Microplastic assessment in remote and high mountain lakes of Gilgit Baltistan, Pakistan.

Microplastic (MP) pollution is a critical environmental challenge worldwide, however limited research is reported in remote lakes of Pakistan. This study assessed MPs (>5mm) prevalence, distribution and risk perspective in water and sediment of eight remote and high-altitude lakes (> 1,500 meter above sea level) of Gilgit Baltistan, Pakistan. The lakes exhibited an average abundance of 152.6 ± 104.6 to 12.1±7 MPs/kg of dry sediments and 2 ± 0.9 to 17.1 ± 17.2 MPs/L of surface water. MPs <200µm dominated in both matrices. Surface water predominantly contained polyester and polypropylene, while polypropylene and polyethylene dominated in sediments. The gradient of elevation did not show any pronounced impact on the fiber loading or MP count in both matrices. Backward air mass trajectory revealed that air masses vastly travelled from western-Asia, Arabian sea and Bay of Bengal with an average transmission distance of 2,500-3,500 km (500 m a.s.l) that can be a potential deposition MP source in the area. Pollution Load Index of the lakes were >1 exhibiting pollution. All other lakes except Batura and Borith manifested a moderate hazard index. Naltar lake along with aforementioned two lakes also manifested high polymer toxicity. Further research should emphasize understanding the mechanisms and biotic interactions in high-mountain ecosystems.

Rapid-onset methemoglobinemia from traditional-medicine-induced potassium nitrate poisoning: successful treatment with methylene blue-a case report.

BACKGROUND: Potassium nitrate poisoning is a rare but potentially serious condition that can result in methemoglobinemia and subsequent cyanosis. This case report presents a unique instance of rapid-onset methemoglobinemia resulting from the ingestion of a traditional medicine preparation containing potassium nitrate, known as "kalmi shora." CASE PRESENTATION: A 14-year-old Pakistani boy reported to the emergency department with a history of sudden-onset headache, drowsiness agitation, irritability, and generalized cyanosis. Pulse oximetry showed a concerning oxygen saturation level of 58%, whereas arterial blood gas analysis revealed a normal partial pressure of oxygen (90 mmHg). The profile of abrupt onset of symptoms, generalized cyanosis, and the discrepancy between the partial pressure of oxygen and oxygen saturation readings necessitated a comprehensive assessment including inquiries into potential toxins. The peculiar appearance of the blood, resembling chocolate in color, further indicated the possibility of methemoglobinemia. The patient was successfully treated with methylene blue, leading to a prompt resolution of symptoms. CONCLUSION: This case highlights the significance of considering toxin exposures, such as traditional-medicine-induced poisoning, in emergency settings. The report contributes to the medical literature by highlighting the potential risks associated with traditional remedies and emphasizes the critical role of prompt diagnosis and intervention in optimizing patient outcomes. Recognition of the specific etiology of methemoglobinemia, in this case, traditional medicine ingestion, is essential for effective management in emergency medicine.

Effects of Simulated Equestrian Therapy in Improving Motor Proficiency among Down Syndrome Children - A Randomized Controlled Trial.

The objective of this study was to investigate the effectiveness of Simulated Equestrian Therapy and Neuro-Motor Therapy in improving Motor Proficiency among Down syndrome children using a double-blinded Randomized Controlled Trial. This study was conducted at Dar-ul-Sukun Institute and Dr. Ziauddin Hospital from April to September 2023 by enrolling a total of 56 participants with Down syndrome (DS) after obtaining informed, voluntary assent from the guardians of the participants. Each participant was allocated randomly to the treatment group (n = 28) that received Simulated Equestrian Therapy (SET) and the control group (n = 28) that received Neuro-motor Therapy (NMT) using the envelop method of simple random sampling. The participants and their guardians were blind to the allocations. Participants' blood pressure and heart rate were recorded before and after each session to ensure safety. Each participant was assessed at baseline and after 6th and 12th week of intervention using Bruinink's test of motor proficiency (BOT-2). The data was analyzed using Medcalc software. The results reveal significant findings for improving motor proficiency after 12th week of intervention of SET and NMT. No protocol was found to be superior to another in improvement of the tested parameters. Hence, our study concludes that SET and NMT effectively improve motor proficiency among DS children. However, studies with a follow-up period should be conducted to further evaluate these therapies' long-term benefits.

