Endoscopic pilonidal sinus treatment (EPSiT) for sacrococcygeal pilonidal sinus disease: A prospective long-term study.

Objectives: To assess short-term and long-term outcomes of endoscopic pilonidal sinus treatment for pilonidal sinus disease. METHODS: The prospective study was conducted at Shifa International Hospital, Islamabad, Pakistan, from July 2015 to July 2021, and comprised all pilonidal sinus cases undergoing minimal invasive endoscopic pilonidal sinus treatment who were treated by a single surgical team. The primary outcomes were duration of healing, post-operative morbidities, persistence of discharge and recurrence at 1-7 years. The secondary outcomes were operative time, return to work, cosmetic results and patient satisfaction. The patients were observed for wound healing and discharge on follow-up in the out-patient department at 1, 3, 6 and 24 weeks. They were further followed up every year through telephonic survey for persistence or recurrence of symptoms. Patient satisfaction was assessed using the 36-item Short Form Survey questionnaire filled at admission and then at 6 weeks post-surgery. Data was analysed using SPSS 23. RESULTS: Of the 67 patients, 55(82%) were males and 12(18%) were females. The overall mean age was 25.69±8.305 years. There were 13(19.4%) patients with a history of recurrent disease and previous procedures for pilonidal sinus, while 54(80.6%) had no previous surgery. The median operative time was 35 minutes (interquartile range: 20-45 minutes). Complete wound healing was achieved in 60(89.6%) patients, while recurrence was seen in 7(10.4%). The median time off work was 2.5 days (interquartile range: 1-3 days). Patient satisfaction with the procedure was significantly high (p<0.05). CONCLUSIONS: Endoscopic pilonidal sinus treatment appeared to be a good minimally invasive surgical technique for the treatment of pilonidal sinus disease in terms of both short-term and long-term outcomes.

Role of Postoperative Intact Parathyroid Hormone Levels in Predicting Hypocalcaemia after Thyroidectomy.

OBJECTIVE: To determine the sensitivity and specificity of intact parathyroid hormone (iPTH) levels in predicting hypocalcaemia after thyroidectomy. STUDY DESIGN: A descriptive cross-sectional study. Place and Duration of the Study: Department of General Surgery, Shifa International Hospital and Shifa Foundation, Islamabad, from May 2021 to 2022. METHODOLOGY: The sample size was calculated to be 205 with consecutive non-probability sampling. Serum iPTH levels and serum calcium levels were measured postoperatively at 6 hours and 24 hours and recorded in a proforma for analysis. After collection, the data were entered and analysed using SPSS version 24.0. RESULTS: Among 205 patients, 157 (76.6%) were females and 48 (23.4%) were males. At 6 hours postoperatively, 121 (59%) patients had normal iPTH levels and 123 (60%) patients had normal serum calcium levels (p = 0.15). At 24-hour, 130 (63.4%) patients had normal iPTH levels and 92 (44.9%) patients had normal serum calcium levels (p = 0.001). Overall, 8 (3.9%) patients developed symptomatic hypocalcaemia (p = <0.001). The sensitivity and specificity of iPTH levels at ≤15 pg/ml were 100% and 70%, respectively, but at 24 pg/ml cut-off level, the specificity increased to 90% with sensitivity of 100%. CONCLUSION: Low serum iPTH levels at 6 hours after surgery can predict hypocalcaemia in patients undergoing thyroidectomy, even if serum calcium levels appear normal at that time. KEY WORDS: Parathyroid hormone, Serum calcium, Hypocalcaemia, Total thyroidectomy, Calcium homeostasis.

Spatial distribution and health risks assessment of heavy metals in e-waste dumping sites from Pakistan.

