Social determinants of pacemaker reuse among patients and family members in Pakistan.

OBJECTIVES: This survey aimed to quantify the opinions of CIED reuse among patients and family members in Pakistan and to identify the social determinants which may predict these views. METHODS: A questionnaire formulating attitudes toward PPM reuse was administered to patients and family members at cardiology institutes in Pakistan from 1 July 2022 to 30 September 2022. The eligibility criteria (age > 18 years; inline for PPM placement) were taken into account and incomplete responses were excluded from the final analysis. RESULTS: A total of 9,246 participants recorded their responses, of which 7,152 (78.16%) accepted pre-used PPMs. The lower social class had more PPM reuse acceptance rate than the middle and upper class (92.72% vs. 60.52% vs. 35.38%), respectively. Age ≥ 65 (OR(95%CI): 0.68 (0.41-0.99); P-value = 0.023), male gender (OR(95%CI): 0.55 (0.35-0.72), P-value = 0.016), unemployment (OR(95%CI): 0.47 (0.25-0.64); P-value = 0.007), poor health status (OR(95%CI): 0.72 (0.53-0.92); P-value = 0.041), and lower social class (OR(95%CI): 0.36 (0.28-0.53); P-value = 0.003) were social determinants of PPM reuse acceptance. CONCLUSION: Patients and their family members endorse the concept of PPM reuse in Pakistan who cannot afford new devices.

Procedural complications associated with percutaneous mitral balloon valvotomy: A systematic review.

BACKGROUND: As Percutaneous mitral balloon valvotomy (PMBV) remains the keystone in treating mitral stenosis, we conducted this review to elucidate the cumulative frequency and predictors of complications following PMBV and their occurrence in various patient populations. AREAS COVERED: We searched digital databases for relevant studies covering complications of PMBV and retrieved articles using the Medical Subject Heading (MeSH) keywords. EXPERT OPINION: A total of 37 articles (8 RCTs, 7 nonrandomized clinical trials, 22 observational studies) were selected for qualitative analysis. A total of 11,803 patients undergoing PMBV among 37 studies were included, with a mean success rate of 84.54%. The most common complication was mitral regurgitation (8.2%) followed by an atrial septal defect (2.4%). Other relevant complications like stroke, pericardial tamponade, rupture of mitral leaflets, and conduction abnormalities were present in <1% of the patients.

Clinical outcomes of fasting in patients with chronic heart failure with preserved ejection fraction: A prospective analysis.

Fasting is a part of many world religions and in Islam fasting is obligatory for every adult Muslim during the month of Ramadan. Islam has exempted sick people from fasting; however, many people still partake in this activity. We investigated how Islamic fasting affects patients with heart failure with preserved ejection fraction (HFpEF). We enrolled 938 patients (fasting n = 456; non-fasting = 482) in this prospective observational study. The fasting group showed a decrease in NYHA functional class III (23.36% vs. 17.77%; p-value < 0.05) and IV (3.76% vs. 2.19%; p-value < 0.05), and an increase in class I(35.57% vs. 43.64%; p-value < 0.05). symptoms. This is an important area for physicians to advise patients with HFpEF to fast in the month of Ramadan as it can have a favorable effect on their symptoms and quality of life.

Selective recovery of phosphorus from acid leach liquor of iron ore by garlic peel adsorbent.

Dephosphorisation of iron ore is an important challenge to the sustainable development of iron-making industry. Hydrometallurgical processing is quite effective in the reduction of phosphorus level from iron ores, where dilute sulfuric acid is commonly chosen as the lixiviant due to its prominent cost-effectiveness. A cheap and effective biosorbent synthesized from garlic peel was proposed in present study to recover phosphorus selectively from acid leach liquor directly under acidic conditions near pH 1-2, allowing high purity phosphorus to be recovered and the residual acid to be recycled for the next round of leaching. This proposal would sharply reduce the dephosphorisation costs of iron ore. Various batch experiments were carried out under different conditions including varying pH, contact time, adsorbent dosages, and metal ion concentration to identify the optimal adsorption parameters for the model solutions. Results showed that the optimal pH for phosphate adsorption was around 1.5 and adsorption equilibrium was attained in 240 min, and the maximum adsorption capacity for phosphate was 1.40 mmol g-1 and 0.81 mmol g-1 at equilibrium pH of 1.5 and 6.5, respectively. A NaOH solution was effective to elute the adsorbed phosphate, and the eluted solution contained mainly Na3PO4 and NaOH. Recovery of phosphorus from the iron ore leach liquor by the garlic peel adsorbent was quite effective, and the adsorption efficiency could retain 85% of the original adsorption capability even after five cycles of adsorption and desorption. In summary, the Zr-loaded garlic peel appears a potential low-cost and effective adsorbent for phosphate recovery from the acid leach liquor of high phosphorus iron ore.

Recovery of Silver Using Adsorption Gels Prepared from Microalgal Residue Immobilized with Functional Groups Containing Sulfur or Nitrogen.