Effects of Virtual Reality-Based Mirror Therapy on Upper Extremity Motor Function, Manual Performance and Gross Manual Dexterity Among Stroke Patients: A Meta-Analysis.

In recent years, innovative technologies have gained prominence in stroke patient rehabilitation worldwide, with virtual reality-based mirror therapy (VRBMT) emerging as a notable example. Hence, the present study aims to determine the efficacy of VRBMT on upper extremity motor function, manual performance, and gross manual dexterity among stroke patients. The systematic search utilized Population, Intervention, Comparison, Outcome, and Design (PICOD) paradigm, and the study searched was based on 2012-2023, utilizing different databases. The meta-analysis data was evaluated using MedCalc version 18.11.3. The Pooled effect size mean was statistically examined using a fixed and random effect model. Among the 6 studies selected, 4 studies involving upper-limb stroke patients were identified between the VRBMT. Pooled analysis of VRBMT revealed no significant effect on motor function [standardized mean difference (SMD) 0.815; 95% CI 0.00 to 81.37; P = 0.5562]. The remaining 2 of 6 studies participated in the study of the manual performance stroke patients (SMD 0.869; 95% CI 0.00 to 93.22; P = 0.0684). The pooled analysis of VRBMT revealed no significant effect. The last 2 of 6 included studies on gross manual dexterity in stroke. The pooled analysis also showed no significant effects on VRBMT (SMD 0.198; 95% CI 0.00 to 0.00; P = 0.6951). The present study concluded although VRBMT exhibits potential as a novel method for stroke rehabilitation, its effects on gross manual dexterity, manual performance, and upper extremity motor function are not statistically significant may be due to a limited number of studies on VRBMT in stroke patients.

Microsporidia secretory effectors and their roles in pathogenesis.

Microsporidia, a group of unicellular eukaryotic parasites, rely intensely on secretory effectors for successful invasion and proliferation within host cells. This review focuses on the identification, characterization, and functional roles of effectors, including secretory proteins and microRNAs. The adhesion proteins like the Ricin-B-lectin facilitate initial invasion, which binds to the host cell surface. Once inside, microsporidia deploy a range of effectors to modulate host immune responses, such as serpin proteins, and redirect host cell metabolism to meet the parasite's nutritional needs through hexokinase. Some effectors such as microRNAs, alter the host gene expression to create a more favorable intracellular parasitic environment. In conclusion, the secretory effectors of microsporidia play a pivotal role spanning from host cell invasion to intracellular establishment. In the future, more effectors secreted by microsporidia will be studied, which will not only help to elucidate the molecular mechanism of pathogenic manipulation of the host but also help to provide the potential targets for anti-parasitic treatments.

Effects of nonimmersive virtual reality using Wii-Fit exercises on balance and cognition in Parkinson disease: A meta-analysis.

BACKGROUND: Patients' compliance and receptivity to nonimmersive virtual reality (NIVR) can enhance their long-term exercise therapy compliance for neurological illnesses. Patients with Parkinson disease (PD) have age-standardized rates of disability, death, and prevalence that are rising the fastest; several researches have revealed that there is no known cure for PD at this time. Thus, the current study investigates how NIVR affects patients with PD using Wii-Fit exercises. Therefore, the present study investigates the effects of NIVR using Wii-Fit exercises among patients with PD. MATERIALS AND METHODS: The population, intervention, comparison, outcome approach was used to select the research studies. Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online, PubMed, Physiotherapy Evidence Database, and ProQuest were checked for citations from 2012 to 2022. RevMan was used to analyze data. A fixed and random effects model was used to analyze the pooled effect size in terms of mean and standard deviation. The heterogeneity was calculated using the I2 statistic. Cochrane examined for bias in randomized controlled trials. RESULTS: This review comprised 12 trials in total. Using the Berg Balance Scale, the pooled analysis showed statistically significant effects on the NIVR group (pooled standardized mean difference = 0.61 [95% confidence interval, 0.28-0.95]; I2 = 53%; P = .0003). The pooled effects of cognition showed nonsignificant effects of NIVR (pooled standardized mean difference = 0.15 [95% confidence interval, -0.21 to 0.51]; I2 = 0%; P = .41). CONCLUSIONS: The review suggests that NIVR is effective for balance rehabilitation but ineffective for cognitive improvement in patients with PD aged >18 to 85 years.