The present study focused on to determine the concentration and health risk of heavy metals (Cu, Pb, Zn, Cd, Hg, Cr) in e-waste contaminated soils collected from different provinces of Pakistan. Further, the impact of heavy metals on soil enzyme activities and microbial community was also investigated. The concentration (mg/kg) of Hg, Zn, Fe, Cu, Pb, Cd, and Cr ranged between 0-0.258, 2.284-6.587, 3.005-40.72, 8.67-36.88, 12.05-35.03, 1.03-2.43, and 33.13-60.05, respectively. The results revealed that Lahore site of Punjab province indicated more concentration of heavy metals as compared to other sites. The level of Cr at all sites whereas Hg at only two sites exceeds the World Health Organization standards (WHO) for soil. Soil enzyme activity exhibited dynamic trend among the sites. Maximum enzyme activity was observed for urease followed by phosphatase and catalase. Contamination factor (Cf), Pollution load index (PLI), and geo-accumulation index (Igeo) results showed that all the sites are highly contaminated with Cu, Cd, and Pb. Hazard index (HI) was less than 1 for children and adults suggesting non-carcinogenic health risk. Principle component analysis results depicted relation among Cr, Fr, catalase, and actinomycetes; Cd, OM, urease, and bacteria, and Pb, Cu, Zn, Hg, and phosphatase, suggesting soil enzymes and microbial community profiles were influenced by e-waste pollution. Therefore, there is a dire need to introduce sustainable e-waste recycling techniques as well as to make stringent e-waste management policies to reduce further environmental contamination.

Predicting ambient PM2.5 concentrations via time series models in Anhui Province, China.

Due to rapid expansion in the global economy and industrialization, PM2.5 (particles smaller than 2.5 µm in aerodynamic diameter) pollution has become a key environmental issue. The public health and social development directly affected by high PM2.5 levels. In this paper, ambient PM2.5 concentrations along with meteorological data are forecasted using time series models, including random forest (RF), prophet forecasting model (PFM), and autoregressive integrated moving average (ARIMA) in Anhui province, China. The results indicate that the RF model outperformed the PFM and ARIMA in the prediction of PM2.5 concentrations, with cross-validation coefficients of determination R2, RMSE, and MAE values of 0.83, 10.39 µg/m3, and 6.83 µg/m3, respectively. PFM achieved the average results (R2 = 0.71, RMSE = 13.90 µg/m3, and MAE = 9.05 µg/m3), while the predicted results by ARIMA are comparatively poorer (R2 = 0.64, RMSE = 15.85 µg/m3, and MAE = 10.59 µg/m3) than RF and PFM. These findings reveal that the RF model is the most effective method for predicting PM2.5 and can be applied to other regions for new findings.

Prevalence of hepatitis D virus infection in Central Italy has remained stable across the last 2 decades with dominance of subgenotypes 1 and characterized by elevated viral replication.

OBJECTIVES: Here we investigate Hepatitis D virus (HDV)-prevalence in Italy and its fluctuations over time and we provide an extensive characterization of HDV-infected patients. METHODS: The rate of HDV seroprevalence and HDV chronicity was assessed in 1579 hepatitis B surface antigen (HBsAg)+ patients collected from 2005 to 2022 in Central Italy. RESULTS: In total, 45.3% of HBsAg+ patients received HDV screening with an increasing temporal trend: 15.6% (2005-2010), 45.0% (2011-2014), 49.4% (2015-2018), 71.8% (2019-2022). By multivariable model, factors correlated with the lack of HDV screening were alanine-aminotransferase (ALT) less than two times of upper limit of normality (<2ULN) and previous time windows (P <0.002). Furthermore, 13.4% of HDV-screened patients resulted anti-HDV+ with a stable temporal trend. Among them, 80.8% had detectable HDV-ribonucleic acid (RNA) (median [IQR]:4.6 [3.6-5.6] log copies/ml) with altered ALT in 89.3% (median [IQR]:92 [62-177] U/L). Anti-HDV+ patients from Eastern/South-eastern Europe were younger than Italians (44 [37-54] vs 53 [47-62] years, P <0.0001), less frequently nucleos(t)ide analogs (NUC)-treated (58.5% vs 80%, P = 0.026) with higher HDV-RNA (4.8 [3.6-5.8] vs 3.9 [1.4-4.9] log copies/ml, P = 0.016) and HBsAg (9461 [4159-24,532] vs 4447 [737-13,336] IU/ml, P = 0.032). Phylogenetic analysis revealed the circulation of HDV subgenotype 1e (47.4%) and -1c (52.6%). Notably, subgenotype 1e correlated with higher ALT than 1c (168 [89-190] vs 58 [54-88] U/l, P = 0.015) despite comparable HDV-RNA. CONCLUSIONS: HDV-screening awareness is increasing over time even if some gaps persist to achieve HDV screening in all HBsAg+ patients. HDV prevalence in tertiary care centers tend to scarcely decline in native/non-native patients. Detection of subgenotypes, triggering variable inflammatory stimuli, supports the need to expand HDV molecular characterization.

