Effect of Coca-Cola on the Dissolution of Persimmon-Related Phytobezoar in a Tertiary Care Hospital.

Introduction Bezoars, masses of indigestible foreign bodies formed in the gastrointestinal tract, pose challenges in their management. Phytobezoars are particularly problematic due to their difficult diagnosis and resilience towards treatment. Recently, Coca-Cola has emerged as a potential solution due to its acidic composition and mucolytic properties. However, existing evidence is limited, highlighting the need for comprehensive studies. This research explores the efficacy of Coca-Cola in dissolving persimmon-related phytobezoars, aiming to contribute valuable insights to non-invasive treatment options. Material and methods Conducted as a descriptive case series, this study employed gastric cola lavage using non-probability purposive sampling. Patients aged 18-70 with persimmon-related phytobezoars were included. Two nasogastric tubes were inserted for cola lavage over 12 hours, utilizing three liters of cola until the disappearance of symptoms. When the bezoar disappeared, it was considered as complete success to the treatment. Results Out of 31 patients, 45.2% were male and 54.8% were female, with a mean age of 56.77 ± 9.01 years. Efficacy was noted in 54.8% of cases. Age less than 50 and no history of diabetes mellitus were associated with higher chances of treatment success (p-value ≤0.05). Conclusion Ingestion of Coca-Cola was highly effective, safe, and reliable for the dissolution of persimmon-related phytobezoars, as the frequency of efficacy was high in our study. Coca-Cola ingestion is a non-invasive and cost-effective mode of phytobezoar dissolution that should be taken as a first-line initial treatment option to attain desired outcomes.

Surgical Strategies for Ingrown Toenails: A Comprehensive Review of Techniques, Outcomes, and Advancements.

Ingrown toenail (IGTN), known as onychocryptosis or unguis incarnatus, is a painful condition affecting the big toe, with symptoms including pain, inflammation, and infection. This review explores surgical options for IGTN, categorized into altering the nail plate or diminishing periungual tissues. Conservative treatments alleviate early-stage symptoms, while surgical interventions are reserved for severe cases. Various surgical techniques are discussed, such as the Winograd technique, Vandenbos procedure, chemical matricectomy, radiofrequency ablation, bipolar diathermy, carbon dioxide laser ablation, Zadik's procedure, Howard-Dubois procedure, Super U procedure, Noël's procedure, knot technique, and toenail paronychium flap. The choice of procedure depends on the severity and recurrence of IGTN.

Evaluating the symmetric and asymmetric effectiveness of low carbon energy consumption for ecological footprint in China: the role of environment-related technological innovation.

The objective of this study is to scrutinize the impact of low carbon energy consumption, environmental-related technological innovation, urbanization, economic growth, and trade on China's ecological footprint from 1980 to 2021. To investigate the nature of the long-term connections between the variables, we employ the symmetric and asymmetric autoregressive distributed lag (ARDL) technique to explore the long- and short-run elasticities of coefficients. The results of ARDL and NARDL verified the environmental Kuznets curve (EKC) hypothesis in the long run in the presence of low carbon energy consumption. Moreover, the findings show that the positive part of low carbon energy consumption is negatively connected with the ecological footprint. Alternatively, the positive part of low carbon energy consumption is positively linked with the ecological footprint. The outcome highlights that environment-related technological innovation reduces the level of ecological footprint. Similarly, urbanization has a detrimental effect on the ecological footprint. Based on the estimated findings, it is suggested that China's economy should place a greater emphasis on increasing its level of investment in the low carbon energy sector and adopting severe environmental legislation to protect the economy from environmental burden.

Optimized Extraction of Polyphenols from Unconventional Edible Plants: LC-MS/MS Profiling of Polyphenols, Biological Functions, Molecular Docking, and Pharmacokinetics Study.