Green synthesis of Fe and Zn-NPs, phytochemistry and pharmacological evaluation of Phlomis cashmeriana Royle ex Benth.

This investigation portrays the phytochemical screening, green synthesis, characterization of Fe and Zn nanoparticles, their antibacterial, anti-inflammation, cytotoxicity, and anti-thrombolytic activities. Four dissimilar solvents such as, n-hexane, chloroform, ethyl acetate and n-butanol were used to prepare the extracts of Phlomis cashmeriana Royle ex Benth. This is valued medicinal plant (Family Lamiaceae), native to mountains of Afghanistan and Kashmir. In the GC-MS study of its extract, the identified phytoconstituents have different nature such as terpenoids, alcohol and esters. The synthesized nanoparticles were characterized by SEM, UV, XRD, and FT-IR. The phytochemical analysis showed that the plant contains TPC (total phenolic content) 297.51 mg GAE/g and TFC (total flavonoid content) 467.24 mg CE/g. The cytotoxicity values have shown that the chloroform, n-butanol and aqueous extracts were more toxic than other extracts. The anti-inflammatory potential of n-butanol and aqueous extracts was found higher than all other extracts. Chloroform and n-hexane extracts have low MIC values against both E. coli and S. aureus bacterial strains. Chloroform and aqueous extracts have great anti-thrombolytic potential than all other extracts. Overall, this study successfully synthesized the nanoparticles and provides evidence that P. cashmeriana have promising bioactive compounds that could serve as potential source in the drug formulation.

Investigating the potential of monocyclic B9N9 and C18 rings for the electrochemical sensing, and adsorption of carbazole-based anti-cancer drug derivatives: DFT-based first-principle study.

CONTEXT: For the first time, the use of monocyclic rings C18 and B9N9 as sensors for the sensing of carbazole-based anti-cancer drugs, such as tetrahydrocarbazole (THC), mukonal (MKN), murrayanine (MRY), and ellipticine (EPT), is described using DFT simulations and computational characterization. The geometries, electronic properties, stability studies, sensitivity, and adsorption capabilities of C18 and B9N9 counterparts towards the selected compounds confirm that the analytes interact through active cavities of the C18 and B9N9 rings of the complexes. METHODS: Based on the interaction energies, the sensitivity of surfaces towards EPT, MKN, MRY, and THC analytes is observed. The interaction energy of EPT@B9N9, MKN@B9N9, MRY@B9N9, and THC@B9N9 complexes are observed - 20.40, - 19.49, - 20.07, and - 18.27 kcal/mol respectively which is more exothermic than EPT@C18, MKN@C18, MRY@C18, and THC@C18 complexes are - 16.37, - 13.97, - 13.96, and - 11.39 kcal/mol respectively. According to findings from the quantum theory of atoms in molecules (QTAIM) and the reduced density gradient (RDG), dispersion forces play a significant role in maintaining the stability of these complexes. The electronic properties including FMOs, density of states (DOS), natural bond orbitals (NBO), charge transfer, and absorption studies are carried out. In comparison of B9N9 and C18, the analyte recovery time for C18 is much shorter (9.91 × 10-11 for THC@C18) than that for B9N9 shorter recovery time value of 3.75 × 10-9 for EPT@B9N9. These results suggest that our reported sensors B9N9 and C18 make it faster to detect adsorbed molecules at room temperature. The sensor response is more prominent in B9N9 due to its fine energy gap and high adsorption energy. Consequently, it is possible to think of these monocyclic systems as a potential material for sensor applications.

Nasopharyngeal Airway in the Trachea: A Case Report.