Endothelial ERα promotes glucose tolerance by enhancing endothelial insulin transport to skeletal muscle.

The estrogen receptor (ER) designated ERα has actions in many cell and tissue types that impact glucose homeostasis. It is unknown if these include mechanisms in endothelial cells, which have the potential to influence relative obesity, and processes in adipose tissue and skeletal muscle that impact glucose control. Here we show that independent of impact on events in adipose tissue, endothelial ERα promotes glucose tolerance by enhancing endothelial insulin transport to skeletal muscle. Endothelial ERα-deficient male mice are glucose intolerant and insulin resistant, and in females the antidiabetogenic actions of estradiol (E2) are absent. The glucose dysregulation is due to impaired skeletal muscle glucose disposal that results from attenuated muscle insulin delivery. Endothelial ERα activation stimulates insulin transcytosis by skeletal muscle microvascular endothelial cells. Mechanistically this involves nuclear ERα-dependent upregulation of vesicular trafficking regulator sorting nexin 5 (SNX5) expression, and PI3 kinase activation that drives plasma membrane recruitment of SNX5. Thus, coupled nuclear and non-nuclear actions of ERα promote endothelial insulin transport to skeletal muscle to foster normal glucose homeostasis.

Macrophage-to-endothelial cell crosstalk by the cholesterol metabolite 27HC promotes atherosclerosis in male mice.

Hypercholesterolemia and vascular inflammation are key interconnected contributors to the pathogenesis of atherosclerosis. How hypercholesterolemia initiates vascular inflammation is poorly understood. Here we show in male mice that hypercholesterolemia-driven endothelial activation, monocyte recruitment and atherosclerotic lesion formation are promoted by a crosstalk between macrophages and endothelial cells mediated by the cholesterol metabolite 27-hydroxycholesterol (27HC). The pro-atherogenic actions of macrophage-derived 27HC require endothelial estrogen receptor alpha (ERα) and disassociation of the cytoplasmic scaffolding protein septin 11 from ERα, leading to extranuclear ERα- and septin 11-dependent activation of NF-κB. Furthermore, pharmacologic inhibition of cyp27a1, which generates 27HC, affords atheroprotection by reducing endothelial activation and monocyte recruitment. These findings demonstrate cell-to-cell communication by 27HC, and identify a major causal linkage between the hypercholesterolemia and vascular inflammation that partner to promote atherosclerosis. Interventions interrupting this linkage may provide the means to blunt vascular inflammation without impairing host defense to combat the risk of atherosclerotic cardiovascular disease that remains despite lipid-lowering therapies.

Revolutionizing Prosthetic Design with Auxetic Metamaterials and Structures: A Review of Mechanical Properties and Limitations.

Prosthetics have come a long way since their inception, and recent advancements in materials science have enabled the development of prosthetic devices with improved functionality and comfort. One promising area of research is the use of auxetic metamaterials in prosthetics. Auxetic materials have a negative Poisson's ratio, which means that they expand laterally when stretched, unlike conventional materials, which contract laterally. This unique property allows for the creation of prosthetic devices that can better conform to the contours of the human body and provide a more natural feel. In this review article, we provide an overview of the current state of the art in the development of prosthetics using auxetic metamaterials. We discuss the mechanical properties of these materials, including their negative Poisson's ratio and other properties that make them suitable for use in prosthetic devices. We also explore the limitations that currently exist in implementing these materials in prosthetic devices, including challenges in manufacturing and cost. Despite these challenges, the future prospects for the development of prosthetic devices using auxetic metamaterials are promising. Continued research and development in this field could lead to the creation of more comfortable, functional, and natural-feeling prosthetic devices. Overall, the use of auxetic metamaterials in prosthetics represents a promising area of research with the potential to improve the lives of millions of people around the world who rely on prosthetic devices.