Plant bioactive phenolic metabolites have recently attracted the attention of researchers due to their numerous health advantages. Therefore, this study aimed to investigate with advanced techniques the bioactive metabolites and antioxidant and antidiabetic capacity of four unconventional edible plant leaves: lemongrass (Cymbopogon citratus (DC.) Stapf), chicory (Cichorium intybus L.), moringa (Moringa oleifera Lam.), and ryegrass (Lolium perenne L.). The extraction process was optimized using different solvents. These plants' phenolic composition, identification, and characterization have been determined herein using LCESI-QTOF-MS/MS. This research identified 85 phenolic compounds, including 24 phenolic acids, 31 flavonoids, 7 stilbenes and lignans, and 17 other metabolites. Moreover, the study determined that moringa has the highest total phenolic content (TPC; 18.5 ± 1.01 mg GAE/g), whereas ryegrass has the lowest (3.54 ± 0.08 mg GAE/g) among the selected plants. It seems that, compared to other plants, moringa was found to have the highest antioxidant potential and antidiabetic potential. In addition, twenty-two phenolic compounds were quantified in these chosen edible plants. Rosmarinic acid, chlorogenic acid, chicoric acid, ferulic acid, protocatechuic acid, and caffeic acid were the most abundant phenolic acids. In silico molecular docking was also conducted to investigate the structure-function relationship of phenolic compounds to inhibit the alpha-glucosidase. Finally, the simulated pharmacokinetic characteristics of the most common substances were also predicted. In short, this investigation opens the way for further study into these plants' pharmaceutical and dietary potential.

The mechanical effect of geometric design of attachments in invisible orthodontics.

INTRODUCTION: In invisible orthodontics, attachments are used with aligners to better control tooth movement. However, to what extent the geometry of the attachment can affect the biomechanical properties of the aligner is unknown. This study aimed to determine the biomechanical effect of attachment geometry on orthodontic force and moment using 3-dimensional finite element analysis. METHODS: A 3-dimensional model of mandibular teeth, periodontal ligaments, and the bone complex was employed. Rectangular attachments with systematic size variations were applied to the model with corresponding aligners. Fifteen pairs were created to move the lateral incisor, canine, first premolar, and second molar mesially for 0.15 mm, respectively. The resulting orthodontic forces and moments were analyzed to compare the effect of attachment size. RESULTS: Expansion in the attachment size showed a continuous increase in force and moment. Considering the attachment size, the moment increased more than the force, resulting in a slightly higher moment-to-force ratio. Expanding the length, width, or thickness of the rectangular attachment by 0.50 mm increases the force and moment up to 23 cN and 244 cN-mm, respectively. The force direction was closer to the desired movement direction with larger attachment sizes. CONCLUSIONS: Based on the experimental results, the constructed model successfully simulates the effect of the size of attachments. The larger the size of the attachment, the greater the force and moment, and the better the force direction. The appropriate force and moment for a particular clinical patient can be obtained by choosing the right attachment size.

Role of interatrial conduction in atrial fibrillation: Mechanistic insights from renewal theory-based fibrillatory dynamic analysis.

Background: Interatrial conduction has been postulated to play an important role in atrial fibrillation (AF). The pathways involved in interatrial conduction during AF remain incompletely defined. Objective: We recently showed physiological assessment of fibrillatory dynamics could be performed using renewal theory, which determines rates of phase singularity formation (λf) and destruction (λd). Using the renewal approach, we aimed to understand the role of the interatrial septum and other electrically coupled regions during AF. Method: RENEWAL-AF is a prospective multicenter observational study recruiting AF ablation patients (ACTRN 12619001172190). We studied unipolar electrograms obtained from 16 biatrial locations prior to ablation using a 16-electrode Advisor HD Grid catheter. Renewal rate constants λf and λd were calculated, and the relationships between these rate constants in regions of interatrial connectivity were examined. Results: Forty-one AF patients (28.5% female) were recruited. A positive linear correlation was observed between λf and λd (1) across the interatrial septum (λf r2 = 0.5, P < .001, λd r2 = 0.45, P < .001), (2) in regions connected by the Bachmann bundle (right atrial appendage-left atrial appendage λf r2 = 0.29, P = .001; λd r2 = 0.2, P = .008), and (3) across the inferior interatrial routes (cavotricuspid isthmus-left atrial septum λf r2 = 0.67, P < .001; λd r2 = 0.55, P < .001). Persistent AF status and left atrial volume were found to be important effect modifiers of the degree of interatrial renewal rate statistical correlation. Conclusion: Our findings support the role of interseptal statistically determined electrical disrelation in sustaining AF. Additionally, renewal theory identified preferential conduction through specific interatrial pathways during fibrillation. These findings may be of importance in identifying clinically significant targets for ablation in AF patients.