We report a case of a cannulated nasopharyngeal airway (NPA) in a patient having a neurological deficit, absent gag reflex, and no clinically obvious signs of respiratory distress. The patient had two episodes of vomiting before admission and was admitted with the initial working diagnosis of aspiration pneumonia; however, a preliminary chest X-ray (CXR) revealed an NPA, sitting vertically in the airway. It is our emphasis that thorough clinical history and radiological imaging are of paramount importance in prompt management of such airway complications.

Dialysis-Reversible Complete Heart Block Without Severe Metabolic Derangements.

We present the case of an elderly female who presented to the emergency department with dizziness. She was found to have an acute chronic kidney injury complicated by a complete heart block (CHB). She received a transvenous pacemaker and was taken for hemodialysis (HD) with complete resolution of her heart block. The following day, she was noted to be symptomatic and bradycardic. A repeat electrocardiogram showed a recurrence of the CHB. She was taken again for HD which led to the resolution of her conduction abnormalities. Electrophysiology was consulted and she had a permanent pacemaker implanted prior to being discharged.

Gazing Beyond the Horizon: A Systematic Review Unveiling the Theranostic Potential of Quantum Dots in Alzheimer's Disease.

Alzheimer's disease (AD), a neurodegenerative disorder characterized by cognitive decline, poses a significant healthcare challenge worldwide. The accumulation of amyloid-beta (Aß) plaques and hyperphosphorylated tau protein drives neuronal degeneration and neuroinflammation, perpetuating disease progression. Despite advancements in understanding the cellular and molecular mechanisms, treatment hurdles persist, emphasizing the need for innovative intervention strategies. Quantum dots (QDs) emerge as promising nanotechnological tools with unique photo-physical properties, offering advantages over conventional imaging modalities. This systematic review endeavors to elucidate the theranostic potential of QDs in AD by synthesizing preclinical and clinical evidence. A comprehensive search across electronic databases yielded 20 eligible studies investigating the diagnostic, therapeutic, or combined theranostic applications of various QDs in AD. The findings unveil the diverse roles of QDs, including inhibiting Aß and tau aggregation, modulating amyloidogenesis pathways, restoring membrane fluidity, and enabling simultaneous detection of AD biomarkers. The review highlights the potential of QDs in targeting multiple pathological hallmarks, delivering therapeutic payloads across the blood-brain barrier, and facilitating real-time imaging and high-throughput screening. While promising, challenges such as biocompatibility, surface modifications, and clinical translation warrant further investigation. This systematic review provides a comprehensive synthesis of the theranostic potential of QDs in AD, paving the way for translational research and clinical implementation.

Contemporary trends of leadless pacemaker implantation in the United States.

INTRODUCTION: Leadless pacemakers (LPM) have established themselves as the important therapeutic modality in management of selected patients with symptomatic bradycardia. To determine real-world utilization and in-hospital outcomes of LPM implantation since its approval by the Food and Drug Administration in 2016. METHODS: For this retrospective cohort study, data were extracted from the National Inpatient Sample database from the years 2016-2020. The outcomes analyzed in our study included implantation trends of LPM over study years, mortality, major complications (defined as pericardial effusion requiring intervention, any vascular complication, or acute kidney injury), length of stay, and cost of hospitalization. Implantation trends of LPM were assessed using linear regression. Using years 2016-2017 as a reference, adjusted outcomes of mortality, major complications, prolonged length of stay (defined as >6 days), and increased hospitalization cost (defined as median cost >34 098$) were analyzed for subsequent years using a multivariable logistic regression model. RESULTS: There was a gradual increased trend of LPM implantation over our study years (3230 devices in years 2016-2017 to 11 815 devices in year 2020, p for trend <.01). The adjusted mortality improved significantly after LPM implantation in subsequent years compared to the reference years 2016-2017 (aOR for the year 2018: 0.61, 95% CI: 0.51-0.73; aOR for the year 2019: 0.49, 95% CI: 0.41-0.59; and aOR for the year 2020: 0.52, 95% CI: 0.44-0.62). No differences in adjusted rates of major complications were demonstrated over the subsequent years. The adjusted cost of hospitalization was higher for the years 2019 (aOR: 1.33, 95% CI: 1.22-1.46) and 2020 (aOR: 1.69, 95% CI: 1.55-1.84). CONCLUSION: The contemporary US practice has shown significantly increased implantation rates of LPM since its approval with reduced rates of inpatient mortality.

