National guidelines for the diagnosis and treatment of hilar cholangiocarcinoma.

A consensus meeting of national experts from all major national hepatobiliary centres in the country was held on May 26, 2023, at the Pakistan Kidney and Liver Institute & Research Centre (PKLI & RC) after initial consultations with the experts. The Pakistan Society for the Study of Liver Diseases (PSSLD) and PKLI & RC jointly organised this meeting. This effort was based on a comprehensive literature review to establish national practice guidelines for hilar cholangiocarcinoma (hCCA). The consensus was that hCCA is a complex disease and requires a multidisciplinary team approach to best manage these patients. This coordinated effort can minimise delays and give patients a chance for curative treatment and effective palliation. The diagnostic and staging workup includes high-quality computed tomography, magnetic resonance imaging, and magnetic resonance cholangiopancreatography. Brush cytology or biopsy utilizing endoscopic retrograde cholangiopancreatography is a mainstay for diagnosis. However, histopathologic confirmation is not always required before resection. Endoscopic ultrasound with fine needle aspiration of regional lymph nodes and positron emission tomography scan are valuable adjuncts for staging. The only curative treatment is the surgical resection of the biliary tree based on the Bismuth-Corlette classification. Selected patients with unresectable hCCA can be considered for liver transplantation. Adjuvant chemotherapy should be offered to patients with a high risk of recurrence. The use of preoperative biliary drainage and the need for portal vein embolisation should be based on local multidisciplinary discussions. Patients with acute cholangitis can be drained with endoscopic or percutaneous biliary drainage. Palliative chemotherapy with cisplatin and gemcitabine has shown improved survival in patients with irresectable and recurrent hCCA.

Hexavalent chromium exposure activates the non-canonical nuclear factor kappa B pathway to promote immune checkpoint protein programmed death-ligand 1 expression and lung carcinogenesis.

Lung cancer is the leading cause of cancer-related death worldwide; however, the mechanism of lung carcinogenesis has not been clearly defined. Chronic exposure to hexavalent chromium [Cr(VI)], a common environmental and occupational pollutant, causes lung cancer, representing an important lung cancer etiology factor. The mechanism of how chronic Cr(VI) exposure causes lung cancer remains largely unknown. By using cell culture and mouse models and bioinformatics analyses of human lung cancer gene expression profiles, this study investigated the mechanism of Cr(VI)-induced lung carcinogenesis. A new mouse model of Cr(VI)-induced lung carcinogenesis was developed as evidenced by the findings showing that a 16-week Cr(VI) exposure (CaCrO4, 100 µg per mouse once per week) via oropharyngeal aspiration induced lung adenocarcinomas in male and female A/J mice, whereas none of the sham-exposed control mice had lung tumors. Mechanistic studies revealed that chronic Cr(VI) exposure activated the non-canonical NFκB pathway through the long non-coding RNA (lncRNA) ABHD11-AS1/deubiquitinase USP15-mediated tumor necrosis factor receptor-associated factor 3 (TRAF3) down-regulation. The non-canonical NFκB pathway activation increased the interleukin 6 (IL-6)/Janus kinase (Jak)/signal transducer and activator of transcription 3 (Stat3) signaling. The activation of the IL-6/Jak signaling axis by Cr(VI) exposure not only promoted inflammation but also stabilized the immune checkpoint molecule programmed death-ligand 1 (PD-L1) protein in the lungs, reducing T lymphocyte infiltration to the lungs. Given the well-recognized critical role of PD-L1 in inhibiting anti-tumor immunity, these findings suggested that the lncRNA ABHD11-AS1-mediated non-canonical NFκB pathway activation and PD-L1 up-regulation may play important roles in Cr(VI)-induced lung carcinogenesis.

Percutaneous Transhepatic Sphincterotome-Guided Management of Post-Living Donor Liver Transplant Biliary Anastomotic Stricture: An Innovative Approach.

