Efficacy and safety of pulsed-field versus conventional thermal ablation for atrial fibrillation: A systematic review and meta-analysis.

Background: Pulsed-field ablation (PFA) has emerged as an innovative alternative to radiofrequency (RF) and cryoablation because it selectively targets myocardial tissue. Thus, we aim to estimate the efficacy and safety of PFA versus thermal ablation for atrial fibrillation (AF) ablation. Methods: A systematic review and meta-analysis were retrieved from PubMed, WOS, SCOPUS, EMBASE, and CENTRAL through September 2023. We used RevMan V. 5.4 to pool dichotomous data using risk ratio (RR) and continuous data using mean difference (MD) with a 95% confidence interval (CI). PROSPERO ID: CRD42023480321. Results: We included 17 studies with a total of 2255 patients. PFA was significantly associated with a decreased incidence of AF recurrence (RR: 0.66 with 95% CI [0.51, 0.87], p = .003). However, there was no significant difference between PFA and thermal ablation in arrhythmia recurrence (RR: 0.92 with 95% CI [0.74, 1.46], p = .42). PFA was significantly associated with decreased total procedure time (MD: -15.15 with 95% CI [-20.23, -10.07], p < .00001), decreased heart rate change (MD: -7.39 with 95% CI [-12.16, -2.62], p = .002), decreased phrenic nerve palsy (RR: 0.38 with 95% CI [0.15, 0.98], p = .05), and reduced esophageal lesions (RR: 0.09 with 95% CI [0.01, 0.69], p = .02). On the contrary, PFA was significantly associated with increased pericardial tamponade (RR: 6.14 with 95% CI [1.43, 26.33], p = .01). Conclusion: PFA was significantly associated with decreased AF recurrence, total procedure time, heart rate change, phrenic nerve palsy, esophageal lesion, and increased incidence of pericardial tamponade compared with thermal ablation.

Dexmedetomidine Moderate Sedation Versus General Anesthesia on the Diagnostic Yield of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: A Randomized Controlled Study.

Background: One of the factors that affect the diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the level of sedation. Objectives: Therefore, we aimed to compare dexmedetomidine (DEX) as moderate sedation (MS) versus general anesthesia (GA) on the diagnostic yield of EBUS-TBNA. Methods: This randomized open-label controlled trial was carried out on 70 patients older than 18 years of age, classified as American Society of Anesthesiologists (ASA) II or III, and scheduled for EBUS-TBNA. Patients were randomly allocated into two equal groups. Group D received 1 µg/kg fentanyl 2 minutes before induction with a 1 µg/kg infusion of DEX for 10 minutes, then maintenance with 0.5 - 1 µg/kg/h aiming for a Ramsey Sedation Scale of 4 - 5 while preserving hemodynamics. Group GA received 1 µg/kg fentanyl, 2 mg/kg propofol, and 0.5 mg/kg atracurium (then 0.1 mg/kg every 20 minutes). Results: Group D had a significantly higher rate of recalling the procedure (P = 0.005) and a lower rate of shortness of breath compared to group GA (P = 0.038). Intraoperative heart rate measurements at baseline were not significantly different between groups but were significantly lower at 5 min, 10 min, 15 min, 20 min, and at the end of surgery in group D compared to group GA (P < 0.05). Intraoperative mean arterial blood pressure measurements at baseline, 5 min, 10 min, 15 min, 20 min, and at the end of surgery were not significantly different between groups. Recovery time was significantly shorter in group D compared to group GA (P < 0.001). Conclusions: Compared to GA, MS with DEX showed a comparable diagnostic yield with faster recovery time and better patient satisfaction, as evidenced by a willingness to repeat procedures when needed and less shortness of breath in EBUS-TBNA.

Efficacy of adding ketamine to levobupivacaine in paravertebral block on acute and chronic pain in thoracotomy: a randomized controlled double-blinded trial.