Full-Thickness Macular Hole: An Exceptional Case Presentation in Behçet's Disease.

Behçet's disease (BD) is a vascular disorder affecting a variety of organ systems. It is an auto-immune disease with inflammatory vasculitis that is systemic in nature, the exact etiology of which is unknown. Obliterative vasculitis, recurrent aphthous ulcers, mucocutaneous manifestations, recurrent genital ulcerations, and intraocular inflammation, especially chronic relapsing uveitis, are the characteristic features of BD. The case report presents a unique manifestation of BD in a 20-year-old Pakistani male who presents with a one-year-old history of viral encephalitis, after which he developed a blurring of vision. On examination, he had recurrent aphthous ulcers, recurrent ulcerations of genitalia, and a history of lesions of the skin. After making the patient undergo a cascade of investigations for evaluating and assessing the various signs and symptoms, a diagnosis of BD with bilateral panuveitis and a full-thickness macular hole (FTMH) in the right eye was established. Immuno-suppressants, steroids, and azathioprine were used as treatment options, following which the state of remission was attained.

Association of chronic kidney disease and end-stage renal disease with procedural complications and inpatient outcomes of leadless pacemaker implantations across the United States.

BACKGROUND: Leadless pacemakers have emerged as a promising alternative to transvenous pacemakers in patients with kidney disease. However, studies investigating leadless pacemaker outcomes and complications based on kidney dysfunction are limited. OBJECTIVE: The objective of this study was to evaluate the association of chronic kidney disease (CKD) and end-stage renal disease (ESRD) with inpatient complications and outcomes of leadless pacemaker implantations. METHODS: National Inpatient Sample and International Classification of Diseases, Tenth Revision codes were used to identify patients with CKD and ESRD who underwent leadless pacemaker implantations in the United States from 2016 to 2020. Study end points assessed included inpatient complications, outcomes, and resource utilization of leadless pacemaker implantations. RESULTS: A total of 29,005 leadless pacemaker placements were identified. Patients with CKD (n = 5245 [18.1%]) and ESRD (n = 3790 [13.1%]) were younger than patients without CKD and had higher prevalence of important comorbidities. In crude analysis, ESRD was associated with higher prevalence of major complications, peripheral vascular complications, and inpatient mortality. After multivariable adjustment, CKD and ESRD were associated with inpatient mortality (CKD: adjusted odds ratio [aOR], 1.62 [95% CI, 1.40-1.86]; ESRD: aOR, 1.38 [95% CI, 1.18-1.63]) and prolonged length of stay (CKD: aOR, 1.55 [95% CI, 1.46-1.66]; ESRD: aOR, 1.81 [95% CI 1.67-1.96]). ESRD was also associated with higher hospitalization costs (aOR, 1.63; 95% CI, 1.50-1.77) and major complications (aOR, 1.33; 95% CI, 1.13-1.57) after leadless pacemaker implantation. CONCLUSION: Approximately one-third of patients undergoing leadless pacemaker implantation had CKD or ESRD. CKD and ESRD were associated with greater length and cost of stay and inpatient mortality.

Exploring the multimodal health-promoting properties of resveratrol: A comprehensive review.

Resveratrol, a natural polyphenol in various plants, has gained significant attention for its potential health-promoting properties. It has been demonstrated, after reviewing various clinical and in vitro studies, that resveratrol possesses potent antioxidant potential. Resveratrol demonstrates cellular component protection by directly neutralizing free radicals (FRs) and enhancing the expression of natural antioxidant enzymes, thereby mitigating oxidative damage to proteins, lipids, and nucleic acids. Clinical trials have shown promising results, indicating that resveratrol supplementation can enhance antioxidant defenses and reduce oxidative damage markers in various populations. In addition to its antioxidant effects, resveratrol exhibits potent anti-inflammatory properties. It can modulate key inflammatory pathways, such as nuclear factor-kappa B (NF-κB) and mitogen-activated protein kinases (MAPKs), thereby suppressing the production of pro-inflammatory cytokines and chemokines. Furthermore, resveratrol's multimodal effects extend beyond its antioxidant and anti-inflammatory properties. It has been discovered to exert regulatory effects on various cellular processes, including apoptosis, cell cycle progression, angiogenesis, and immunological responses. The primary aim of this review paper is to provide a thorough overview of the current knowledge on resveratrol, including its chemical composition, bioaccessibility, clinical effectiveness, and utilization in nanotechnology to enhance its bioavailability. From future perspectives, revising the administration methods for certain contexts and understanding the underlying systems responsible for resveratrol's effects will require further inquiry. For the highest potential health results, advanced trial-based research is necessary for combinational nano-delivery of resveratrol.