Although biodiesel oil extracted from microalgae attracts much attention as one of the most promising green energies, its high production cost is a big problem, impeding its extensive use. In order to lower the production cost, the effective use of microalgal residue after extracting biofuel was investigated as a feed material of functional materials. In the present work, a new adsorbent for silver(I) was prepared by immobilizing functional groups of polyethylene-polyamine or dithiooxamide, which exhibita high affinity for soft Lewis acids such as silver(I) ions. Their adsorption behaviors for silver(I) were investigated from aqueous nitrate and acidothiourea media. The effects of the concentrations of nitrate and thiourea, as well as of sulfuric acid, were qualitatively interpreted. From the study of adsorption isotherms on these gels, they were found to exhibita higher adsorption capacity than the majority of those reported to date.

Shilling Attacks Detection in Recommender Systems Based on Target Item Analysis.

Recommender systems are highly vulnerable to shilling attacks, both by individuals and groups. Attackers who introduce biased ratings in order to affect recommendations, have been shown to negatively affect collaborative filtering (CF) algorithms. Previous research focuses only on the differences between genuine profiles and attack profiles, ignoring the group characteristics in attack profiles. In this paper, we study the use of statistical metrics to detect rating patterns of attackers and group characteristics in attack profiles. Another question is that most existing detecting methods are model specific. Two metrics, Rating Deviation from Mean Agreement (RDMA) and Degree of Similarity with Top Neighbors (DegSim), are used for analyzing rating patterns between malicious profiles and genuine profiles in attack models. Building upon this, we also propose and evaluate a detection structure called RD-TIA for detecting shilling attacks in recommender systems using a statistical approach. In order to detect more complicated attack models, we propose a novel metric called DegSim' based on DegSim. The experimental results show that our detection model based on target item analysis is an effective approach for detecting shilling attacks.

Adsorptive removal of cesium using bio fuel extraction microalgal waste.

An adsorption gel was prepared from microalgal waste after extracting biodiesel oil by a simple chemical treatment of crosslinking using concentrated sulfuric acid. The adsorbent exhibited notably high selectivity and adsorption capacity towards Cs(+) over Na(+) from aqueous solutions, within the pH range of slightly acidic to neutral. The adsorption followed Langmuir isotherm and the maximum adsorption capacity of the gel for Cs(+) calculated from Langmuir model was found to be 1.36 mol kg(-1). Trace concentration of Cs(+) ions present in aqueous streams was successfully separated from Na(+) ions using a column packed with the adsorbent at pH 6.5. The adsorption capacity of the gel towards Cs(+) in column operation was 0.13 mol kg(-1). Although the adsorbed Cs(+) ions were easily eluted using 1M hydrochloric acid solution, simple incineration is proposed as an alternative for the treatment of adsorbent loaded with radioactive Cs(+) ions due to the combustible characteristics of this adsorbent.

Preparation of novel alginate based anion exchanger from Ulva japonica and its application for the removal of trace concentrations of fluoride from water.

A green seaweed, Ulva japonica, was modified by loading multivalent metal ions such as Zr(IV) and La(III) after CaCl2 cross-linking to produce metal loaded cross-linked seaweed (M-CSW) adsorbents, which were characterized by elemental analysis, functional groups identification, and metal content determination. Maximum sorption potential for fluoride was drastically increased after La(III) and Zr(IV) loading, which were evaluated as 0.58 and 0.95 mmol/g, respectively. Loaded fluoride was quantitatively desorbed by using dilute alkaline solution for its regeneration. Mechanism of fluoride adsorption was inferred in terms of ligand exchange reaction between hydroxyl ion on co-ordination sphere of the loaded metal ions of M-CSW and fluoride ion in aqueous solution. Application of M-CSW for the treatment of actual waste plating solution exhibited successful removal of fluoride to clear the effluent and environmental standards in Japan, suggesting high possibility of its application for the treatment of fluoride rich waste water.

Adsorptive removal of fluoride from aqueous medium using a fixed bed column packed with Zr(IV) loaded dried orange juice residue.

The potential of the adsorbent prepared from DOJR marketed as cattle food in Japan was identified as an efficient and low cost adsorbent for fluoride using fixed bed column. DOJR was loaded with Zr(IV) ions to develop active adsorption sites for fluoride. Fluoride adsorption performance of column packed with Zr(IV) loaded DOJR was assessed under variable operating conditions such as Zr(IV) loading temperature, initial fluoride concentration, bed depth, initial pH, and flow rate. Breakthrough curve modeling showed that Thomas and bed depth service time (BDST) models were in good agreement with the experimental data. Application of adsorbent investigated in this study to the treatment of actual waste plating solution containing fluoride ion showed successful removal below acceptable standard in Japan using a fixed bed column, hence, Zr(IV)-DOJR can be expected to be a promising candidate for the treatment waste water containing trace amount of fluoride ion in fixed bed column.

N-aminoguanidine modified persimmon tannin: a new sustainable material for selective adsorption, preconcentration and recovery of precious metals from acidic chloride solution.

