Robotic-assisted laparoscopic excision of a rare primary seminal vesicle leiomyoma.

A primary seminal vesicle leiomyoma (PSVL) is a rare male genitourinary tract tumor. No previous reports have utilized a robotic-assisted laparoscopic posterior approach (RALPA) for surgical management. A 76-year-old man was incidentally found to have a 5cm lobulated mass posterior to the bladder in an abdominal/pelvic computed tomography scan. Biopsy confirmed leiomyoma. RALPA was utilized to excise the mass without complications. PSVLs are benign tumors with obstructive and minimal metastatic potential. Robotic-assisted surgery provides high fidelity, low risk, and an accelerated postoperative course compared to open surgery. The RALPA should be considered when surgical excision of PSVLs is required.

The Assessment of Knowledge, Attitude, and Practice of Paracetamol and Ibuprofen Administration Among Saudi Parents in the Makkah Region.

Introduction Paracetamol and ibuprofen, widely used for pediatric fever and pain, are safe when administered correctly. However, the caregiver's lack of understanding poses risks such as overdose. Addressing knowledge gaps is crucial due to reported variations in over-the-counter medication practices. "Fever phobia" underscores parental anxiety, stressing the ongoing need for research in this healthcare domain. Methodology This is a descriptive cross-sectional design targeting Saudi parents and caregivers from the Makkah region who have children aged 0-10 years. Data was collected via a self-administered validated online questionnaire in the Arabic language using a convenient sampling technique. The data was cleaned in Excel and analyzed using SPSS version 29 (IBM Inc., Armonk, New York). Results Our study included 449 parents and caregivers in the Makkah Region, of whom 337 (75.1%) were female, 179 (39.9%) were aged 18-29, and 425 (94.7%) were Saudi nationals. Knowledge assessment revealed gaps; e.g., only 86 (26.6%) identified baby weight as a dosage factor. Attitudes varied, with 152 (47.1%) associating paracetamol/ibuprofen with liver harm. Logistic regression showed no significant predictors for high-level knowledge, positive attitudes, or good practices, except for gender-influencing good practices (p=0.035, aOR=1.839). Significantly, males exhibited better practices regarding using of paracetamol. Conclusion Our study highlights knowledge gaps among parents and caregivers in the Makkah Region regarding pediatric fever management with paracetamol and ibuprofen. Attitudes varied, and gender significantly influenced good practices, with males demonstrating better adherence to the proper practice of managing children using paracetamol and ibuprofen.

CHA2DS2-VASc predicts readmission, outcomes and resource utilization in patients undergoing coronary artery bypass grafting: A 7-year National Readmission Database study.

BACKGROUND: CHA2DS2-VASc score is used to assess thromboembolic risk in patients with atrial fibrillation (AF)/atrial flutter (AFL), however its utilization to predict outcomes and readmission at following discharge in patients undergoing coronary artery bypass grafting (CABG) regardless of AF/AFL presence is understudied. We sought to assess its utility in predicting outcomes, length of hospital stay (LOS), and healthcare-associated costs (HAC) in these patients. METHOD: The National Readmission Database (NRD) was queried from 2010 to 2017 for patients with/without AF/AFL undergoing CABG using the International Classification of Diseases, Ninth and Tenth editions (ICD-9-&-10). Multiple regression analysis and multivariate analysis using Cox-Hazard analysis were used to evaluate outcomes up to 90-day readmission from discharge, LOS, and HAC against CHA2DS2-VASc score (cut-off-score:6) were abstracted from the database. RESULTS: Of the 420,458 patients that underwent CABG, 76,859 (18.3 %) were re-admitted to hospital within 90-days from discharge. Statistically significant increase in 90-day all-cause readmissions were demonstrated with increasing CHA2DS2-VASc score [No AF/AFL vs AF/AFL: score-0 (2.4 % vs1.4 %), score-6 (3.1 % vs 4.5 %, p-value<0.0001]. Similar trends were seen in re-admissions for TIA/Stroke and heart failure. The survival rate for all events were lower with incremental increase in CHA2DS2-VASc score (score-0 = 100 %; score-6 = 73 %, p-value<0.0001). Greater LOS and HAC was associated with increasing higher CHA2DS2-VASc score (standardized-beta[ß]; no AF/AFL vs AF/AFL: LOS = score-1: 0.08 vs 0.06, score-6: 0.12 vs 0.13. HAC = score-1: 0.02 vs 0.009, score-6: 0.02 vs 0.01, p-value <0.001). CONCLUSION: CHA2DS2-VASc score is an easy-to-use tool that predicts poorer outcomes, higher readmission, longer LOS, higher HAC, not just in patients with AF/AFL undergoing CABG, but also in those without AF/AFL.