Post-liver transplantation biliary complications remain a serious concern and are associated with reduced patient and graft survival. Among various biliary complications, anastomotic stricture (AS) is the most frequent and challenging one. The frequency of AS after living donor liver transplantation (LDLT) is higher as compared to deceased donor liver transplantation. The management involves endoscopic retrograde cholangiopancreatography and/or percutaneous transhepatic biliary drainage, but refractory cases necessitate surgical revision. We present a case of complex biliary AS in a 63-year-old man after LDLT. The conventional approaches including endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, and cholangioscope-guided interventions remained unsuccessful. An innovative approach using a wire-guided sphincterotome through percutaneous transhepatic route successfully managed the complex post-LDLT AS. This is perhaps the first reported case of novel utilization of sphincterotome through transhepatic route for the management of AS in LDLT, averting major surgical interventions with related morbidity and mortality.

Pharmacist insights into antimicrobial stewardship: A social marketing approach.

BACKGROUND: Antimicrobial resistance is a worldwide public health problem. Antimicrobial stewardship programs (ASPs) optimize antimicrobial use within hospitals. The social marketing framework has been used in analyzing systems and devising best practices. OBJECTIVE: (s): To use the social marketing framework to explore pharmacist experiences and perceptions of structural, behavioral and interventional strategies that support ASPs. METHODS: A qualitative approach utilizing semi-structured individual interviews was utilized. A purposive sample of hospital pharmacists was invited to participate. An interview guide was constructed to describe participant experience and perceptions regarding ASPs in their institutions based on elements of social marketing: Behavioral goals; Customer Insight; Segmentation and Targeting; Competition; Exchange; and Marketing and Interventional mix. Interviews were recorded digitally and transcribed verbatim. Thematic analysis was conducted using deductive methods. A combination of case-based and code-based approaches allowed individual and holistic analyses respectively. Codes were collated into themes and subthemes. RESULTS: Saturation of themes occurred with 25 interviews from 17 hospitals. ASP metrics included: consumption of antibiotics using days of therapy and defined daily dose, rates of C. difficile and multidrug resistant organisms, resistance patterns, and provider adherence to the ASP. Active stewardship tools such as preauthorization, and prospective feedback/audit were preferred over passive tools such as order sets and automatic stop orders. A physician champion and a clinical pharmacist with infectious disease training were core elements in the multidisciplinary team. Despite certain areas being considered key for stewardship, participants emphasized a hospital-wide approach including outpatient departments; discharge stewardship emerged as a primary theme. Leadership supported ASPs with finances, rapid and novel diagnostics, Clinical Decision Support Systems, mobile technology, and continuous staff training. CONCLUSIONS: The social marketing framework has been used to explore pharmacist perceptions that inform successful qualities including metrics, restriction methods, personnel, benefits, barriers, training needs/modes, and promotional avenues that support ASPs in hospitals.

Incidence and factors associated with burnout in radiologists: A systematic review.

Rationale and objectives: Burnout among physicians has a prevalence rate exceeding 50%. The radiology department is not immune to the burnout epidemic. Understanding and addressing burnout among radiologists has been a subject of recent interest. Thus, our study aims to systematically review studies reporting the prevalence of burnout in physicians in the radiology department while providing an overview of the factors associated with burnout among radiologists. Materials and methods: The search was conducted from inception until November 13th, 2022, in PubMed, Embase, Education Resources Information Center, PsycINFO, and psycArticles. Studies reporting the prevalence of burnout or any subdimensions among radiology physicians, including residents, fellows, consultants, and attendings, were included. Data on study characteristics and estimates of burnout syndrome or any of its subdimensions were collected and summarized. Results: After screening 6379 studies, 23 studies from seven countries were eligible. The number of participants ranged from 26 to 460 (median, 162; interquartile range, 91-264). In all, 18 studies (78.3%) employed a form of the Maslach Burnout Inventory. In comparison, four studies (17.4%) used the Stanford Professional Fulfillment Index, and one study (4.3%) used a single-item measure derived from the Zero Burnout Program survey. Overall burnout prevalence estimates were reported by 14 studies (60.9%) and varied from 33% to 88%. High burnout prevalence estimates were reported by only five studies (21.7%) and ranged from 5% to 62%. Emotional exhaustion and depersonalization prevalence estimates were reported by 16 studies (69.6%) and ranged from 11%-100% and 4%-97%, respectively. Furthermore, 15 studies (65.2%) reported low personal accomplishment prevalence, ranging from 14.7% to 84%. There were at least seven definitions for overall burnout and high burnout among the included studies, and there was high heterogeneity among the cutoff scores used for the burnout subdimensions. Conclusion: Burnout in radiology is increasing globally, with prevalence estimates reaching 88% and 62% for overall and high burnout, respectively. A myriad of factors has been identified as contributing to the increased prevalence. Our data demonstrated significant variability in burnout prevalence estimates among radiologists and major disparities in burnout criteria, instrument tools, and study quality.

