Challenges in the transfusion management of a 15-month-old pediatric patient with Bombay blood group phenotype.

Bombay blood group phenotype is often mistyped as O group which can lead to hemolytic transfusion reactions. There are a very few case reports of Bombay blood group phenotype in pediatric age group. Herein, we report an interesting case of Bombay blood group phenotype in a fifteen-month-old pediatric patient who presented with features of raised intracranial pressure and required an emergency surgery. The Bombay blood group was detected on detailed immunohematology work up which was further confirmed by molecular genotyping. The challenges faced in developing countries for transfusion management of such a case have been discussed.

Does green environmental innovation really matter for carbon-free economy? Nexus among green technological innovation, green international trade, and green power generation.

This study examines the association among the green energy production (GEP), green technological innovation (GTI), and green international trade (GIT) on the ecological footprints (EFP). In addition, this research applies fully modified least square (FMOLS) to estimate the empirical outcomes, while dynamic least square (DOLS) is used to check the robustness of the outcomes. Although, the selection of the assessment technique depends on the order of integration of the selected series. Before estimation, some diagnostic tests are also performed to ensure the reliability of the data set. Furthermore, the empirical outcomes of the present analysis are twofold: at begin, this research discovered a negative relationship between GEP and EFP. Secondly, this research reveals that GTI has also an adverse impact on EFP along with GIT, which is unsurprising. Results imply that advancement in green technological innovations tends to improve the EQ by reducing the level of EFP.

The relationship between staple food crops consumption and its impact on total factor productivity: does green economy matter?

The agriculture sector is a key driver of economic growth and provides employment opportunities across the globe generally. However, in today's world, agricultural product demand is more influenced by taste, prices, and nutritional value due to climatic variation. The study has analyzed the current situation grain productivity by using the data of farm inputs and major grain crops of Pakistan from (1960-2020). The study consists of a two-stage analysis in the first stage, the total factor productivity (TFP) variable is obtained by using the parametric Tornqvisit-Theil index output-input-aggregation method separately for each crop; rice, maize, and wheat. After that, the unit root test is used to check the stationarity and trend of the variables in the long run. Subsequently, the autoregressive distributed lag (ARDL) model is applied to check the existence of cointegration in the long run and short run among the variables. The results of the study disclosed that the consumption of rice has a positive relationship with its total factor productivity, but, wheat and maize have a negative long-run cointegration relationship with the respective productivities. The study results have shown that the consumption pattern of staple crops has substantially changed, due to climatic variation, and the current food consumption trend is revealing new dimensions and trends owing to variation in climate change and anthropogenic pressure which demands to adapt climate resilient farm practices.

Does environmental sustainability affect the renewable energy consumption? Nexus among trade openness, CO2 emissions, income inequality, renewable energy, and economic growth in OECD countries.

This study investigates the impact of carbon emissions, real oil prices, income inequality, economic growth, and trade openness on renewable energy consumption (REC) in twenty-three (23) OECD economies. The study employs the Westerlund panel cointegration technique to verify the existence of long-run equilibrium and the Augmented Mean Group (AMG) estimator to assess the long-run relationship between the variables, which allows for slope heterogeneity and cross-sectional dependency. Moreover, the panel causality test of Dumitrescu and Hurlin (DH) is utilized to gauge the causal relationship between the variables. The findings of our study reveal that REC is positively related to economic growth, real oil prices, income inequality, and trade openness, but negatively related to CO2 emissions in OECD countries. In addition, there is one-way causality from GDP per capita to renewable energy consumption and a bidirectional causality between income inequality and REC. Furthermore, the results indicate that OECD policymakers and governments should regard foreign trade as a "clean energy fostering mechanism" while developing energy demand policies that are environmentally friendly.

The Management of Patients With Penetrating Aortic Ulcers: A Systematic Review.

BACKGROUND: Penetrating aortic ulcers (PAUs) are an entity within acute aortic syndrome. They often remain undiagnosed and are found incidentally or when they become symptomatic. Management is currently guided by clinical judgment. This review aims to identify indications for treatment and inform management. METHODS: We searched PubMed for studies on the management of PAUs. The outcome measures were mortality, progression and resolution of symptoms. RESULTS: This review incorporates 27 studies involving 1356 patients with PAU. Data was available regarding symptoms for 1213 patients (494 symptomatic, 719 asymptomatic). Overall late mortality for PAUs was found to be higher than 30-day mortality. Early mortality was higher for symptomatic patients as compared to those with asymptomatic PAUs. Early mortality was lowest for PAUs treated with endovascular interventions (5%), followed by PAUs managed medically and highest following open surgical management. Indications for treatment included symptoms, progression/instability, aortic diameter >5 cm, concomitant aortic pathology or pleural effusion. 13% of patients managed conservatively at initial presentation demonstrated progression and were considered for intervention subsequently. 9% of patients required reintervention after initial endovascular surgery. CONCLUSION: Endovascular treatment, if anatomically suitable, should be considered as first line treatment for symptomatic PAUs. Patients with asymptomatic PAUs, if associated with high-risk features such as PAU diameter >20 mm, PAU depth >10 mm, aortic diameter >42 mm, concomitant pathology, morphological change or an infective etiology, should also be considered for intervention. Small asymptomatic PAUs with no high-risk features may be managed conservatively but must undergo regular surveillance.

Hybrid endovascular repair of aneurysmal right-sided aortic arch and Kommerell's diverticulum using a two-vessel branched stent graft: Case report and review of literature.

Right-sided aortic arches are rare, affecting approximately 0.1% of the population. They are a result of abnormal development of the primitive aortic arches and may present later in life with later life with aneurysmal expansion of the aberrant left subclavian artery 'Kommerell's diverticulum'. These can be challenging to treat effectively. We report a rare case presenting with mild dysphagia and right-sided aneurysmal aortic arch with aneurysmal aberrant left-sided. The patient underwent hybrid endovascular repair incorporating bilateral carotid-subclavian bypasses and dual-arch-branch endograft placement to the left and right common carotid arteries. Although endovascular approaches have been described, there are no reports of branched endografts in this scenario. Right-sided aneurysmal aortic arch and the aneurysmal aberrant left subclavian artery are rare and represent a significant therapeutic challenge. Endovascular repair in conjunction with extra-anatomical bypass utilising a custom-made branched thoracic endograft is feasible.

The general surgical care practitioner improves surgical outpatient streamlining and the delivery of elective surgical care.

The feasibility of implementing a surgical care practitioner (SCP) role for the delivery of secondary care within the general surgery department of a district general hospital was evaluated. Streamlining patients into an SCP-led 'one-stop' gallbladder clinic for symptomatic uncomplicated cholelithiasis led to a reduction in follow-up clinic workload for major elective laparoscopic work and more appropriate triaging of primary care referrals. Each of these improvements contributed to an efficient service model.

Popliteal cystic adventitial disease causing intermittent claudication in a young athlete: a case report.

Cystic adventitial disease (CAD) is a rare condition that usually affects the popliteal artery and presents with symptoms of intermittent claudication in the younger population. Here, we present the case of a young athlete with popliteal cystic adventitial disease and discuss available treatment options.