Back to Basics: The Diagnostic Value of a Complete Blood Count in the Clinical Management of COVID-19.

Since the beginning of the COVID-19 pandemic, scientists have struggled significantly to understand the complexity of COVID-19 pathophysiology. COVID-19 has demonstrated a notoriously unpredictable clinical course. This unpredictability constituted a significant obstacle to clinicians in predicting the disease course among COVID-19 patients, more specifically, in predicting who would develop severe cases and possibly die from the infection. This brief report aims to assess the diagnostic value of using a complete blood count (CBC) and applying high-dimensional analysis, i.e., principal component analysis (PCA), on it to differentiate between patients with mild and severe COVID-19 infection. The data of 855 patients were retrieved from multiple centres in Saudi Arabia. Descriptive statistics, such as counts, percentages, and medians (interquartile ranges) were used to describe patients' characteristics and CBC parameters. Analytical statistics, such as the Mann-Whitney U test, were used to compare between survivors and non-survivors. PCA was applied using the CBC parameters, and the results were compared between survivors and non-survivors. Patients in this study had a median age of 41, with an almost equal ratio of men to women. Most participants were Saudis, and non-survivors were 13.22% of the total cohort. The median values of all CBC indices were within reference ranges; however, some statistically significant differences were observed between survivors and non-survivors. Non-survivors had lower hemoglobin levels and lower hematocrit, lymphocyte, and eosinophil counts but higher WBC and neutrophil counts compared to survivors. PCA on the CBC results of survivors yielded a significantly different profile than non-survivors, indicating the possibility of its use in the context of COVID-19. The diagnostic value of CBC in the clinical management of COVID-19 should be utilized in clinical guidelines for managing COVID-19 cases.

Effect of Diabetes Education on Complications and Diabetic Control Amongst Adult Patients with Diabetes in Madinah, Saudi Arabia.

BACKGROUND: Diabetes is a chronic condition that may become dangerous if there is insufficient insulin to help the body function properly. The proper care for diabetes depends on how well patients observe guidelines and prescriptions; consequently, patient education is critical. Poor learning may cause bad treatment and complications or other problems related to the disease. OBJECTIVES: This study aims to evaluate patients' knowledge of diabetes, assigning a knowledge (K) score out of 100, and investigate the possible impact of educating patients, through general means or via healthcare professionals, on patient knowledge of diabetes control demonstrated in the absence/presence of diabetic complications. METHODS: This multi-center interview-based cross-sectional study used a questionnaire in Madinah, Saudi Arabia. This study was conducted on adults with diabetes who were aged 15-80. We used the Michigan Diabetic Knowledge Test (MDKT) to assess the knowledge of patients with diabetes. RESULTS: This study included 364 participants. The gender distribution was 48.33% male and 51.67% female. Most of them had type 2 diabetes (T2DM) without insulin (48.63%), followed by those with T2DM on insulin (36.26%), and patients with type 1 diabetes (T1DM) (15.11%). Patients with T2DM had significantly higher K scores than patients with type 1. Additionally, T2DM non-insulin patients' k-scores significantly exceeded those with T1DM. General and healthcare education both helped increase patients' K-scores. Mostly, patients with diabetes without any complications had significantly higher knowledge compared to those having them. Lastly, regardless of whether the education was delivered by general or professional means, the effect on glycated hemoglobin (HbA1C) levels was not significant. CONCLUSIONS: Our study revealed that patients with T2DM exhibited higher knowledge than patients with T1DM. Furthermore, receiving education, whether by a healthcare professional or by general means, improved the knowledge levels of patients with T2DM but not patients with T1DM. Regarding diabetes complications, it was found that those with a higher level of knowledge had fewer complications. However, no evidence receiving education influenced the levels of HbA1C, neither in patients with T1DM nor T2DM.