Short Tandem Repeat (STR) DNA Analysis for Using Coffee Cups As Forensic Medicine Evidence.

Introduction Forensic science has continually evolved, with innovations in DNA analysis techniques playing a pivotal role in improving the accuracy and reliability of criminal investigations. Short tandem repeats (STRs) have been a game-changer in forensic science, offering unique genetic markers to pinpoint individual identities. This study explores the application of STR DNA analysis to an unconventional source: coffee cups. Materials and methods In a study involving 16 unrelated, healthy individuals aged 26 to 32, DNA was investigated from coffee cups and mouth cavities, comparing the results to a previous coffee cup DNA study. Buccal swabs provided reference samples, air-dried for 10 minutes, and stored at 20°C. DNA quantification revealed a significant decrease in coffee cup samples (0.015 to 0.049 ng/µL) compared to the reference, with no DNA in negative controls. Some STR loci displayed inhibition and lower heterozygosity in the research samples. Ethical approval (REC 53-592) and adherence to the Declaration of Helsinki ensured ethical standards. This research highlights potential challenges in obtaining efficient DNA profiles from various sources. Results There was a significant variation in DNA concentrations among the different cup types, with ceramic cups yielding the highest concentrations. Moreover, the DNA profiling outcomes ranged from full profiles, which allow for precise individual identification, to partial profiles, which pose challenges for conclusive matches. These findings have profound implications for forensic science. The study demonstrates the potential of coffee cups as sources of DNA evidence in criminal investigations, even if partial profiles are obtained. Such evidence can assist in suspect identification, victim profiling, and corroborating witness statements. Conclusion This study highlights the application of STR DNA analysis for coffee cups, opening new avenues for forensic investigations and highlighting the need for continued research and development in this exciting field. This observation aligns with existing research on DNA recovery from various surfaces, and further research is warranted to refine the methodology, consider usage patterns, and address ethical and legal concerns regarding the collection and use of DNA evidence from common objects.

Future of Using Robotic and Artificial Intelligence in Implant Dentistry.

The integration of robotic technology and artificial intelligence (AI) in implant dentistry has ushered in a new era of precision and efficiency. This abstract aims to understand the integration, implications, potential, and challenges of robotic technology and AI in implant dentistry. Robotic systems offer unparalleled accuracy in implant placement, reducing human error and improving treatment outcomes. AI algorithms analyze extensive patient data to assist in diagnosis, treatment planning, and implant design, optimizing the overall process. Successful case studies demonstrate improved implant survival rates and patient satisfaction. However, ethical considerations and the balance between human expertise and reliance on technology must be addressed. Ongoing research aims to enhance these technologies and integrate them with digital workflows. Collaboration and knowledge sharing among practitioners, researchers, and industry experts are essential to drive progress and ensure responsible implementation. The future of implant dentistry lies in harnessing the potential of robotics and AI while upholding the highest standards of patient care and ethical practice.

Patient-related risk factors of prosthetic joint infections following total hip and knee arthroplasty at King Abdulaziz Medical City, a 10-year retrospective study.

BACKGROUND: Total joint arthroplasty (TJA) can be associated with the development of periprosthetic joint infection (PJI). It is necessary to determine the modifiable and non-modifiable risk factors of PJI to provide optimum healthcare to TJA candidates. METHODS: This single-center retrospective review investigated 1198 patients who underwent TJA from 2012 to 2022. The data analysis comprised two stages. The first stage was a descriptive analysis, while the second stage was a bivariate analysis. The sociodemographic data, medical history, operative details, and presence of PJI postoperatively were evaluated. RESULTS: The study sample consisted of 1198 patients who underwent TJA. The mean patient age was 63 years. Among the patients, only 1.3% had PJI. No comorbidity was significantly related to PJI. General anesthesia was used in almost 21% of the patients and was significantly associated with a higher risk of infection (p = 0.049). An increased operative time was also significantly related to PJI (p = 0.012). Conversely, tranexamic acid (TXA) administration was a protective factor against PJI (p = 0.017). CONCLUSION: Although PJI is not a common complication of TJA, multiple risk factors such as general anesthesia and prolonged operative time play a significant role in its development. In contrast, TXA administration is thought to reduce the risk of PJI effectively.