Background: The inappropriate management of pain after thoracotomy results in serious complications. Several adjuvants have been added to the thoracic paravertebral block (TPVB) to enhance its effects. This work aimed to evaluate the effect of adding ketamine to TPVB on thoracotomy-related acute and chronic pain. Methods: This randomized controlled double-blinded trial included 60 patients scheduled for open thoracotomy. Patients were equally randomized into 2 groups: group K: received TPVB + 1 mL ketamine (50 mg). Group C (n = 30): received TPVB (19 mL of 0.5% levobupivacaine + 1 mL normal saline) as a control arm. Results: Group K exhibited a significant delay in requesting analgesia, required less morphine in the first 24 and 48 hours, and reported lower numerical rating scale at rest and at deep breathing at various time points compared with the control group. However, both groups were comparable in post-thoracotomy pain syndrome and the incidence of complications at 2 months and 3 months. Conclusions: Adding ketamine to TPVB resulted in better analgesia as demonstrated by significantly delayed time to first rescue analgesia, lower total amount of consumed opioid, and pain score without considerable effect on chronic pain and complications in patients undergoing thoracotomy.

The FIFA 11+ injury prevention program reduces the incidence of lower extremity injuries in football players: a systematic review and meta-analysis.

INTRODUCTION: The FIFA 11+ preventive program is designed to reduce the incidence of injury in sports. However, to gain a better understanding of its effect a systematic review and meta-analysis is needed. The current review aims to investigate the effect of the FIFA 11+ preventive program on injury incidence among male and female football players. EVIDENCE ACQUISITION: This study used Scopus, PEDro, SPORTDiscus, and ProQuest as data sources. The initial selection of the studies, thorough assessment of the tile, and abstract. Extraction of the necessary study data was conducted by two independent researchers. Another two independent researchers assessed the quality of each included study against 39 used criteria. These criteria were combined from several popular quality assessment scales. The incidence of injuries measured in the lower extremities in football players after addressing the FIFA11+ was the outcome of interest. EVIDENCE SYNTHESIS: This review included 12 trials of variable methodological quality from which 10 trials were selected for the meta-analysis. In general, the FIFA11+ program showed a significant reduction (P<0.1) in lower limb injury incidence for male young and adults in comparison to other programs. However, evidence of its effectiveness in females is lacking and more studies are needed. CONCLUSIONS: The FIFA 11+ program is recommended to be used and implemented as a preventive strategy in males. Although, the result showed a significant reduction in injury incidence in adult males, heterogeneity between studies is high which may reduce the generalizability of the results. More studies are needed to investigate the effect of the FIFA 11+ program on females.

Licorice-root extract and potassium sorbate spray improved the yield and fruit quality and decreased heat stress of the 'osteen' mango cultivar.

Heat stress, low mango yields and inconsistent fruit quality are main challenges for growers. Recently, licorice-root extract (LRE) has been utilized to enhance vegetative growth, yield, and tolerance to abiotic stresses in fruit trees. Potassium sorbate (PS) also plays a significant role in various physiological and biochemical processes that are essential for mango growth, quality and abiotic stress tolerance. This work aimed to elucidate the effects of foliar sprays containing LRE and PS on the growth, yield, fruit quality, total chlorophyll content, and antioxidant enzymes of 'Osteen' mango trees. The mango trees were sprayed with LRE at 0, 2, 4 and 6 g/L and PS 0, 1, 2, and 3 mM. In mid-May, the mango trees were sprayed with a foliar solution, followed by monthly applications until 1 month before harvest. The results showed that trees with the highest concentration (6 g/L) of LRE exhibited the maximum leaf area, followed by those treated with the highest concentration (3 mM) of PS. Application of LRE and PS to Osteen mango trees significantly enhanced fruit weight, number of fruits per tree, yield (kg/tree), yield increasing%, and reduced number of sun-burned fruits compared to the control. LRE and PS foliar sprays to Osteen mango trees significantly enhanced fruit total soluble solids ˚Brix, TSS/acid ratio, and vitamin C content compared to the control. Meanwhile, total acidity percentage in 'Osteen' mango fruits significantly decreased after both LRE and PS foliar sprays. 'Osteen' mango trees showed a significant increase in leaf area, total chlorophyll content, total pigments, and leaf carotenoids. Our results suggest that foliar sprays containing LRE and PS significantly improved growth parameters, yield, fruit quality, antioxidant content, and total pigment concentration in 'Osteen' mango trees. Moreover, the most effective treatments were 3 mM PS and 6 g/L LRE. LRE and PS foliar spray caused a significant increase in yield percentage by 305.77%, and 232.44%, in the first season, and 242.55%, 232.44% in the second season, respectively.