Pericardial tamponade in coronary interventions: Morbidity and mortality.

BACKGROUND: Cardiac tamponade or pericardial tamponade (PT) can be a complication following invasive cardiac procedures. METHODS: Patients who underwent various procedures in the cardiac catheterization lab (viz. coronary interventions) were identified using the International Classification of Diseases, Ninth and Tenth Edition, Clinical Modification (International classification of diseases [ICD]-9-Clinical modification [CM] and ICD-10-CM, respectively) from the Nationwide Inpatient Sample (NIS) database. Patient demographics, presence of comorbidities, PT-related events, and in-hospital death were also abstracted from the NIS database. RESULTS: The frequency of PT-related events in the patients undergoing CI from 2010 to 2017 ranged from 3.3% to 8.4%. Combined in-hospital mortality/morbidity of PT-related events were higher with increasing age (odds ratio [OR] [95% CI]: chronic total occlusion (CTO) = 1.19 [1.10-1.29]; acute coronary syndrome (ACS) = 1.21 [1.11-1.33], both p < 0.0001) and female sex (OR [95%CI]: CTO = 1.70 [1.45-2.00]; ACS = 1.72 [1.44-2.06], both p < 0.0001). In-hospital mortality related to PT-related events was found to be 8.5% for coronary procedures. In-hospital mortality was highest amongst the patients undergoing percutaneous transluminal coronary angioplasty (PTCA) for ACS (ACS vs. non-CTO PTCA vs. CTO PTCA: 15.7% vs. 10.4% and 14.4%, p < 0.0001 and ACS vs. non-CTO PTCA vs. CTO PTCA: 12.1% vs. 8.1% and 5.6%, p = 0.0001, respectively). CONCLUSIONS: In the real-world setting, PT-related events in CI were found to be 3.3%-8.4%, with in-hospital mortality of 8.5%. The patients undergoing PTCA for ACS were found to have highest mortality. Older patients undergoing CTO PTCA independently predicted higher mortality.

Clinical Applications of Cardiac Magnetic Resonance Parametric Mapping.

Cardiovascular magnetic resonance (CMR) imaging is widely regarded as the gold-standard technique for myocardial tissue characterization, allowing for the detection of structural abnormalities such as myocardial fatty replacement, myocardial edema, myocardial necrosis, and/or fibrosis. Historically, the identification of abnormal myocardial regions relied on variations in tissue signal intensity, often necessitating the use of exogenous contrast agents. However, over the past two decades, innovative parametric mapping techniques have emerged, enabling the direct quantitative assessment of tissue magnetic resonance (MR) properties on a voxel-by-voxel basis. These mapping techniques offer significant advantages by providing comprehensive and precise information that can be translated into color-coded maps, facilitating the identification of subtle or diffuse myocardial abnormalities. As unlikely conventional methods, these techniques do not require a substantial amount of structurally altered tissue to be visually identifiable as an area of abnormal signal intensity, eliminating the reliance on contrast agents. Moreover, these parametric mapping techniques, such as T1, T2, and T2* mapping, have transitioned from being primarily research tools to becoming valuable assets in the clinical diagnosis and risk stratification of various cardiac disorders. In this review, we aim to elucidate the underlying physical principles of CMR parametric mapping, explore its current clinical applications, address potential pitfalls, and outline future directions for research and development in this field.

Chemical analogue based drug design for cancer treatment targeting PI3K: integrating machine learning and molecular modeling.