An Unusual Cause of Recurrent Visible Hematuria; Posterior Urethral Hemangioma: A Case Report and Review of Literature.

Urinary tract hemangiomas are uncommon entity to urologists, despite their benign nature and course; they can cause significant patient's hemodynamic instability or distress if not recognized and managed properly. Here, we present a case of urethral hemangioma with its treatment, follow-up course and review of literature of similar cases. Introduction: Bloody urine or urethral bleeding can be the initial presentation of a number of different medical and surgical conditions, some of which are benign and others are malignant, when encountered, they are alarming and must be evaluated thoroughly. As a cause, urethral hematomas are faced rarely, among all urinary tract sites; they are the second least common(1). Due to their paucity in clinical practice, there is no agreed approach on their management and each case has to be individualized. In the literature, different assessment and treatment methods were tried with satisfactory outcomes in each one. Here we report a case with detailed, concise explanation of such pathology and a comprehensive comparison in light of previous literature. Keywords: Urethral hemangioma, urethral bleeding, benign urinary tract tumors.

Estimate a patient's 10 years cardiovascular risk using the Arteriosclerotic cardiovascular disease tool in a cross-sectional study in Al-Harja, Asser, Saudi Arabia, 2021.

Introduction: Recently, the cases of arteriosclerotic cardiovascular disease (ASCVD) have been increasing in the rural areas of southwest Saudi Arabia. Therefore, this study sought to consider the relevant contributing factors, such as traditional dietary habits and a diet rich in cholesterol and fat, few opportunities for disease screening, false beliefs about chronic disease management medications, delays in diagnosis, and the great distances required for travel to cardiac specialist centers. Methods: A cross-sectional study was conducted at 12 primary health care (PHC) centers, using the ASCVD tool. The total required sample was determined to be 440 participants after calculating based on the total population of Al-Harja. Systematic random sampling was performed using a list of PHC centers and fixed intervals. The study's outcome is ASCVD risk score divided into four categories: low risk <5%, borderline risk 5%-7.5%, intermediate risk >7.5%-20%, and high risk >20%. Data were collected through interview questionnaires, measurements, and laboratory sample investigations. Result: It was revealed that 16.59% of the participants were classified in the high-risk category for having ASCVD in the next 10 years. There was a significant association between the ASCVD risk score and obesity (P = 0.03). Prior diagnoses for either hypertension or diabetes mellitus (P = 0.00) were significantly associated with an increased ASCVD risk score. Conclusion: An alarmingly high prevalence of high-risk ASCVD scores was seen among male participants, with 54 (22.78%) in the high-risk category, while 19 female participants (9.36%) were in the same category. Therefore, we can conclude that male participants are two times as likely to have a high ASCVD risk than female participants.

Knowledge, Attitudes, and Concerns Regarding COVID-19 Vaccination Among Unvaccinated Elderly People in the Aseer Region, Saudi Arabia.

BACKGROUND: Vaccination is the best weapon to prevent any disease, especially pandemics like COVID-19, and building herd immunity is the best way to control the disease's spread. On one side, vaccine availability is important, and on the other, its successful distribution is faced with difficulty in a wide geographical area. Availability and distribution go hand in hand, which is the public health challenge. Vaccines are taking over, clearing up concerns about vaccination and making the public ready. The high-risk public should receive vaccines without resistance, which is of utmost importance. Unvaccinated older adults are at higher risk for COVID-19 infection, morbidity, and mortality. The reasons why older people who have not been vaccinated against COVID-19 do not want to receive vaccines when they are available include a lack of knowledge about COVID-19 vaccination and listening to incorrect sources of information. With this background, this study aimed to assess the knowledge, attitudes, and concerns of unvaccinated older adults in the Aseer Region, Saudi Arabia. METHODS: A community-based cross-sectional study was planned to find out the knowledge and attitudes of the elderly in the Assir Region, Saudi Arabia. A total of 434 unvaccinated elderly persons were recruited randomly from the list of elderly (>60 years) who were unvaccinated. The data was gathered using a structured interview schedule in Arabic. RESULTS: Out of 434 participants, more than half (54.8%) were male. Most of the participants were Saudi citizens (91.5%). Of the participants, nearly one-fifth (19.8%) of them had a previous history of COVID-19 infection. The participants' main sources of information about vaccination against COVID-19 were the mass media (41.9%), followed by word of mouth from friends, families, or neighbors (41.7%), and social media (16.4%). More than three-fourths of them (85.7%) had poor knowledge regarding the COVID-19 vaccination. The participants' poor knowledge grades were mainly among those aged >80 years, illiterate, unemployed participants, and current smokers. Those participants relying on social media had the highest number of concerns (6.663.21) regarding the safety and efficacy of vaccines. CONCLUSIONS: Most participants have poor knowledge, and their knowledge of COVID-19 vaccination is limited. Participants whose main source of knowledge is the mass media need to intensify their education activities in the mass media. Social media, whose primary source of information is social media, has the greatest number of issues that require immediate attention. Social media content must be scanned, and misinformation needs to be addressed.