Efficacy of heterologous boosting against SARS-CoV-2 using a recombinant interferon-armed fusion protein vaccine (V-01): a randomized, double-blind and placebo-controlled phase III trial.

Waning of neutralizing titres along with decline of protection efficacy after the second dose of COVID-19 vaccines was observed, including China-made inactivated vaccines. Efficacy of a heterologous boosting using one dose of a recombinant SARS-CoV-2 fusion protein vaccine (V-01) in inactivated vaccine-primed population was studied, aimed to restore the immunity. A randomized, double-blind and placebo-controlled phase III trial was conducted in healthy people aged 18 years or older in Pakistan and Malaysia. Each eligible participant received one dose of the V-01 vaccine developed by Livzon Mabpharm Inc. or placebo within the 3-6 months after the two-dose primary regimen, and was monitored for safety and efficacy. The primary endpoint was protection against confirmed symptomatic SARS-CoV-2 infection. A total of 10,218 participants were randomly assigned to receive a vaccine or placebo. Virus-neutralizing antibodies were assessed in 419 participants. A dramatic increase (11.3-fold; 128.3-1452.8) of neutralizing titres was measured in the V-01 group at 14 days after the booster. Over two months of surveillance, vaccine efficacy was 47.8% (95%CI: 22.6-64.7) according to the intention-to-treat principle. The most common adverse events were transient, mild-to-moderate pain at the injection site, fever, headache, and fatigue. Serious adverse events occurred almost equally in V-01 (0.12%) and placebo (0.16%) groups. The heterologous boosting with the V-01 vaccine was safe and efficacious, which could elicit robust humoral immunity under the epidemic of the Omicron variant.Trial registration: ClinicalTrials.gov identifier: NCT05096832.

On implementation of a semi-analytic strategy to develop an analytical solution of a steady-state isothermal tube drawing model.

In this paper, we consider an isothermal glass tube drawing model consisting of three coupled nonlinear partial differential equations. The steady-state solution of this model is required in order to investigate its stability. With the given initial and boundary conditions, it is not possible to determine an analytical solution of this model. The difficulty lies in determining the constants of integrations while solving the second order ordinary differential equation analytically appearing in the steady-state model. To overcome this difficulty, we present a numerical based approach for the first time to develop an analytical solution of the steady-state isothermal tube drawing model. We use a numerical technique called shooting method to convert the boundary value problem into a set of initial value problems. Once the model has been converted into a system of differential equations with initial values, an integrating technique is implemented to develop the analytical solution. The computed analytical solution is then compared with the numerical solution to better understand the accuracy of obtained solution with necessary discussions.

Demographic variation and risk factors regarding breast cancer among females in Southern Punjab, Pakistan.