Cancer is a generic term for a group of disorders defined by uncontrolled cell growth and the potential to invade or spread to other parts of the body. Gene and epigenetic alterations disrupt normal cellular control, leading to abnormal cell proliferation, resistance to cell death, blood vessel development, and metastasis (spread to other organs). One of the several routes that play an important role in the development and progression of cancer is the phosphoinositide 3-kinase (PI3K) signaling pathway. Moreover, the gene PIK3CG encodes the catalytic subunit gamma (p110γ) of phosphoinositide 3-kinase (PI3Kγ), a member of the PI3K family. Therefore, in this study, PIK3CG was targeted to inhibit cancer by identifying a novel inhibitor through computational methods. The study screened 1015 chemical fragments against PIK3CG using machine learning-based binding estimation and docking to select the potential compounds. Later, the analogues were generated from the selected hits, and 414 analogues were selected, which were further screened, and as most potential candidates, three compounds were obtained: (a) 84,332, 190,213, and 885,387. The protein-ligand complex's stability and flexibility were then investigated by dynamic modeling. The 100 ns simulation revealed that 885,387 exhibited the steadiest deviation and constant creation of hydrogen bonds. Compared to the other compounds, 885,387 demonstrated a superior binding free energy (ΔG = -18.80 kcal/mol) with the protein when the MM/GBSA technique was used. The study determined that 885,387 showed significant therapeutic potential and justifies further experimental investigation as a possible inhibitor of the PIK3CG target implicated in cancer.

Prevalence, Cardiac Phenotype, and Outcomes of Transthyretin Variants in the UK Biobank Population.

Importance: The population prevalence of cardiac transthyretin amyloidosis (ATTR) caused by pathogenic variation in the TTR gene (vATTR) is unknown. Objective: To estimate the population prevalence of disease-causing TTR variants and evaluate associated phenotypes and outcomes. Design, Setting, and Participants: This population-based cohort study analyzed UK Biobank (UKB) participants with whole-exome sequencing, electrocardiogram, and cardiovascular magnetic resonance data. Participants were enrolled from 2006 to 2010, with a median follow-up of 12 (IQR, 11-13) years (cutoff date for the analysis, March 12, 2024). Sixty-two candidate TTR variants were extracted based on rarity (minor allele frequency ≤0.0001) and/or previously described associations with amyloidosis if more frequent. Exposure: Carrier status for TTR variants. Main Outcomes and Measures: Associations of TTR carrier status with vATTR prevalence and cardiovascular imaging and electrocardiogram traits were explored using descriptive statistics. Associations between TTR carrier status and atrial fibrillation, conduction disease, heart failure, and all-cause mortality were evaluated using adjusted Cox proportional hazards models. Genotypic and diagnostic concordance was examined using International Statistical Classification of Diseases, Tenth Revision codes from the hospital record. Results: The overall cohort included 469 789 UKB participants (mean [SD] age, 56.5 [8.1] years; 54.2% female and 45.8% male). A likely pathogenic/pathogenic (LP/P) TTR variant was detected in 473 (0.1%) participants, with Val142Ile being the most prevalent (367 [77.6%]); 91 individuals (0.02%) were carriers of a variant of unknown significance . The overall prevalence of LP/P variants was 0.02% (105 of 444 243) in participants with European ancestry and 4.3% (321 of 7533) in participants with African ancestry. The LP/P variants were associated with higher left ventricular mass indexed to body surface area (ß = 4.66; 95% CI, 1.87-7.44), and Val142Ile was associated with a longer PR interval (ß = 18.34; 95% CI, 5.41-31.27). The LP/P carrier status was associated with a higher risk of heart failure (hazard ratio [HR], 2.68; 95% CI, 1.75-4.12) and conduction disease (HR, 1.88; 95% CI, 1.25-2.83). Higher all-cause mortality risk was observed for non-Val142Ile LP/P variants (HR, 1.98; 95% CI, 1.06-3.67). Thirteen participants (2.8%) with LP/P variants had diagnostic codes compatible with cardiac or neurologic amyloidosis. Variants of unknown significance were not associated with outcomes. Conclusions and Relevance: This study found that approximately 1 in 1000 UKB participants were LP/P TTR variant carriers, exceeding previously reported prevalence. The findings emphasize the need for clinical vigilance in identifying individuals at risk of developing vATTR and associated poor outcomes.