Robotics and Artificial Intelligence and Their Impact on the Diagnosis and Treatment of Cardiovascular Diseases.

A new era has begun in the treatment of cardiovascular disorders as a direct result of the significant developments that have been made in robotics and artificial intelligence (AI). This abstract investigates the potential and impact that AI algorithms and robotic systems may have in the diagnosis and treatment of cardiovascular problems. The field of cardiovascular treatments has been completely transformed by robotically assisted surgeries, which have enabled minimally invasive procedures with increased patient safety and decreased recovery time. The incorporation of AI algorithms into cardiovascular care has made early abnormality identification, risk classification, and tailored treatment planning significantly easier. However, problems including patient safety, data privacy, and smooth integration into existing healthcare systems need to be solved. This abstract places an emphasis on the necessity of collaboration and responsible implementation in order to fully harness the promise of robotics and AI in cardiovascular care, which will ultimately lead to improved patient outcomes and an enhanced quality of life.

Lifestyle habits and obesity indices among male adolescents in Riyadh, Saudi Arabia.

Obesity among adolescents is a global health apprehension which requires early prevention. The aim of this study was to determine the association between lifestyle habits including physical activity, sedentary behaviors and eating habits with obesity indices of body mass index (BMI) and waist-to-height ratio (WHtR) among male adolescents in Riyadh, Saudi Arabia. We randomly selected 471 secondary school male adolescents aged 14-18 years. A pre-validated self-reported questionnaire was used to record the data on physical activity level, sedentary behaviors, sleep duration and eating habits. The International Obesity Task Force (IOTF) cutoff values for adolescents under 18 years of age were used to define overweight and obesity. Total energy expenditure was calculated using metabolic equivalent-minutes per week. Anthropometry including weight, height, BMI, waist circumference, waist/height ratio (WHtR), were assessed. 53.7% and 48.4% of the adolescents were overweight/obese and had abdominal obesity; respectively. Those with overweight and obesity or above 50% of WHtR were much less active in terms of METs-min/week from vigorous-intensity sports, sum of all METs-min/week from all vigorous-intensity physical activity, total METs-min/week from all physical activity compared with non-obese adolescents and below 50% of WHtR. The present study identified the lifestyle habits that were associated with obesity and may represent valid targets for the prevention and management of obesity among Saudi adolescents. Knowledge of the factors that contribute to obesity could be used in preventive programs for the control of obesity among adolescents.

Macrophages in immunoregulation and therapeutics.

Macrophages exist in various tissues, several body cavities, and around mucosal surfaces and are a vital part of the innate immune system for host defense against many pathogens and cancers. Macrophages possess binary M1/M2 macrophage polarization settings, which perform a central role in an array of immune tasks via intrinsic signal cascades and, therefore, must be precisely regulated. Many crucial questions about macrophage signaling and immune modulation are yet to be uncovered. In addition, the clinical importance of tumor-associated macrophages is becoming more widely recognized as significant progress has been made in understanding their biology. Moreover, they are an integral part of the tumor microenvironment, playing a part in the regulation of a wide variety of processes including angiogenesis, extracellular matrix transformation, cancer cell proliferation, metastasis, immunosuppression, and resistance to chemotherapeutic and checkpoint blockade immunotherapies. Herein, we discuss immune regulation in macrophage polarization and signaling, mechanical stresses and modulation, metabolic signaling pathways, mitochondrial and transcriptional, and epigenetic regulation. Furthermore, we have broadly extended the understanding of macrophages in extracellular traps and the essential roles of autophagy and aging in regulating macrophage functions. Moreover, we discussed recent advances in macrophages-mediated immune regulation of autoimmune diseases and tumorigenesis. Lastly, we discussed targeted macrophage therapy to portray prospective targets for therapeutic strategies in health and diseases.