Early detection of myocardial iron overload in patients with ß-thalassemia major using cardiac magnetic resonance T1 mapping.

BACKGROUND: The T2* technique, used for quantifying myocardial iron content (MIC), has limitations in detecting early myocardial iron overload (MIO). The in vivo mapping of the myocardial T1 relaxation time is a promising alternative for the early detection and management of MIO. METHODS: 32 ß-thalassemia major (ßTM) patients aged 11.5 ± 4 years and 32 healthy controls were recruited and underwent thorough clinical and laboratory assessments. The mid-level septal iron overload was measured through T1 mapping using a modified Look-Locker inversion recovery sequence with a 3 (3 s) 3 (3 s) 5 scheme. Septum was divided at the mentioned level into 3 zones corresponding to segments 8 and 9 in the cardiac segmentation model. RESULTS: 21.9 % of ßTM had clinical cardiac morbidity. The cut-off of T1 mapping of hepatic and myocardium to differentiate between the patients and control groups was ≤466 and ≥ 923 ms respectively. The T1 technique was able to detect 4 patients with high MIC, two of them were not detected by the T2* technique. There was a statistically significant correlation between the average T1 values of the studied zones in patients with ßTM and the liver iron content (LIC), the T1 values within segment 8 of the liver, age of patients, the age at first transfusion, age of splenectomy and serum ferritin value. CONCLUSION: The addition of the T1 mapping sequence to the conventional T2* technique was able to increase the efficacy of the MIC detection protocol by earlier detection of MIO. This would guide chelation therapy to decrease myocardial morbidity.

PM10 dysregulates epithelial barrier function in human corneal epithelial cells that is restored by antioxidant SKQ1.

Exposure to airborne particulate <10 µm (PM10) adversely affects the ocular surface. This study tested PM10 on epithelial barrier integrity in immortalized human corneal epithelial cells (HCE-2) and mouse cornea, and whether antioxidant SKQ1 is restorative. HCE-2 were exposed to 100 µg/ml PM10 ± SKQ1 for 24 h. An Electric Cell-Substrate Impedance Sensing (ECIS) system monitored the impact of PM10. RT-PCR, western blotting and immunofluorescence measured levels of barrier and associated proteins, stanniocalcin 2 (STC2), and a kit measured total calcium. In vivo, female C57BL/6 mice were exposed to either control air or PM10 (±SKQ1) in a whole-body exposure chamber, and barrier associated proteins tested. Tight junction and mucins proteins in the cornea were tested. In HCE-2, PM0 vs control significantly reduced mRNA and protein levels of tight junction and adherence proteins, and mucins. ECIS data demonstrated that PM10 vs control cells exhibited a significant decrease in epithelial barrier strength at 4000 Hz indicated by reduced impedance and resistance. PM10 also upregulated STC2 protein and total calcium levels. In vivo, PM10 vs control reduced zonula occludens 1 and mucins. SKQ1 pre-treatment reversed PM10 effects both in vitro and in vivo. In conclusion, PM10 exposure reduced tight junction and mucin proteins, and compromised the seal between cells in the corneal epithelium leading to decreased epithelial barrier strength. This effect was reversed by SKQ1. Since the corneal epithelium forms the first line of defense against air pollutants, including PM10, preserving its integrity using antioxidants such as SKQ1 is crucial in reducing the occurrence of ocular surface disorders.

Myricetin-loaded SBA-15 silica nanoparticles for enhanced management of pyrexia, pain, and inflammation through modulation of MAPK/NF-κB and COX-2/PGE-2 pathways: Evidence from the biochemical, histological, and metabolomic analysis.