ClinGen Hereditary Cardiovascular Disease Gene Curation Expert Panel: Reappraisal of Genes associated with Hypertrophic Cardiomyopathy.

Background: Hypertrophic cardiomyopathy (HCM) is an inherited cardiac condition affecting ~1 in 500 and exhibits marked genetic heterogeneity. Previously published in 2019, 57 HCM-associated genes were curated providing the first systematic evaluation of gene-disease validity. Here we report work by the ClinGen Hereditary Cardiovascular Disorders Gene Curation Expert Panel (HCVD-GCEP) to reappraise the clinical validity of previously curated and new putative HCM genes. Methods: The ClinGen systematic gene curation framework was used to re-classify the gene-disease relationships for HCM and related syndromic entities involving left ventricular hypertrophy. Genes previously curated were included if their classification was not definitive, and if the time since curation was >2-3 years. New genes with literature assertions for HCM were included for initial evaluation. Existing genes were curated for new inheritance patterns where evidence existed. Curations were presented on twice monthly calls, with the HCVD-GCEP composed of 29 individuals from 21 institutions across 6 countries. Results: Thirty-one genes were re-curated and an additional 5 new potential HCM-associated genes were curated. Among the re-curated genes, 17 (55%) genes changed classification: 1 limited and 4 disputed (from no known disease relationship), 9 disputed (from limited), and 3 definitive (from moderate). Among these, 3 (10%) genes had a clinically relevant upgrade, including TNNC1, a 9th sarcomere gene with definitive HCM association. With new evidence, two genes were curated for multiple inheritance patterns (TRIM63, disputed for autosomal dominant but moderate for autosomal recessive; ALPK3, strong for autosomal dominant and definitive for recessive). CSRP3 was curated for a semi-dominant mode of inheritance (definitive). Nine (29%) genes were downgraded to disputed, further discouraging clinical reporting of variants in these genes. Five genes recently reported to cause HCM were curated: RPS6KB1 and RBM20 (limited), KLHL24 and MT-TI (moderate), and FHOD3 (definitive). Conclusions: We report 29 genes with definitive, strong or moderate evidence of causation for HCM or isolated LVH, including sarcomere, sarcomere-associated and syndromic conditions.

A Critical Examination of Academic Hospital Practices-Paving the Way for Standardized Structured Reports in Neuroimaging.

Background/Objectives: Imaging studies are often an integral part of patient evaluation and serve as the primary means of communication between radiologists and referring physicians. This study aimed to evaluate brain Magnetic Resonance Imaging (MRI) reports and to determine whether these reports follow a standardized or narrative format. Methods: A series of 466 anonymized MRI reports from an academic hospital were downloaded from the Picture Archiving and Communication System (PACS) in portable document format (pdf) for the period between August 2017 and March 2018. Two hundred brain MRI reports, written by four radiologists, were compared to a structured report template from the Radiology Society of North America (RSNA) and were included, whereas MR-modified techniques, such as MRI orbits and MR venography reports, were excluded (n = 266). All statistical analyses were conducted using Statistical Package for the Social Sciences (SPSS) statistical software (version 16.4.1, MedCalc Software). Results: None of the included studies used the RSNA template for structured reports (SRs). The highest number of brain-reported pathologies was for vascular disease (24%), while the lowest was for infections (3.5%) and motor dysfunction (5.5%). Radiologists specified the Technique (n = 170, 85%), Clinical Information (n = 187, 93.5%), and Impression (n = 197, 98.5%) in almost all reports. However, information in the Findings section was often missing. As hypothesized, radiologists with less experience showed a greater commitment to reporting additional elements than those with more experience. Conclusions: The SR template for medical imaging has been accessible online for over a decade. However, many hospitals and radiologists still use the free-text style for reporting. Our study was conducted in an academic hospital with a fellowship program, and we found that structured reporting had not yet been implemented. As the health system transitions towards teleservices and teleradiology, more efforts need to be put into advocating standardized reporting in medical imaging.