Re-Entrant Honeycomb Auxetic Structure with Enhanced Directional Properties.

This paper presents a modified re-entrant honeycomb auxetic structure. The structure is constructed by adding an additional horizontal member between the vertical and re-entrant member of the semi-re-entrant honeycomb model to increase the overall compliance of the structure in order to obtain higher values of negative Poisson's ratio (NPR). An analytical model of the structure is presented, taking into account the bending, shear, and axial deformations. The model is verified using finite element analysis (FEA) and tensile testing. The results of FEA and tensile testing corroborate the results of the presented mathematical model. The structure is also compared to the existing re-entrant honeycomb structure. The newly added strut has shown a direct effect on the directional properties of the overall structure. With an increase in the newly added strut to re-entrant lengths, NPR was significantly enhanced in the x-direction and reduced in the y-direction loadings. The structure shows an improved Young's modulus compared to solid material in both loading directions, especially for the low values of the new strut and re-entrant lengths ratio. The structure also shows that high NPR can be achieved for low relative density compared to semi re-entrant honeycomb structure.

Nanomaterials for biogas augmentation towards renewable and sustainable energy production: A critical review.

Nanotechnology is considered one of the most significant advancements in science and technology over the last few decades. However, the contemporary use of nanomaterials in bioenergy production is very deficient. This study evaluates the application of nanomaterials for biogas production from different kinds of waste. A state-of-the-art comprehensive review is carried out to elaborate on the deployment of different categories of nano-additives (metal oxides, zero-valent metals, various compounds, carbon-based nanomaterials, nano-composites, and nano-ash) in several kinds of biodegradable waste, including cattle manure, wastewater sludge, municipal solid waste, lake sediments, and sanitary landfills. This study discusses the pros and cons of nano-additives on biogas production from the anaerobic digestion process. Several all-inclusive tables are presented to appraise the literature on different nanomaterials used for biogas production from biomass. Future perspectives to increase biogas production via nano-additives are presented, and the conclusion is drawn on the productivity of biogas based on various nanomaterials. A qualitative review of relevant literature published in the last 50 years is conducted using the bibliometric technique for the first time in literature. About 14,000 research articles are included in this analysis, indexed on the Web of Science. The analysis revealed that the last decade (2010-20) was the golden era for biogas literature, as 84.4% of total publications were published in this timeline. Moreover, it was observed that nanomaterials had revolutionized the field of anaerobic digestion, methane production, and waste activated sludge; and are currently the central pivot of the research community. The toxicity of nanomaterials adversely affects anaerobic bacteria; therefore, using bioactive nanomaterials is emerging as the best alternative. Conducting optimization studies by varying substrate and nanomaterials' size, concentration and shape is still a field. Furthermore, collecting and disposing nanomaterials at the end of the anaerobic process is a critical environmental challenge to technology implementation that needs to be addressed before the nanomaterials assisted anaerobic process could pave its path to the large-scale industrial sector.

Gastric Schwannoma: A Case Report and Literature Review.

Gastric schwannomas (GS) are very rare spindle cell, submucosal mesenchymal tumors that arise from Schwann cells of nerve plexuses in the stomach wall. They are usually benign but can become malignant and metastasize to other organs. Surgical resection with biopsy is the gold standard for diagnosis and management of GS. In this article, we present a 68-year-old female patient who presented with abdominal pain, nausea, vomiting, and belching for a couple of months. Upon further evaluation, she was found to have a 4.2 cm gastric mass, which was consistent with gastric schwannoma through biopsy and immunohistochemistry. The patient underwent complete surgical resection of the tumor without any complications. In this article, we will discuss the literature about GS including its clinical presentation, diagnosis, and management options.

Dieulafoy Lesion of the Colon: A Rare Finding During Colonoscopy.