Role of doppler ultrasound in detecting vascular complications in recipients of living donor liver transplant (LDLT).

OBJECTIVE: To determine the role of Doppler ultrasound in the detection of vascular complications in recipients of living donor liver transplant, keeping contrast-enhanced computerised tomography of abdomen as the gold standard. METHODS: The retrospective study was conducted from February 16 to April 1, 2022, at the Pakistan Kidney and Liver Institute and Research Centre, Lahore, Pakistan, and comprised data of living donor liver transplant recipients who had undergone contrast-enhanced computerised tomography of abdomen within 24 hours of Doppler ultrasound between January 2021 and January 2022. For the diagnosis of hepatic vascular complications, the diagnostic values of Doppler ultrasound parameters were derived by correlating Doppler ultrasound findings with contrast-enhanced computerised tomography results. Data was analysed using SPSS 20. RESULTS: Of the 35 patients, 24(68.6%) were men and 11(31.4%) were women. The overall mean age was 45.86±13.8 years. For hepatic artery thrombosis, the use of Doppler ultrasound criteria yielded a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 100%, 96.6%, 83.3%, 100%, and 97.1% respectively. For hepatic artery stenosis, overall sensitivity, specificity, positive predictive value, negative predictive value and accuracy of Doppler ultrasound was 100%, 96.8%, 75%, 100% and 97.1% respectively. Doppler ultrasound parameters resulted in a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 100% each in detecting portal vein and hepatic venous outflow tract thrombosis. Overall, Doppler ultrasound sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy was found to be 100%, 88.8%, 89.4%, 100% and 94.2% respectively. CONCLUSIONS: Doppler ultrasound was adequate to document vascular complications after living donor liver transplant in majority of the cases with high accuracy and sensitivity.

Saudi Arabia Health Systems: Challenging and Future Transformations With Artificial Intelligence.

The healthcare system in Saudi Arabia is facing several challenges, including an aging population, an increase in chronic diseases, and a shortage of healthcare professionals. To address these challenges, the government is taking proactive steps, including expanding healthcare infrastructure, promoting the use of technology, improving the quality of healthcare services, and emphasizing the importance of preventive healthcare. In addition, the adoption of artificial intelligence (AI) solutions can play a crucial role in transforming the healthcare system by improving efficiency, reducing costs, and enhancing the quality of care. However, the adoption of AI solutions comes with challenges such as the need for high-quality data and the development of regulations and guidelines. The government needs to continue to invest in healthcare and AI solutions to build a more efficient and effective healthcare system that benefits all citizens.

Spinopelvic In Situ Fixation and Early Mobilization: A Case Report and Literature Review.

Pelvic fractures with sacroiliac extension are significant and complicated orthopedic injuries that pose a challenge in management and favorable outcomes. A 50-year-old obese female presented after a motor vehicle accident with pelvic fracture lateral compression. The patient underwent anterior external fixation with a left sacroiliac screw (SIS) on the next day of admission and was kept in a non-weight-bearing state. During her hospital stay, she developed deep vein thrombosis (DVT) and was treated. During the follow-up on the sixth week, the patient was not complying with her immobilization instructions and was exposing the left lower limb to weight bearing. The radiologic evaluation demonstrated a pulled-out SIS with a stable fracture. Considering that the patient was obese, had a history of DVT and COVID-19 infection, and the fracture was minimally displaced, it was decided to perform a spinopelvic in-situ fixation from L4 to S2 and augment it with a left SIS. The patient tolerated the surgery well and was referred to physiotherapy for early mobilization with full weight bearing. During her six-month and two-year follow-ups, she was well mobilized with no active complaints, and radiographic studies showed good healing, no displacement, no signs of instability, and a stable construct. Our case report presents a very rare and difficult but successful management of a fracture displacement in a non-compliant patient with one pulled-out screw through fast-tracked in situ spinopelvic fixation with early mobilization and full weight bearing. To our knowledge, this is one of the rare reports detailing a patient undergoing in situ spinopelvic fixation due to minimally displaced fracture with comorbidities such as obesity and DVT. Our report demonstrates the viability of accepting pulled-out screws, with respect to the patient's health, the fracture's geometry, a quick follow-up in situ spinopelvic fixation, early mobilization, full weight-bearing outcomes, and a lower risk for complications.