Large Anal Polyp Disguised as Rectal Prolapse.

Rectal prolapse is a relatively rare condition where the rectal mucosa protrudes out of the anal canal. The diagnosis is made through a physical exam and clinical evaluation, and surgical treatment options can vary. Anal polyps masquerading as rectal prolapse have rarely been described in the literature. A 79-year-old man presented with a four-year history of a bulging, protruding mass from his anus that is exacerbated with defecation and bowel movements. He was initially diagnosed with rectal prolapse and had a proctosigmoidectomy performed robotically. Shortly after the procedure, his symptoms recurred, and he was referred to a different surgeon for reevaluation. A large, prolapsed polyp was visible on the physical exam. A colonoscopy and an anoscopy were performed. The CT abdomen/pelvis revealed a mass within the rectum, and the biopsy showed an adenomatous polyp with high-grade dysplasia. The patient underwent a transanal excision of the rectal polyp, with symptoms permanently resolving. For an accurate diagnosis, it is crucial to conduct a comprehensive assessment of the patient's history, a physical exam, and an unusual clinical course of rectal prolapse. The rarity of large, prolapsed polyps, along with their similar presentation to that of other anorectal conditions, may have contributed to this patient's diagnosis of rectal prolapse and the subsequent proctosigmoidectomy in place of a transanal excision of a polyp. The palpation of a stalk on a physical exam should raise suspicion of a polyp, and further workup, such as a colonoscopy and/or anoscopy, should be conducted to confirm the diagnosis.

Effects of Dietary Fiber Intake and the Prevalence of Constipation Among Patients With End-Stage Renal Disease (ESRD) in Jeddah, Saudi Arabia: A Cross-Sectional Observational Study.

RATIONALE/BACKGROUND: Hemodialysis (HD) patients with end-stage renal disease (ESRD) are particularly prone to constipation, which has become a growing public health issue. Nutritional therapy, such as fiber intake, significantly influences the management of constipation. In Saudi Arabia, there is limited data on fiber consumption and its correlation with constipation management in HD patients. AIMS: The study aimed to investigate the correlation between dietary fiber intake and its effect on the prevalence of constipation in HD patients. MATERIALS AND METHODS: This cross-sectional observational study of 77 ESRD patients on HD aged 18+ was conducted in a single dialysis center over six months. A questionnaire was employed to diagnose constipation (as defined by the Rome IV criteria of constipation), and seven-day food records were used to evaluate dietary fiber intake. RESULTS: A study found a high prevalence of constipation (53%) among participants, with a lower daily fiber intake than recommended. However, a significant relationship was found between fiber intake and constipation (p < 0.05) with lower fiber intake in constipated patients compared to non-constipated (p = 0.001). CONCLUSION: The study highlights a significant link between fiber intake and constipation in HD patients, suggesting adequate daily intake of fiber was effective in preventing constipation and that nutritional counseling should include adequate daily fiber intake in medical therapy management.

Adiponectin and leptin profiles among obese pregnant women with preeclampsia vs. non-preeclampsia: a systematic review and meta-analysis.