ANN: adversarial news net for robust fake news classification.

With easy access to social media platforms, spreading fake news has become a growing concern today. Classifying fake news is essential, as it can help prevent its negative impact on individuals and society. In this regard, an end-to-end framework for fake news detection is developed by utilizing the power of adversarial training to make the model more robust and resilient. The framework is named "ANN: Adversarial News Net," emoticons have been extracted from the datasets to understand their meanings concerning fake news. This information is then fed into the model, which helps to improve its performance in classifying fake news. The performance of the ANN framework is evaluated using four publicly available datasets, and it is found to outperform baseline methods and previous studies after adversarial training. Experiments show that Adversarial Training improved the performance by 2.1% over the Random Forest baseline and 2.4% over the BERT baseline method in terms of accuracy. The proposed framework can be used to detect fake news in real-time, thereby mitigating its harmful effects on society.

Sleep stage prediction using multimodal body network and circadian rhythm.

Quality sleep plays a vital role in living beings as it contributes extensively to the healing process and the removal of waste products from the body. Poor sleep may lead to depression, memory deficits, heart, and metabolic problems, etc. Sleep usually works in cycles and repeats itself by transitioning into different stages of sleep. This study is unique in that it uses wearable devices to collect multiple parameters from subjects and uses this information to predict sleep stages and sleep patterns. For the multivariate multiclass sleep stage prediction problem, we have experimented with both memoryless (ML) and memory-based models on seven database instances, that is, five from the collected dataset and two from the existing datasets. The Random Forest classifier outclassed the ML models that are LR, MLP, kNN, and SVM with accuracy (ACC) of 0.96 and Cohen Kappa 0.96, and the memory-based model long short-term memory (LSTM) performed well on all the datasets with the maximum attained accuracy of 0.88 and Kappa 0.82. The proposed methodology was also validated on a longitudinal dataset, the Multiethnic Study of Atherosclerosis (MESA), with ACC and Kappa of 0.75 and 0.64 for ML models and 0.86 and 0.78 for memory-based models, respectively, and from another benchmarked Apple Watch dataset available on Physio-Net with ACC and Kappa of 0.93 and 0.93 for ML and 0.92 and 0.87 for memory-based models, respectively. The given methodology showed better results than the original work and indicates that the memory-based method works better to capture the sleep pattern.

Identifying key soil characteristics for Francisella tularensis classification with optimized Machine learning models.

Francisella tularensis (Ft) poses a significant threat to both animal and human populations, given its potential as a bioweapon. Current research on the classification of this pathogen and its relationship with soil physical-chemical characteristics often relies on traditional statistical methods. In this study, we leverage advanced machine learning models to enhance the prediction of epidemiological models for soil-based microbes. Our model employs a two-stage feature ranking process to identify crucial soil attributes and hyperparameter optimization for accurate pathogen classification using a unique soil attribute dataset. Optimization involves various classification algorithms, including Support Vector Machines (SVM), Ensemble Models (EM), and Neural Networks (NN), utilizing Bayesian and Random search techniques. Results indicate the significance of soil features such as clay, nitrogen, soluble salts, silt, organic matter, and zinc , while identifying the least significant ones as potassium, calcium, copper, sodium, iron, and phosphorus. Bayesian optimization yields the best results, achieving an accuracy of 86.5% for SVM, 81.8% for EM, and 83.8% for NN. Notably, SVM emerges as the top-performing classifier, with an accuracy of 86.5% for both Bayesian and Random Search optimizations. The insights gained from employing machine learning techniques enhance our understanding of the environmental factors influencing Ft's persistence in soil. This, in turn, reduces the risk of false classifications, contributing to better pandemic control and mitigating socio-economic impacts on communities.