Use of anti-viral therapies in hospitalised COVID-19 patients in the United Arab Emirates: a cost-effectiveness and health-care resource use analysis.

BACKGROUND: This study attempts to estimate the cost-effectiveness of the antiviral remdesivir, as recommended in the 2021 COVID treatment guidelines for the United Arab Emirates, compared to standard of care (SOC), but also favipiravir (FAVI), which was also recommended for the treatment of hospitalized COVID patients. METHODS: A cost-effectiveness model was built using published efficacy data for RDV, FAVI and SOC as well as local epidemiology data. The outcomes measured included hospital bed days averted, mortality, costs and cost per outcome over one year. One-way, probabilistic and scenario analyses were undertaken to reflect uncertainty in the estimates. RESULTS: When modelled over one year, the results indicated that treatment of adults in need of supplemental oxygen with RDV + SOC could result in 11,338 fewer general ward bed days, 7,003 fewer ICU days and 5,451 fewer ICU + MIV bed days compared to SOC alone and similar results when compared with FAVI + SOC. The model results also showed that there were 374 fewer deaths associated with the use of RDV + SOC compared to SOC alone. The model also estimates substantial potential cost-savings associated with RDV + SOC treatment compared with SOC alone (USD 3,454 per patient). The results of the one-way sensitivity analysis showed that the model was sensitive to estimates of length of stay and the cost of hospitalization. Despite this, the model predicted cost-savings in all scenarios versus all comparators. CONCLUSIONS: The model estimated that using RDV + SOC could result in substantial reductions in HCRU and cost savings regardless of the comparator. However, it should be noted that reliable clinical information on FAVI was limited therefore it is challenging to interpret these results. All the potential benefits modelled here for RDV + SOC can have implications not only for the health of the UAE population but for improving hospital capacity to deal with other conditions.

A molecularly imprinted electrochemical sensor for specific and ultrasensitive determination of an aminoglycoside drug: the role of copper ions in the determination.

Herein, a molecularly imprinted polymer (MIP) was fabricated for specific sensing of an aminoglycoside e.g. kanamycin (KANA). Carbon paste modified with a MIP specific to Cu2+-KANA was first introduced. Copper (Cu2+) as a metal ion was used as a signal tracer and an amplifier, producing a current response measured by differential pulse voltammetry (DPV). Introducing the aminoglycoside drug into the solution containing Cu2+ did not affect the current response of the NIP/CPE. Under the optimum conditions, the as-fabricated sensor exhibited an increase in the current response in the range of 0.55-550 nM with a good limit of detection (LOD, S/N = 3) of 161 pM. The sensor exhibited many advantages including high sensitivity and selectivity, good stability and reproducibility, and cost-effectiveness. Moreover, it was successfully applied for the determination of KANA in milk and honey samples with RSD % not more than 3.3%, suggesting the reliability of the as-designed sensor.

Pacemaker Malfunction in a Patient With Congestive Heart Failure and Hypertension.

A pacemaker is a medical device commonly used to regulate a patient's heartbeat in cases where the heart's natural electrical impulses may be erratic or compromised. Failure of a pacemaker, or pacemaker malfunction, can be life-threatening and requires immediate action to prevent serious complications. This case report describes a 75-year-old male patient with a history of ventricular tachycardia, congestive heart failure, hypertension, and smoking who was admitted to the hospital with symptoms of palpitations, dizziness, lightheadedness, and decreased level of alertness. The patient had a single-chamber pacemaker implanted two years prior to the current admission. Upon physical examination, the patient's pacemaker had failed, and he was diagnosed with pacemaker failure. Differential diagnoses were ranked from most likely to least likely, based on the patient's history and physical examination, and included pacemaker failure, arrhythmia, myocardial infarction, and pulmonary embolism. Treatment included the replacement of the pacemaker, and the patient was discharged in stable condition.