Myricetin (MYR) is a natural flavonoid that has several biological functions. However, some of its beneficial effects are diminished due to low water solubility, stability, and bioavailability. Herein, several kinds of silica nanoparticles (MCM-41 and SBA-15) were loaded with MYR to improve its biological activity as an analgesic, antipyretic, and anti-inflammatory component, thereby overcoming its drawbacks. The nanoparticles (MYR@SBA-15) were formulated optimally, transforming MYR into an amorphous state. This transformation was confirmed via several strategies, including differential scanning calorimetry, Fourier transform infrared spectroscopy, and powder x-ray diffraction. As a result, there was a significant enhancement in the solubility and rate of dissolution in water. The anti-inflammatory benefits as an innovative strategy and the underlying mechanism of action of MYR and its SBA-15 silica nanoparticles (MYR@SBA-15) were investigated based on the biochemical, histological, immunohistochemical, and metabolomic assays alongside their antipyretic and analgesic characteristics. Compared to the usage of raw MYR, the administration of MYR@SBA-15 at doses of 25, 50, and 100 mg/kg significantly decreases pain perception by inhibiting the body's writhing motions induced by acetic acid. Furthermore, it helps regulate increased body temperature caused by baking yeast and effectively stabilizes it. It reduces the release of NO and PGE-2 in a concentration-dependent manner by down-regulating iNOS and COX-2 expression in the inflammatory model. MYR and MYR@SBA-15 also inhibit the nuclear translocation of NF-κB, downregulate the expression of mitogen-activated protein kinases (MAPKs), such as p38, ERK1/2, and JNK protein, and reduce the generation of proinflammatory cytokines, such as TNF-α. In addition, inflammatory cardinal signs like paw edema caused by carrageenan in rats are greatly suppressed by MYR and MYR@SBA-15 treatment when compared to the untreated group. More noteworthy outcomes are shown in the MYR@SBA-15, particularly at a dose of 100 mg/kg. These results of biochemical and immuno-histochemistry suggest that MYR@SBA-15 may be a useful analgesic antipyretic and may also help reduce inflammation by altering MAPKs/NF-κB and COX-2/PGE-2 signaling cascades. Serum metabolomics study demonstrated modifications in various low molecular weight metabolites with arthritis development. These metabolite levels were restored to normal when MYR@SBA-15 was administered via modulating several metabolic pathways, i.e., pyrimidine, energy metabolism, and proteins. Overall, MYR-loaded SBA-15 silica nanoparticles have demonstrated significant promise in enhancing the disturbed metaboloic pathways and providing a substantial capacity to regulate several oxidative stress and inflammatory mediators.

Applications of artificial intelligence in emergency and critical care diagnostics: a systematic review and meta-analysis.

Introduction: Artificial intelligence has come to be the highlight in almost all fields of science. It uses various models and algorithms to detect patterns and specific findings to diagnose a disease with utmost accuracy. With the increasing need for accurate and precise diagnosis of disease, employing artificial intelligence models and concepts in healthcare setup can be beneficial. Methodology: The search engines and databases employed in this study are PubMed, ScienceDirect and Medline. Studies published between 1st January 2013 to 1st February 2023 were included in this analysis. The selected articles were screened preliminarily using the Rayyan web tool, after which investigators screened the selected articles individually. The risk of bias for the selected studies was assessed using QUADAS-2 tool specially designed to test bias among studies related to diagnostic test reviews. Results: In this review, 17 studies were included from a total of 12,173 studies. These studies were analysed for their sensitivity, accuracy, positive predictive value, specificity and negative predictive value in diagnosing barrette's neoplasia, cardiac arrest, esophageal adenocarcinoma, sepsis and gastrointestinal stromal tumors. All the studies reported heterogeneity with p-value <0.05 at confidence interval 95%. Conclusion: The existing evidential data suggests that artificial intelligence can be highly helpful in the field of diagnosis providing maximum precision and early detection. This helps to prevent disease progression and also helps to provide treatment at the earliest. Employing artificial intelligence in diagnosis will define the advancement of health care environment and also be beneficial in every aspect concerned with treatment to illnesses.

Response Surface Methodology for Ni-Zeolite Catalyst Optimization in Syngas Production.