OBJECTIVE: Preeclampsia (PE) affects only about 10% of women who meet the criteria for obesity based on their body mass index (BMI). Obesity is suggested to play a role in preeclampsia pathophysiology, and in addition to BMI, associated biomarkers with higher sensitivity and specificity, such as with adipokines from adipose tissue, are needed to enable clinical risk assessment. This study aimed to investigate obese pregnant women with and without PE by comparing clinical profiles and adipokine profiles specific to general adipose tissue (adiponectin and leptin). MATERIALS AND METHODS: This meta-analysis was conducted following the PRISMA and was registered in PROSPERO (CRD42023478706). We utilized Cochrane, Scopus, and PubMed/Medline databases. The Cochrane ROBINS-I instrument was employed to assess the quality of studies. Pooled standard mean difference (SMD) and p-value were analyzed using a random-effects model with the DerSimonian-Laird method, while subgroup analysis with the Chi-square test and the inconsistency index (I2) were used to assess potential sources of heterogeneity. RESULTS: Three observational studies included a total of 2,646 obese pregnant women and found that adiponectin was more likely to have a lower level in pregnant women with obesity [SMD=-0.32; 95% CI: -0.34-0.17, p=0.003] and leptin was more likely to be higher in obese pregnant women with PE rather than non-PE [SMD=0.53; 95% CI: -0.19-1.08, p<0.00001]. CONCLUSIONS: Adiponectin levels were more likely to be lower in pregnant women with obesity in the PE group than in the non-PE group, and leptin levels were more likely to be higher.

Influence of halogen-halogen interactions in the self-assembly of pillar[5]arene-based supramolecular polymers.

Halogen-halogen interactions play a pivotal role in the formation and stability of supramolecular assemblies. Herein, we investigate the assembly dynamics and dissociation pathways of linear supramolecular polymers based on pillar[5]arene-mediated by guest halogen-halogen interactions (C-X × X-C) in both the solution and solid states. The structure of the solid-state supramolecular assembly was determined by single-crystal X-ray diffraction analysis. The binding affinities of four different 1,4-dihalobutane guests with pillar[5]arene were investigated by 1H NMR spectroscopic titration and isothermal titration calorimetry (ITC). The formation of the halogen-bonded linear supramolecular polymer in solution was demonstrated using diffusion-ordered spectroscopy (DOSY) and ITC. Our findings highlight the dependence of the dissociation process on halogen nature within the encapsulated guest, revealing that the process is entropically driven (TΔS = 27.12 kJ mol-1) and enthalpically disfavored (ΔH = 9.99 kJ mol-1). Moreover, the disassembly of supramolecular polymers promoted by N-containing compounds was investigated using 1H NMR spectroscopy and ITC, revealing that the process is driven both enthalpically (ΔH = -2.64 kJ mol-1) and entropically (TΔS = 15.70 kJ mol-1). Notably, the data suggest the formation of N⋯I bonding interactions at both ends of the inclusion guest, elucidating the intricate interplay of halogen interactions and host-guest chemistry in supramolecular polymer systems.

Vibrio alginolyticus: A Rare Cause of Otitis Externa off the Coast of Florida.

Vibrio alginolyticus, a gram-negative marine bacterium, poses significant health risks through various infections transmitted via contaminated seawater or seafood consumption. This case report details a 42-year-old male presenting with chronic seropurulent discharge from his ear, ultimately diagnosed with otitis externa caused by V. alginolyticus. Examination findings and antibiotic sensitivity testing informed the treatment strategy, leading to a successful resolution. The increasing incidence of V. alginolyticus infections, particularly in warm coastal water, necessitated heightened clinical awareness and appropriate management. As global temperatures rise, proactive measures including patient education and accurate diagnosis become crucial in preventing disease progression and complications associated with V. alginolyticus infections.

Heart failure with preserved ejection fraction management: a systematic review of clinical practice guidelines and recommendations.

Multiple guidelines exist for the diagnosis and management of heart failure with preserved ejection fraction (HFpEF). We systematically reviewed current guidelines and recommendations, developed by national and international medical organizations, on the management of HFpEF in adults to aid clinical decision-making. We searched MEDLINE and EMBASE on 28 February 2024 for publications over the last 10 years as well as websites of organizations relevant to guideline development. Of the ten guidelines and recommendations retrieved, seven showed considerable rigour of development and were subsequently retained for analysis. There was consensus on the definition of HFpEF and the diagnostic role of serum natriuretic peptides and resting transthoracic echocardiography. Discrepancies were identified in the thresholds of serum natriuretic peptides and transthoracic echocardiography parameters used to diagnose HFpEF. There was agreement on the general pharmacological and supportive management of acute and chronic HFpEF. However, differences exist in strategies to identify and address specific phenotypes. Contemporary guidelines for HFpEF management agree on measures to avoid its development and the consideration of cardiac transplantation in advanced disease. There were discrepancies in recommended frequency of surveillance for patients with HFpEF and sparse recommendations on screening for HFpEF in the general population, use of diagnostic scoring systems, and the role of newly emerging therapies.