Dieulafoy lesions are common dilated submucosal vessels that can present with gastrointestinal (GI) bleeding. These lesions are usually found in the stomach or esophagus and colonic Dieulafoy lesions are very rare. Clinical presentation can vary from mild non-threatening GI bleeding to massive and recurrent hemorrhage. Here, we discuss a case of a 71-year-old female patient who presented with a bright red bleed per rectum. Colonoscopy was performed, which revealed a bleeding Dieulafoy lesion in the descending colon with clotted blood in the transverse and descending colon. In this article, we will also review the literature related to the epidemiology, clinical presentation, diagnosis, and management of Dieulafoy lesions.

A Case of Heterotopic Gastric Tissue in Duodenal Bulb: An Interesting Endoscopic Finding.

Gastric heterotopia (GH) is a rare, congenital condition where gastric tissue is found outside of its normal location in the gastric mucosa. It is usually benign and can be found throughout the gastrointestinal (GI) tract. In the duodenum, it is usually seen as multiple polyps, specifically in the duodenal bulb. Here, we discuss the case of a 67-year-old male patient who presented with hematemesis, melena, and abdominal pain. Esophagogastroduodenoscopy (EGD) and biopsy revealed a mass consisting of heterotopic gastric mucosa along with an esophageal ulcer. In this article, we will discuss the literature related to the clinical presentation, diagnosis, and management of GH.

A Case of Gastric Outlet Obstruction Secondary to Parastomal Stomach Herniation.

Parastomal hernia (PH) is an abnormal herniation of tissue or intra-abdominal organ through the fascial defect created at the ostomy site. It is a common complication of stoma creation and usually contains bowel, intra-abdominal fat, or omentum. Herniation of a fixed organ like the stomach is very rare and can lead to significant morbidity and mortality. Here, we present a case of an 83-year-old female with a history of sigmoidectomy and subsequent development of parastomal hernia who presented with abdominal pain, nausea, and vomiting and was found to have stomach herniation into the parastomal hernia sac. She was managed conservatively with intravenous (IV) fluids, electrolyte replacement, and decompression with a nasogastric (NG) tube. In this article, we have discussed the incidence, clinical presentation, diagnosis, and management of gastric involvement in the parastomal hernia that can help clinicians identify and treat it early at the time of presentation.

Selective Androgen Receptor Modulator Induced Hepatotoxicity.

Selective androgen receptor modulators (SARMs) have been developed as an alternate to traditional anabolic steroids due to their favorable effects on the bones and muscles without androgenic side effects. They are very popular among athletes and bodybuilders and are available online or over the counter. The FDA has warned of their side effects including liver injury. Here we present the case of a 29-year-old patient who presented with jaundice, fatigue, and elevated liver function tests after starting SARM supplements. His symptoms improved and eventually resolved with stopping the supplements. The purpose of this case report is to raise awareness and educate clinicians of the potential side effect of hepatotoxicity of these supplements that can help in its early identification and management.

Preparation, urease inhibition mechanisms, and anti-Helicobacter pylori activities of hesperetin-7-rhamnoglucoside.

This work investigated the effects of the bioflavonoid hesperetin-7-rhamnoglucoside isolated from Citrus uranium fruit peel on Helicobacter pylori (H. pylori). Separation and purity, crystalline state, and urease inhibition assays were carried out. Then, molecular docking and molecular dynamics (MD) simulations were conducted with urease as the target protein. Hesp was isolated from citrus peel with a purity of 95.14 µg mg-1 of dry raw material. X-ray diffraction analysis, hydrogen-1 nuclear magnetic resonance, Fourier transform infrared spectroscopy, and differential scanning calorimetry revealed that pure Hesp had the same crystallinity rating as the Hesp standard. The kinetic inhibition study demonstrated that Hesp inhibited H. pylori urease in a competitive and concentration-dependent manner with jack bean urease. In addition, bioimaging studies with laser scanning confocal microscopy and scanning electron microscopy illustrated that Hesp interacted with bacterial cells and induced membrane disruption by creating holes in the outer membranes of the bacterial cells, resulting in the leakage of amino acids. Importantly, molecular docking and 20 ns MD simulations revealed that Hesp inhibited the target protein through slow-binding inhibition and hydrogen bond interactions with active site residues, namely, Gly11 (O⋯H distance = 2.2 Å), Gly13 (O⋯H distance = 2.4 Å), Ser12 (O⋯H distance = 3.3 Å), Lys14 (O⋯H distance = 3.3 Å), and Arg179 (O⋯H distance = 2.7 Å). This work presents novel anti- H. pylori agents from natural sources.