This work addresses the problem of converting waste methane, a significant greenhouse gas, using customized nickel-zeolite catalysts to produce profitable syngas. The investigation employs 5 wt % of Ni on various zeolite supports with Si/Al ratios ranging from 13 to 25. Comprehensive characterization methods, including temperature-programmed reduction, N2 adsorption-desorption, and X-ray diffraction, were used to identify critical structural characteristics that greatly impact the catalyst's performance. The study indicates that the reducibility and basicity of the catalyst, the type of zeolite support, and the kind of carbon deposits formed during the reaction at 800 °C all influence the efficiency of methane conversion to syngas. The best catalyst was found to be 5Ni-Z3, which at 800 °C produced high conversion rates of carbon dioxide (60%) and methane (50%). Lastly, the response surface methodology, in conjunction with numerical simulation, was used to determine the best operating settings for maximizing syngas production with the 5Ni-Z3 catalyst. Reaction temperature, space velocity, and the methane-to-carbon dioxide feed ratio were considered in this analysis. With a methane conversion rate exceeding 92%, a carbon dioxide conversion rate exceeding 90%, and a hydrogen-to-carbon monoxide ratio of 1.00, the catalyst produced experimental results very similar to the SRM predictions when the reaction was conducted at conditions close to the predicted values [temperature around 845 °C, space velocity around 22,000 mL/(h·gcat), and feed ratio close to 0.94]. The effectiveness of the identified operating conditions for the dry reforming process is validated by the near alignment of expected and experimental outcomes.

Temporoparietal Fascia Sandwich Technique in the Immediate Reconstruction of Human Bite Ear Amputation.

BACKGROUND: Traumatic ear amputation is a rare injury. Ear replantation is the gold standard in dealing with amputated ears. However, this is not always feasible. In this case series, the authors discuss the immediate reconstruction of traumatic ear amputation using temporoparietal fascia with the same skin from the amputated ear, which provided a high esthetic result and patient satisfaction. PATIENTS AND METHODS: The authors present a case series of 3 patients from July 2018 to May 2020 who suffered from traumatic ear amputation due to a human bite and were successfully reconstructed using temporoparietal fascia and the same skin from the amputated ear as FTSG.The cartilage was sutured back, the temporoparietal fascia was raised and flipped over the exposed cartilage, and the FTSG previously harvested from the same amputated ear was put on the fascia. Quilting sutures were taken to ensure proper inset of the graft on the fascia. The authors measured the patient-reported outcome using an Ear-Q validated questionnaire. RESULTS: All patients were males, with a mean age of 30.6 years. They were all smokers, and none of them had any comorbidities. No major complications occurred. However, partial graft loss occurred in one patient and healed properly with secondary intention. All patients had high satisfaction scores of more than 70 in the EAR-Q questionnaires. CONCLUSION: Traumatic human bite ear amputations can be reconstructed with good esthetic outcomes by using single-stage temporoparietal fascia and the same skin of the amputated ear as a full-thickness skin graft whenever replantation is not feasible.

Overview of Nanocosmetics with Emphasis on those Incorporating Natural Extracts.

The cosmetic industry is rapidly rising worldwide. To overcome certain deficiencies of conventional cosmetics, nanomaterials have been introduced to formulations of nails, lips, hair, and skin for treating/alleviating hyperpigmentation, hair loss, acne, dandruff, wrinkles, photoaging, etc. Innovative nanocarrier materials applied in the cosmetic sector for carrying the active ingredients include niosomes, fullerenes, liposomes, carbon nanotubes, and nanoemulsions. These exhibit several advantages, such as elevated stability, augmented skin penetration, specific site targeting, and sustained release of active contents. Nevertheless, continuous exposure to nanomaterials in cosmetics may pose some health hazards. This review features the different new nanocarriers applied for delivering cosmetics, their positive impacts and shortcomings, currently marketed nanocosmetic formulations, and their possible toxic effects. The role of natural ingredients, including vegetable oils, seed oils, essential oils, fats, and plant extracts, in the formulation of nanocosmetics is also reviewed. This review also discusses the current trend of green cosmetics and cosmetic regulations in selected countries.

Association Between Calf Muscle Tone, Plantar Surface Area, and Gross Motor Function in Children with Spastic Diplegic Cerebral Palsy.

