating, and palpitations. The diagnosis is supported by elevated levels of urinary metanephrines, and imaging is used to determine the stage. Treatment involves surgical resection when possible. Case Report: A 57-year-old male presented with hematemesis and melena, and endoscopy revealed upper gastrointestinal bleeding. Imaging showed a malignant pheochromocytoma that had infiltrated the upper lobe of the right kidney and the right lobe of the liver, with a tumor thrombus extending into the hepatic inferior vena cava, the right atrium, and the right ventricle. The patient denied surgery and was treated with palliative medical therapy until he died 3 months later. Conclusion: Although rare, malignant pheochromocytomas may present with upper gastrointestinal bleeding. While metastasis to the liver is a typical manifestation of malignant pheochromocytomas, invasion of the inferior vena cava with infiltration to the right ventricle resulting in tricuspid valve malfunction is a rare finding.

Visible and angular interrogation of Kretschmann-based SPR using hybrid Au-ZnO optical sensor for hyperuricemia detection.

Uric acid is a waste product of the human body where high levels of it or hyperuricemia can lead to gout, kidney disease and other health issues. In this paper, Finite Difference Time Doman (FDTD) simulation method was used to develop a plasmonic optical sensor to detect uric acid with molarity ranging from 0 to 3.0 mM. A hybrid layer of gold-zinc oxide (Au-ZnO) was used in this Kretschmann-based Surface Plasmon Resonance (K-SPR) technique with angular interrogation at 670 nm and 785 nm visible optical wavelengths. The purpose of this study is to observe the ability of the hybrid material as a sensing performance enhancer for differentiating between healthy and unhealthy uric acid levels based on the refractive index values from previous study. Upon exposure to 670 nm wavelength, the average sensitivity of this sensor was found to be 0.028°/mM with a linearity of 98.67 % and Q-factor value of 0.0053 mM-1. While at 785 nm, the average sensitivity is equal to 0.0193°/mM with slightly lower linearity at 94.46 % and Q-factor value of 0.0076 mM-1. The results have proven the ability of hybrid material Au-ZnO as a sensing performance enhancer for detecting uric acid when compared with bare Au and can be further explored in experimental work.

Investigation of vibration's effect on driver in optimal motion cueing algorithm.

The increased sensation error between the surroundings and the driver is a major problem in driving simulators, resulting in unrealistic motion cues. Intelligent control schemes have to be developed to provide realistic motion cues to the driver. The driver's body model incorporates the effects of vibrations on the driver's health, comfort, perception, and motion sickness, and most of the current research on motion cueing has not considered these factors. This article proposes a novel optimal motion cueing algorithm that utilizes the driver's body model in conjunction with the driver's perception model to minimize the sensation error. Moreover, this article employs H∞ control in place of the linear quadratic regulator to optimize the quadratic cost function of sensation error. As compared to state of the art, we achieve decreased sensation error in terms of small root-mean-square difference (70%, 61%, and 84% decrease in case of longitudinal acceleration, lateral acceleration, and yaw velocity, respectively) and improved coefficient of cross-correlation (3% and 1% increase in case of longitudinal and lateral acceleration, respectively).

Evaluating the competency of community pharmacists in identifying and managing malnourished patients: A cross sectional survey.

Background: Malnutrition is a global health issue that affects all age groups and regions. The integration of malnutrition screening into community pharmacy practices help address malnutrition. Community pharmacies, with their accessibility and reach, are well-suited to provide essential malnutrition screening services, contributing to improved public health outcomes. Objective: The research objectives encompass evaluating community pharmacists' knowledge, screening proficiency, range of malnutrition services provided, and competence in identifying patients at risk of malnutrition. Method: The study used a cross-sectional design to gather data from CPs in Kaduna State, Nigeria, using an online, self-administered, semi-structured questionnaire. Convenience sampling was used, and the data were evaluated using descriptive statistics. Results: Eighty five percent of the 80 CPs who took the survey and provided responses practiced in urban areas. Approximately 37% and 18% of pharmacists, respectively, had a good and fair understanding of therapeutic nutrition. Additionally, while 33% of pharmacists provided nutritional advice in response to a prescription, 41% of them did so based on specific observations. Patients with severe dehydration (28%), infants and children with growth impairment (25%), and neonates with low birth weight (20%) were identified as high-risk. A little over 30% of survey participants thought patients should have both dietary and medical treatment. Additionally, 34% of pharmacists reported nutritional supplements had a positive impact on public health, while 28% believed they should be sold in pharmacies under pharmacist supervision. Conclusion: Study findings revealed knowledge gaps in addressing malnutrition among CPs. While they play a significant role, improvements are needed in understanding therapeutic nutrition and providing advice. Identifying high-risk patients and recognizing the value of nutritional supplements can enhance public healthcare services and patient well-being.

Cryptococcal Meningitis in an HIV-Negative Pulmonary Tuberculosis Patient: A Case Report.

Cryptococcal meningitis represents a severe opportunistic fungal infection primarily observed in individuals with compromised immune systems. It frequently manifests in symptoms like headaches, vomiting, cranial nerve complications, and cognitive alterations. However, it's worth noting that up to 15% of cases may exhibit no discernible central nervous system-related symptoms. A 70-year-old male, previously diagnosed with pulmonary tuberculosis and undergoing treatment with anti-tubercular medications, was admitted due to changes in consciousness, sporadic low-grade fever, and cognitive impairment. An in-depth investigation revealed his HIV-negative and non-diabetic status, as well as his preserved immune competence. A plain CT head showed a communicating hydrocephalus and a lumbar puncture was positive for Cryptococcus neoformans. Treatment commenced with an induction regimen encompassing amphotericin and fluconazole, concurrently maintaining the anti-tubercular treatment course. The patient's condition displayed improvement, leading to a transition to a maintenance dosage of fluconazole. This case highlighted an extraordinary occurrence of Cryptococcal meningitis in an HIV-negative patient with no history of immunosuppressant use. Notably, Cryptococcal infection should be regarded as a primary consideration in patients afflicted by pulmonary tuberculosis who subsequently present with altered consciousness. The timely identification and proper management of such instances can substantially mitigate the risks of mortality and morbidity associated with this condition.