OBJECTIVE: To explore epidemiology, clinical profiles and contribution of reproductive and non-reproductive risk factors in breast cancer development. METHODS: The case-control study was conducted from October 2017 to March 2018 at Quaid-i-Azam University, Islamabad, Pakistan, and comprised breast cancer patients and age-matched controls recruited from the Bahawalpur Institute of Nuclear Medicine and Oncology, and the Bahawal Victoria Hospital, Bahawalpur. Socio-demographic data, family history of cancer, reproductive health and lifestyle factors were recorded using a structured questionnaire. Data was analysed using SPSS 21 and Stata/IC 14.1. RESULTS: Of the 326 women, 163(50%) each were cases and controls. The mean age for both the groups was identical at 46.04±10.62 years. Positive family history and hypertension were significantly linked to increased breast cancer risk (p<0.05), while intense physical activity, increased anthropometric measurements and breastfeeding per child in months were inversely associated with the risk (p<0.05). CONCLUSIONS: Established risk factors for breast cancer were reaffirmed.

Asymmetric effects of premature deagriculturalization on economic growth and CO2 emissions: fresh evidence from Pakistan.

This paper examines the relationship between deagriculturalization, economic growth, and CO2 emissions in Pakistan from the period 1975 to 2018 by employing a nonlinear autoregressive distributed lag (NARDL) model and Granger causality approach. The asymmetric ARDL findings show that there is a significant negative relationship between agriculturalization and economic growth, while deagriculturalization does not induce economic growth in the long run in Pakistan. Moreover, agriculturalization and deagriculturalization have a negative significant effect on Pakistan's carbon emissions in the long run. This study concludes that the asymmetric results deviate from symmetric results in Pakistan. The asymmetric causality test shows unidirectional asymmetric causality running from agriculturalization, deagriculturalization, and CO2 emissions. Moreover, agriculturalization and deagriculturalization do not Granger cause economic growth in Pakistan. Based on the results, the study stressed to formulate such policies which support economic growth and lower carbon emissions through reforming agriculture sector practices. These outcomes are very useful for Pakistan to formulate relevant policies.

The trade-off between economic growth and environmental quality: does economic freedom asymmetric matter for Pakistan?

This empirical study investigates the dynamic effects of economic freedom on economic growth and air quality for Pakistan over the period 1990-2019. The ARDL results suggest that economic freedom and other variables do not have any visible impact on economic growth and pollution in the short-run. However, in the long-run, economic freedom significantly mitigates air pollution whereas inflation instability increases emissions. The NARDL results show that a partial sum of positive change in economic freedom is negatively linked with economic growth in the short term but has positive effect in the long term. However, the negative change in economic freedom has negative but insignificant impact on growth confirming asymmetric effects. The results for the pollution model show that a partial sum of positive change in economic freedom has positive impact on emissions both in the short and long-runs, whereas a negative change has no significant effect in the short-run and has negative impact in the long-run. Thus, economic freedom supports economic activities that, in turn, escalate emissions in the atmosphere.

Green logistics, economic growth, and environmental quality: evidence from one belt and road initiative economies.

The significance of global green logistics in improving green economic activities is a critically considered and debatable research topic in the context of economic growth and environment. This study aims to analyze the growth and environmental effects of green logistics performance for One Belt and Road Initiative (OBRI) countries over the period 2007-2019. The study used panel data two-stage least squares (2SLS) and generalized method of moments (GMM) estimators with robust inferences. The findings have revealed that green logistics performance improves the economic growth in OBRI, Europe, and MENA economies. While green logistics performance enhances the environmental pollution in OBRI, Central Asia, and MENA economies, it significantly improves the environmental quality in Europe and East and Southeast Asia regions. The control variables have also importance in economic growth and environment in policy implication in OBRI and five sub-regions of OBRI economies. Based on these findings, we can conduct some robust green logistics policies in OBRI.

Physical infrastructure, energy consumption, economic growth, and environmental pollution in Pakistan: an asymmetry analysis.