Aortoiliac Occlusion in a Rare Instance of Leriche Syndrome Type I in a 65-Year-Old Woman With Chronic Leg Discomfort Refractory to Pregabalin.

Aortoiliac occlusive disease (AIOD), also known as Leriche syndrome, is a form of peripheral artery disease (PAD) that involves narrowing, and in severe cases, complete occlusion, of infrarenal abdominal aorta and/or iliac and femoropopliteal arteries. It classically presents as a triad of symptoms, i.e., leg pain, erectile dysfunction, and abnormally weak or absent femoral pulses. If untreated, it can progress to ischemia and gangrene of the affected regions of pelvis and lower extremities. Like any other PAD, AIOD is most commonly caused by atherosclerosis and usually occurs in strong association with severe cardiovascular diseases. Due to the rarity of this disease, its incidence and prevalence are still unknown making it harder to diagnose especially in patients without the classic risk factors and typical presentation. We report a case of AIOD in a 65-year-old woman who presented with atypical symptoms. She was diagnosed with AIOD type I upon further investigation, which was managed successfully.

Deciphering the electrochemical sensing capability of novel Ga12As12 nanocluster towards chemical warfare phosgene gas: insights from DFT.

The applications of 3D inorganic nanomaterials in environmental and agriculture monitoring have been exploited continuously; however, the utilization of semiconductor nanoclusters, especially for detecting warfare agents, has not been fully investigated yet. To fill this gap, the molecular modelling of novel inorganic semiconductor nanocluster Ga12As12 as a sensor for phosgene gas (highly toxic for living things and the environment) is accomplished employing benchmark DFT and TD-DFT investigations. Computational tools have been applied to explore different adsorption sites and the potential sensing capability of the Ga12As12 nanoclusters. The calculated adsorption energy (-21.34 ± 2.7 kcal mol-1) for ten selected complexes, namely, Pgn-Cl@4m-ring (MS1), Pgn-Cl@6m-ring (MS2), Pgn-Cl@XY66 (MS3), Pgn-O@4m-ring (MS4), Pgn-O@XY66 (MS5), Pgn-O@XY64 (MS6), Pgn-O@Y (MS7), Pgn-planar@Y (MS8), Pgn-planar@X (MS9), and Pgn-planar@4m-ring (MS10), manifest the remarkable and excessive adsorption response of the studied nanoclusters. The explored molecular electronic properties, such as interaction distance (3.05 ± 0.5 Å), energy gap (∼2.17 eV), softness (∼0.46 eV), hardness (1.10 ± 0.01 eV), electrophilicity index (10.27 ± 0.45 eV), electrical conductivity (∼1.98 × 109), and recovery time (∼3 × 10-12 s-1) values, ascertain the elevated reactivity and an imperishable sensitivity of the Ga12As12 nanocluster, particularly for its complex MS8. QTAIM analysis exhibits the presence of a strong electrostatic bond (positive ∇2ρ(r) values), electron delocalization (ELF < 0.5), and a strong chemical bond (because of high all-electron density values). In addition, NBO analysis explores the lone pair electron delocalization of phosgene to the nanocluster stabilized by intermolecular charge transfer (ICT) and different kinds of non-covalent interactions. Also, the green region existence expressed by NCI analysis (between the nanocluster and adsorbate) stipulate the energetic and dominant interactions. Furthermore, the UV-Vis, thermodynamic analysis, and density of state (DOS) demonstrate the maximum absorbance (562.11 nm) and least excitation energy (2.21 eV) by the complex MS8, the spontaneity of the interaction process, and the significant changes in HOMO and LUMO energies, respectively. Thus, the Ga12As12 nanocluster has proven to be a promising influential sensing material to monitor phosgene gas in the real world, and this study will emphasize the informative knowledge for experimental researchers to use Ga12As12 as a sensor for the warfare agent (phosgene).