Potential utility of nano-based treatment approaches to address the risk of Helicobacter pylori.

INTRODUCTION: Helicobacter pylori (H. pylori) has occupied a significant place among infectious pathogens and it has been documented as a leading challenge due to its higher resistance to the commonly used drugs, higher adaptability, and lower targeting specificity of the available drugs. AREAS COVERED: New treatment strategies are urgently needed in order to improve the current advancement in modern medicine. Nanocarriers have gained an advantage of drug encapsulation and high retention time in the stomach with a prolonged drug release rate at the targeted site. This article aims to highlight the recent advances in nanotechnology with special emphasis on metallic, polymeric, lipid, membrane coated, and target-specific nanoparticles (NPs), as well as, natural products for treating H. pylori infection. We discussed a comprehensive approach to understand H. pylori infection and elicits to rethink about the increasing threat posed by H. pylori and its treatment strategies. EXPERT OPINION: To address these issues, nanotechnology has got huge potential to combat H. pylori infection and has made great progress in the field of biomedicine. Moreover, combinatory studies of natural products and probiotics in conjugation with NPs have proven efficiency against H. pylori infection, with an advantage of lower cytotoxicity, minimal side effects, and stronger antibacterial potential.[Figure: see text].

Fabrication and Characterization of Steel-Base Metal Matrix Composites Reinforced by Yttria Nanoparticles through Friction Stir Processing.

Friction Stir Processing (FSP) was used to fabricate metal matrix composite, based on steel and reinforced with nano-sized yttrium oxide powder. The powder was packed in a narrow longitudinal groove of 2 mm depth and 1 mm width cut in the steel plate's rear surface. Different rotation speeds of 500-1500 rpm were used, at a fixed traveling speed of 50 mm·min-1. Single-pass and two passes, with the same conditions, were applied. The direction of the second pass was opposite to that of the first pass. After the first pass, complete nugget zones were obtained when the rotation speeds were more than 700 rpm with some particles agglomeration. The added particles showed as narrow elliptical bands, with a band pitch equal to the rotation speed over traveling speed. Performing the second FSP pass in the opposite direction resulted in better particles distributions. Almost defect-free composite materials, with homogenously distributed yttria nano-sized particles, were obtained after two passes when rotation speeds more than 700 rpm were used. The resulting steel matrix grains were refined from ~60 µm of the base metal to less than 3 µm of the processed nugget zone matrix. The hardness and the tensile strength of the fabricated materials improved almost two-fold over the base metal. Uniform microhardness values within the nugget areas were observed at higher rotational speeds. The ductility and toughness of the fabricated composites were reduced compared to the base metal.

Quasilinearization numerical technique for dual slip MHD Newtonian fluid flow with entropy generation in thermally dissipating flow above a thin needle.

In the present article, we investigate the dual slip effect namely the velocity slip and thermal slip conditions on MHD flow past a thin needle. The entropy generation for the incompressible fluids that's water and acetone that flowing above the thin needle is discussed. The energy dissipating term and the magnetic effect is included in the axial direction. The leading partial differential equations are transformed to ODE by an appropriate similarity transformation and solved using a numerical technique that is the Quasilinearization method. The terms for the rate of entropy generation, the Bejan number, and the irreversibility distribution ratio are discussed. Each dimensionless number is shown with velocity slip and also with the magnetic parameter is presented in graphical form. In the result, we conclude that the entropy generation rate is increasing with the increase in thermal slip parameter also some increasing effect is found as the size of the needle increases.