This study explores the symmetric and asymmetric effects of physical infrastructure on energy consumption, economic growth, and air pollution of Pakistan over the period 1990-2019. The ARDL results for the energy consumption model suggest that aircraft carriers (ACC) and road infrastructure foster energy consumption in the short term. For the growth model, the impact of trade is negative and significant in both short run and long run. The results for environmental pollution model suggest that information communication technology (ICT) is positively associated with CO2 emissions, whereas trade is negatively associated with emissions in the short and long run. The road has a positive impact on CO2 emissions while ACC has a negative impact in the long run. The nonlinear ARDL results reveal that negative component of ICT negatively influences energy consumption, while positive component has insignificant impact. Similarly, ACC, road, and trade also exhibit asymmetric effects. ICT has a significantly negative impact on economic growth. Finally, the positive shock to road has a significantly positive impact on pollution but the negative shock has no impact. Additionally, the coefficient of ACC and trade also infer asymmetries in pollution model. The results offer important policy implications for achieving high growth and better environmental quality in Pakistan.

Prospective cross-sectional study using Poisson renewal theory to study phase singularity formation and destruction rates in atrial fibrillation (RENEWAL-AF): Study design.

BACKGROUND: Unstable functional reentrant circuits known as rotors have been consistently observed in atrial fibrillation and are mechanistically believed critical to the maintenance of the arrhythmia. Recently, using a Poisson renewal theory-based quantitative framework, we have demonstrated that rotor formation (λf) and destruction rates (λd) can be measured using in vivo electrophysiologic data. However, the association of λf and λd with clinical, electrical, and structural markers of atrial fibrillation phenotype is unknown. METHODS: RENEWAL-AF is a multicenter prospective cross-sectional study recruiting adult patients with paroxysmal or persistent atrial fibrillation undergoing clinically indicated catheter ablation. Patients will undergo intraprocedural electrophysiologic atrial fibrillation mapping, with λf and λd to be determined from 2-minute unipolar electrogram recordings acquired before ablation. The primary objective will be to determine the association of λf and λd as markers of fibrillatory dynamics with clinical, electrical, and structural markers of atrial fibrillation clinical phenotype, measured by preablation transthoracic echocardiogram and cardiac magnetic resonance imaging. An exploratory objective is the noninvasive assessment of λf and λd using surface ECG characteristics via a machine learning approach. RESULTS: Not applicable. CONCLUSION: This pilot study will provide insight into the correlation between λf/λd with clinical, electrophysiological, and structural markers of atrial fibrillation phenotype and provide a foundation for the development of noninvasive assessment of λf/λd using surface ECG characteristics will help expand the use of λf/λd in clinical practice.

Assessment of cerebral blood flow in adult patients with aortic coarctation.

BACKGROUND: Survival into adult life in patients with aortic coarctation is typical following surgical and catheter-based techniques to relieve obstruction. Late sequelae are recognised, including stroke, hypertension, and intracerebral aneurysm formation, with the underlying mechanisms being unclear. We hypothesised that patients with a history of aortic coarctation may have abnormalities of cerebral blood flow compared with controls. METHODS: Patients with a history of aortic coarctation underwent assessment of cerebral vascular function. Vascular responsiveness of intracranial vessels to hypercapnia and degree of cerebral artery stiffness using Doppler-derived pulsatility indices were used. Response to photic stimuli was used to assess neurovascular coupling, which reflects endothelial function in response to neuronal activation. Patient results were compared with age- and sex-matched controls. RESULTS: A total of 13 adult patients (males=10; 77%) along with 13 controls underwent evaluation. The mean age was 36.1±3.7 years in the patient group. Patients with a background of aortic coarctation were noted to have increased pulse pressure on blood pressure assessment at baseline with increased intracranial artery stiffness compared with controls. Patients with a history of aortic coarctation had less reactive cerebral vasculature to hypercapnic stimuli and impaired neurovascular coupling compared with controls. RESULTS: Adult patients with aortic coarctation had increased intracranial artery stiffness compared with controls, in addition to cerebral vasculature showing less responsiveness to hypercapnic and photic stimuli. Further studies are required to assess the aetiology and consequences of these documented abnormalities in cerebral blood flow in terms of stroke risk, cerebral aneurysm formation, and cognitive dysfunction.