Background: Children diagnosed with spastic diplegic Cerebral Palsy (CP) usually demonstrate hypertonicity of the lower limb muscles which affects the normal alignments and weight reception by the feet. These impairments could be correlated to the limitations in gross motor function such as standing and walking abilities. Understanding these relationships can contribute to developing more effective rehabilitation strategies and improving overall motor outcomes for affected children. Objective: The current study was designed to explore the relationship between plantar surface area, weight distribution on the plantar surface, and gross motor function (namely, standing and walking abilities) in spastic diplegic CP children. Methods: Seventy-one spastic diplegic CP children aged 8-14 years joined this cross-sectional study. The Person's correlation coefficient and regression tests were used to assess the correlation between variables, namely, Gross Motor Function (GMFM), Calf Muscle Tone, Plantar surface area (PSA), and Peak pressure on mid and hind feet (PPMF, PPHF, respectively). These variables were assessed using the GMFM-88 scale, Modified Ashworth scale, and foot scan plantar pressure detection system, respectively. Results: The correlation analysis demonstrated a strong to moderate positive correlation between PSA, PPMF, PPHF, and GMFM-D and GMFM-E. Additionally, regression model showed prediction levels equal to 0.791 for the GMFM-D and 0.720 for the GMFM-E categories, respectively. Conclusion: Standing and walking abilities were positively correlated (r ≥.6) with the increased plantar surface area and higher peak pressure on mid and hind feet in spastic diplegic CP. Future longitudinal studies should investigate changes in gross motor function in relation to improvement in plantar surface area and peak pressure values.

Immediate Loading Implant-Supported Fixed Full-Arch Rehabilitation Using a New Clinical Decision-Support System: A Case Series.

Background Implant-supported full-arch rehabilitation is an effective treatment for edentulous patients. It restores mastication, facial aesthetics, and psychological well-being. Patient-related outcome measures support the validity of this approach, emphasizing the importance of effective prosthodontic interventions for this patient population. This study aims to present a case series for fixed implant-supported full-arch rehabilitation using the new Carames classification (CC). Methods A total of seven patients with generalized periodontitis or non-restorable multiple teeth were indicated for extraction and replacement with a fixed full-arch implant-supported prosthesis. According to the Carames classification, most cases were categorized as CCI or CCII classes for both the upper and lower jaws. Before the surgery, screw-retained provisional complete dentures were constructed and adjusted for the vertical occlusal dimension and smile lines. After the extractions, 70 implants were immediately placed in one or both arches for the seven patients, followed by bone grafts with the dual-zone grafting technique. Multi-unit abutments were then placed and welded to a metal bar for stable fixation. The provisional denture was fitted snugly over the metal bar for immediate functional loading. After three months of healing, it was used as a biocopy to fabricate the final prosthesis. The implant loss and the peri-implant marginal tissue health status were assessed annually for three years. Statistical analysis compared the marginal bone loss as a change from the baseline over the year. Results No implant or prosthesis loss was reported over the three years. Peri-implant marginal tissue health showed promising results without bleeding and suppuration on probing and probing depths between 3 and 3.5 millimeters. Marginal bone loss was minimal over the three years, with some cases showing bone gain. Conclusion Using the Carames classification as a clinical decision support system in implant-supported full-arch rehabilitation showed promising results in peri-implant tissue health and no implant loss during three years of follow-up. The implant placement and prosthesis fabrication protocol in this study could be valuable for further research.

The primary cause of markedly elevated aminotransferases in hospitalized patients with cirrhosis in ischemic hepatitis.

BACKGROUND: Marked elevation in aminotransferases (≥1000 IU/l) is typically associated with acute liver injury. Here, we hypothesized that the cause of elevation in aminotransferases ≥1000 in patients with cirrhosis is likely due to a limited number of disorders and may be associated with poor outcomes. AIM: We aimed to investigate the most common etiologies of acute elevations in aminotransferases in patients with cirrhosis, and to examine their associated outcomes. METHODS: From May 2012 to December 2022, all hospitalized patients with cirrhosis and an aspartate aminotransferase or alanine aminotransferase ≥ 1000 IU/l were identified through Medical University of South Carolina's Clinical Data Warehouse. Complete clinical data were abstracted for each patient, and in-hospital mortality was examined. RESULTS: The cohort was made up of 152 patients, who were 57 ±â€…12 years old, with 51 (34%) women. Underlying liver disease included mainly hepatitis C cirrhosis, alcohol-related cirrhosis, metabolic dysfunction-associated steatohepatitis cirrhosis, autoimmune cirrhosis, primary sclerosing cholangitis cirrhosis, and cryptogenic cirrhosis. The most common cause of marked elevation in aminotransferases in cirrhotic patients was ischemic hepatitis (71%), followed by chemoembolization (7%), autoimmune hepatitis (6%), drug-induced liver injury (3%), post-transjugular intrahepatic portosystemic shunt placement (3%), rhabdomyolysis (3%), and hepatitis C (2%). During hospitalization and over a 1-month follow-up period, the mortality rate in patients with ischemic hepatitis was 73% (79/108), while that for other causes of liver injury was 20% (9/44). CONCLUSION: Ischemic hepatitis is the leading cause of marked elevation of aminotransferases in patients with cirrhosis, with distinctive clinical characteristics than other etiologies, and significantly poorer outcomes.