A new adsorption gel has been developed by immobilizing N-aminoguanidine (AG), a chelating ligand, on persimmon tannin extract through consecutive reactions. Adsorption behavior of the gel was investigated for the adsorptive separation and recovery of precious metal ions from varying concentration of HCl medium. The adsorption isotherms of precious metal ions on the gel were described by the typical monolayer type of Langmuir model and the maximum adsorption capacities were evaluated as 8.90 mol kg(-1) for Au(III), 2.01 mol kg(-1) for Pd(II) and 1.01 mol kg(-1) for Pt(IV). Real time applicability of the gel was examined for the recovery of precious metals from actual leach liquor of e-waste leached with chlorine containing hydrochloric acid. The gel was found to be highly efficient and selective for the uptake of targeted metal ions in the presence of excess base metal ions and also exhibited superior selectivity over commercially available anion exchange resins.

Optimization of an adsorption process for tetrafluoroborate removal by zirconium (IV)-loaded orange waste gel from aqueous solution.

This investigation provides new insights into the effective removal of tetrafluoroborate (BF4-) by means of bio-sorption on waste generated in the orange juice industry. It was undertaken to evaluate the feasibility of zirconium (IV)-loaded saponified orange waste gel for BF4- removal from an aqueous solution. Batch adsorption experiments were carried out to study the influence of various factors such as pH, presence of competing anions, contact time, initial BF4- concentration and temperature on the adsorption of BF4-. The optimum BF4- removal was observed in the equilibrium pH region 2-3. The presence of coexisting anions showed no adverse effect on BF4- removal except SO4(2-). The equilibrium data at different temperatures were reasonably interpreted by the Langmuir adsorption isotherm and the maximum adsorption capacities were evaluated as 2.65, 3.28, 3.87 and 4.77 mmol g(-1) at 293, 298, 303 and 313 K, respectively. Thermodynamic parameters such as deltaGo, deltaHo and deltaSo indicated that the nature of BF4- adsorption is spontaneous and endothermic. The results obtained from this study demonstrate the potential usability of orange waste after juicing as a good BF4- selective adsorbent.

Primary sacral lymphoma: a case report and review of the literature.

AIM: Primary sacral lymphoma is rare. It usually presents in elderly males as low back ache and radiculopathy. CASE REPORT: We hereby report a case of primary sacral lymphoma in a 53-year-old male who presented with low back pain. Imaging showed a sacral lesion which on histopathology proved to be a non-Hodgkin's lymphoma of B cell lineage. MATERIAL AND METHODS: The case is presented for its rarity and for the reason that it mimicked a primary bone tumor. Its recognition is important because it has an excellent prognosis. CONCLUSION: Primary sacral epidural lymphoma should be considered in the differential diagnosis of a sacral mass.

Stray bullet: An accidental killer during riot control.

BACKGROUND: The use of force to control public uprisings, riots, unruly mobs is an important tool in any administrative setup. Law enforcement agencies often resort to aerial firing, which can be responsible for unintended injuries due to stray bullets.This study was designed to study the pattern of stray bullet injuries and to generate awareness about the hazards related to the use of live ammunition during riot control. METHODS: This study was conducted in our unit of the neurosurgery department over a period of 18 months, from June 2008 to December 2010. We enrolled all patients who had head or spine injuries caused by stray bullets from firing during riot control far away from the site of injury. RESULTS: We had two patients with head injury and two with spinal injury sustained because of stray bullets. One of the patients with head injury was operated and the other one was managed conservatively; the latter died on the third day of injury, while the former is surviving with some residual neurological deficit. Amongst the patients with spinal injury, neurological deficits persist till date. None of the patients were aware that they had sustained a bullet injury, and it was only after inquiry that we came to know that the police had resorted to aerial firing for controlling public agitation in nearby areas. CONCLUSION: Aerial firing of live cartridges is generally considered an 'innocuous' method; however, in view of the potential for injury to innocent bystanders, we recommend that the use of live cartridges during aerial firing be banned.

Adsorptive removal of fluoride from aqueous solution using orange waste loaded with multi-valent metal ions.

Adsorption gels for fluoride ion were prepared from orange waste by saponification followed by metal loading. The pectin compounds contained in orange waste creates ligand exchange sites once it is loaded with multi-valent metal ions such as Al(3+), La(3+), Ce(3+), Ti(4+), Sn(4+), and V(4+) to be used for fluoride removal from aqueous solution. The optimum pH for fluoride removal depends on the type of loaded metal ions. The isotherm experiments showed the Langmuir type monolayer adsorption. Among all kinds of metal loaded gels tested, Al loaded gel appeared to exhibit the most favorable adsorption behavior. The adsorption kinetics of fluoride on loaded gel demonstrated fast adsorption process. The presence of NO(3)(-), Cl(-) and Na(+) ions has negligible effect on fluoride removal whereas SO(4)(2-) and HCO(3)(-) retarded the fluoride removal capacity in some extent. Fluoride removal at different adsorbent doses showed that fluoride concentration can be successfully lowered down to the acceptable level of environmental standard. The fluoride adsorption mechanism was interpreted in terms of ligand exchange mechanism. The complete elution of adsorbed fluoride from the gel was successfully achieved using NaOH solution.