Sleep-Disordered Breathing in Patients with Pulmonary Valve Incompetence Complicating Congenital Heart Disease.

OBJECTIVE: Long standing pulmonary regurgitation results in deleterious effects on right heart size and function with late consequences of right heart volume overload including ventricular dilatation, propensity to arrhythmia and right heart failure. As sleep disordered breathing may predispose to elevations in pulmonary vascular resistance and associated negative effects on right ventricular function, we sought to assess this in patients with underlying congenital heart disease. DESIGN: We performed a pilot study to evaluate the incidence of sleep-disordered breathing in a patient population with a history of long standing pulmonary valve incompetence in patients with congenital heart disease using overnight oximetry. PATIENTS: Patients with a background of tetralogy of Fallot repair or residual pulmonary incompetence following previous pulmonary valve intervention for congenital pulmonary stenosis were included. RESULTS: Twenty-two patients underwent overnight oximetry. The mean age of the cohort was 34.3 ± 15.2 years with no patients observed to have severe underlying pulmonary hypertension. Abnormal overnight oximetry was seen in 13/22 patients (59.1%) with 2/22 (9.1%) patients considered to have severe abnormalities. CONCLUSIONS: An important proportion of patients with a background of pulmonary incompetence complicating congenital heart disease are prone to the development of sleep-disordered breathing as assessed by overnight oximetry. Further study into the prevalence and mechanisms of sleep-disordered breathing in a larger cohort are warranted.

Effect of leaching with 5-6 N H2SO4 on thermal kinetics of rice husk during pure silica recovery.

Rice husk is a potential source for renewable energy and silica. To extract the maximum amount of silica, usually the rice husk is treated with strong acids that burn the organic part leaving behind a black residue. In this research, sulfuric acid is used as an oxidizing agent. Efforts are focused to find out more about the behavior of acid-treated rice husk by using thermal exposure, and results are compared with results for raw rice husk which is thermally exposed but not acid treated. Reaction ratio of rice husk combustion and energy of activation were calculated using the thermogravimetric data. Acid treatment was found influential in initiating degradation earlier compared to raw husk and an overall increase in value of activation energy was observed when heating rate was increased.

Headache in a Patient with Complex Congenital Heart Disease: Diagnostic and Therapeutic Considerations.

Headache in adult patients with congenital heart disease may be a manifestation of the underlying cardiac condition or more common alternative causes of headache. In patients with pre-existing congenital heart disease, consideration of potentially uncommon aetiologies of headache is important. We report an uncommon case of headache in a patient with complex congenital heart disease characterised by Ebstein's anomaly with previous surgical repair complicated by idiopathic intracranial hypertension. This case illustrates the importance of understanding the implications of headache with reference to the underlying cardiac disease as well as specific issues related to a relatively young cohort of patients.

Influence of Age on Outcome in Patients with Pulmonary Arterial Hypertension.

BACKGROUND: The development of effective orally administered medical therapy for pulmonary arterial hypertension (PAH) has made a significant impact on outcome in patients with PAH. Identification of patient groups likely to derive optimal benefit is important, given cost and potential side effects; the clinical effectiveness of these therapies in older patients with PAH is unclear as the presence of co-morbidity may limit benefits of therapy. AIMS: We evaluated the epidemiology of PAH in a contemporary cohort to assess the influence of age on long-term outcome using PAH-specific therapies. RESULTS: A total of 119 patients (88% female; mean age 65±12 years) were reviewed, comprising 52% with underlying connective tissue disease. Bosentan was the PAH specific agent most frequently used. The baseline 6MWT distance in the entire cohort was 304m with age associated with a significant decline in 6MWT. CONCLUSIONS: In a large cohort of patients treated with PAH-specific therapies, patients less than 55 years of age showed improvement in 6MWT with older patients demonstrating stabilisation or decline.