The Impact of COVID-19 on Functional Capacity and Pulmonary Outcomes in the Hail Region: A Cross-Sectional Study.

Background/Objectives: COVID-19, caused by the novel coronavirus SARS-CoV-2, has had a significant impact on life worldwide since its emergence in late 2019. The virus has caused a global pandemic, leading to widespread health, social, economic, and psychological effects. COVID-19 mainly affects the respiratory system. This study aimed to compare the functional capacity and pulmonary function outcomes between COVID-19 patients and individuals who have not been infected in the Hail region. Methods: Individuals of both genders above 18 years old who had been infected with COVID-19 in the previous 6 months or had never been infected were eligible to participate. Local hospitals and social media apps were used to recruit willing participants. Heart rate, pulse oxygen saturation, blood pressure, pulmonary function test, hand grip strength, and functional tests (6 min walk test, 30 s sit-to-stand test, and timed up and go test) were measured and compared between the groups. Statistical analysis was performed using SPSS Version 25. Results: Forty individuals affected with COVID-19 and forty-one healthy individuals were recruited. Our results showed that in individuals affected with COVID-19, scores on the minute ventilation, 30 s sit-to-stand, and 6 min walk tests were significantly lower than among healthy individuals. Other outcomes did not show any statistical differences between the groups. Conclusion: This study contributes to a greater understanding of the functional capacity status of individuals with COVID-19. Patients affected by COVID-19 may develop an impaired lung capacity and a decreased function capacity. These factors may negatively affect physical and cognitive health status. Future studies should evaluate the benefits of interventions with rehabilitation exercises following COVID-19. In light of the functional capacity and pulmonary function decline in individuals affected by COVID-19, interventions encompassing pulmonary and functional rehabilitation exercises are recommended to improve physical fitness and pulmonary function post-COVID-19.

Assessment of Binge Eating Behavior, Body Shape Concerns, and Associated Factors among Female Adolescents of Northern Saudi Arabia: A Cross-Sectional Study.

Globally, binge eating behavior has emerged as a significant public health concern, especially among female adolescents. Body shape concerns in female adolescents can lead to body dissatisfaction and other mental health issues. Using a cross-sectional study design, we evaluated the frequency of binge eating behavior, body shape concerns, and associated factors among 400 female adolescents. We utilized a pretested Arabic binge eating scale (BES) and a body shape questionnaire-shorter version (BSQ-8C) to collect the required data. We performed Spearman's correlation analysis to find the strength and direction of the correlation between the BES and BSQ-8C scores. Finally, we applied binomial logistic regression analysis to identify the predictors of body shape concerns. Of the studied participants, 5.5% and 6.2% had medium and severe binge eating behavior. We found a significant positive correlation between the BES and BSQ-8C scores (rho = 0.434, p < 0.001). Also, we found that body shape concerns were significantly higher among the monthly family income category of 5000 to 7000 SAR (p = 0.005), the severe binge eating categories (p = 0.009), and obese adolescents (p = 0.001). The present study results can be applied to the development of focused interventions and strategies to address these concerns in this group.

Antegrade approach versus retrograde approach percutaneous coronary intervention for chronic total occlusion: An updated meta-analysis.

BACKGROUND: Retrograde approach has notably improved success rates of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). However, longer procedural time, increase use of fluoroscopy and contrast dye have been reported in retrograde techniques in CTO PCI. We aimed to study in-hospital and long-term outcomes of retrograde approach versus antegrade approach in CTO PCI. METHODS: We searched PubMed, Scopus, WOS, and Cochrane Central until June 2023 to include all relevant studies that compared retrograde approach versus antegrade approach in patients with CTO PCI. We synthesized the outcome data using a random-effects model, expressing the effect estimates as odds ratios (OR) or mean difference (MD) with corresponding 95 % confidence intervals (CI). RESULTS: A total of 18 studies comprising 21,276 patients were included in the analysis. Regarding in-hospital outcomes, antegrade approach was associated with lower odds of MACE (OR= 0.34, 95 % CI: 0.23 to 0.51), all-cause mortality (OR= 0.35, 95 % CI: 0.19 to 0.64), MI (OR= 0.36, 95 % CI: 0.25 to 0.53), urgent pericardiocentesis (OR= 0.27, 95 % CI: 0.16 to 0.46), CIN (OR= 0.46, 95 % CI: 0.33 to 0.65), procedural complications (OR= 0.52, 95 % CI: 0.33 to 0.83), target vessel perforation (OR= 0.45, 95 % CI: 0.32 to 0.64). while antegrade was associated with higher success rates (OR= 1.16, 95 % CI: 1.1 to 1.22). CONCLUSION: Compared to antegrade technique, retrograde was associated with higher risk for in-hospital and long-term adverse events, and preferably should be performed in more complex CTO lesions.

Evaluation of Pharmacy Intern Interventions on Antimicrobial Use in University-Affiliated Hospitals: A Retrospective Analysis.

Background: Appropriate use of antimicrobials is essential to enhance therapeutic safety and efficacy. Clinical pharmacists play a crucial role in optimizing antimicrobial use; however, the contribution of pharmacy interns in antimicrobial use has not been studied. The objective of this study was to ascertain the quantity and nature of interventions related to antimicrobials documented by pharmacy interns, along with the rates at which physicians accepted these interventions. Methods: From August 2017 to March 2022, this study retrospectively evaluated antimicrobial-related interventions recorded by pharmacy interns during their rotations at King Khalid University. The categories of interventions included medication selection, addition of antimicrobials, dose or frequency adjustments, medication discontinuation, de-escalation, therapeutic drug monitoring, and others. Statistical analysis was conducted to identify patterns and correlations. Results: This study evaluated 1295 antimicrobial-related interventions, with high physician acceptance rates of 91.6% and 4.0% accepted with modifications. The most frequent interventions were dose/frequency adjustments (36.3%) and medication discontinuation (23%). Vancomycin, colistin, and meropenem were the most frequently intervened antimicrobials. Documented clinical outcomes included enhancing treatment efficacy (37.3%), reducing treatment toxicity (26.81%), and avoiding unnecessary antimicrobial exposure (21.8%). Significant correlations were observed between hospital units and intervention types, indicating unit-specific intervention patterns. Conclusions: Theses findings highlight the vital role of pharmacy interns in optimizing antimicrobial therapy. Future research should focus on evaluating the long-term clinical and economic benefits of their involvement.

The Use of Systemically Absorbed Drugs to Explore An In Vitro Bioequivalence Approach For Comparing Non-Systemically Absorbed Active Pharmaceutical Ingredients in Drug Products For Use in Dogs.

PURPOSE: Currently, for veterinary oral formulations containing one or more active pharmaceutical ingredient (API) that are not systemically absorbed and act locally within the gastrointestinal (GI) tract, the use of terminal clinical endpoint bioequivalence (BE) studies is the only option for evaluating product BE. This investigation explored the use of a totality of evidence approach as an alternative to these terminal studies. METHODS: Three formulations of tablets containing ivermectin plus praziquantel were manufactured to exhibit distinctly different in vitro release characteristics. Because these APIs are highly permeable, plasma drug concentrations served as a biomarker of in vivo dissolution. Tablets were administered to 27 healthy Beagle dogs (3-way crossover) and the rate and extent of exposure of each API for each formulation was compared in a pairwise manner. These results were compared to product relative in vitro dissolution profiles in 3 media. In vivo and in vitro BE predictions were compared. RESULTS: In vivo/in vitro inconsistencies in product relative performance were observed with both compounds when considering product performance across the 3 dissolution media. Formulation comparisons flagged major differences that could explain this outcome. CONCLUSIONS: The finding of an inconsistent in vivo/in vitro relationship confirmed that in vitro dissolution alone cannot assure product BE for veterinary locally acting GI products. However, when combined with a comparison of product composition and manufacturing method, this totality of evidence approach can successfully alert scientists to potential therapeutic inequivalence, thereby supporting FDA's efforts to Replace, Reduce, and/or Refine terminal animal studies.