Characterization and Cytotoxicity Assessment of Synthesized Palladium (II) Complex-Encapsulated Zinc Oxide Nanoparticles for Cancer Treatment.

The treatment of cancer often leads to a range of adverse effects. Encapsulating drugs can mitigate these effects and enhance drug efficacy by enabling a controlled release at the site of interest. This study details the successful synthesis of zinc oxide nanoparticles (ZnONPs) through the precipitation of Zn(NO3)2·6H2O with KOH. A Pd(II) complex drug was synthesized from a Schiff base ligand derived from 2-hydroxybenzohydrazide and (E)-1-(2-(p-tolyl)hydrazono)propan-2-one using potassium tetrachloropalladate(II). This complex was subsequently incorporated into ZnONPs. Characterization of the resulting compounds was performed using Transmission Electron Microscopy (TEM), Dynamic Light Scattering (DLS), Zeta Potential, Fourier Transform Infrared (FTIR) Spectroscopy, and UV-visible spectroscopy. TEM imaging revealed particle sizes of 160.69 ± 4.74 nm for ZnONPs and 185.28 ± 2.3 nm for the Pd(II) complex-encapsulated ZnONPs. The Zeta potential values were 6.53 mV for ZnONPs and 7.36 mV for Pd(II) complex-encapsulated ZnONPs. UV-visible spectroscopy showed an absorption peak at 360 nm for ZnONPs, while the Pd(II) complex-encapsulated ZnONPs exhibited a peak at 410 nm. FTIR analysis indicated the presence of the Pd(II) complex within the ZnONPs, as evidenced by a consistent Zn-O vibrational band at 832 cm-1 and a shift in another peak from 460 to 413 cm-1. Additionally, the detection of a C = N stretching vibration at 1548 cm-1 and a carbonyl stretch at 1626 cm-1 was observed. The Encapsulation Efficiency (E.E.) of the Pd(II) complex was 97.2%. A drug release experiment conducted at pH 7 showed a steady-state release pattern after 16 h, with a cumulative release of 44.3%. The cytotoxic effects of the Pd(II) complex and its encapsulated form in ZnONPs on the MCF-7 cell line were assessed via MTT test. The Pd(II) complex encapsulated within ZnONPs exhibited decreased toxicity relative to the unencapsulated drug, as evidenced by a higher IC50 value of 418.5 µg/ml. This suggests that the encapsulation facilitates a sustained release, which allows for targeted accumulation within cells. The elevated IC50 value indicates that the drug delivery system may be engineered to modulate the release of the drug in a more controlled manner, potentially resulting in a prolonged release profile rather than an immediate therapeutic impact.

Morphometric and histopathological evaluation of modified Elnady's plastinated tissue compared to non-plastinated tissue: Highlighting its relevance for teaching and research.

The present study aims to evaluate the morphometric and histopathological properties of Modified Elnady's plastinated tissue after a period compared to non-plastinated tissue. The plastination technique is utilized in research and teaching due to the potential health risks associated with prolonged exposure to formalin. The tissues and organs are permanently dried during plastination and can be used for further anatomical, histopathological and surgical educational purposes. This method involves drying tissue and allowing synthetic materials like glycerin to permeate it. The study compared non-plastinated and plastinated tissue post-plastination to determine if structural alterations differed from those linked to plastination. The study examined the histopathological examination of dogs' skin, muscles, liver, lung, and intestine using formalin-fixed organs for paraffin embedding and previously plastinated organs for a plastinated group. The study examined non-plastinated and plastinated tissues, their histological composition and biometric parameters revealing typical structures in the non-plastinated group. Plasmodiumted tissues exhibited a compacted appearance, volume changes, nuclear clarity, and cytoplasmic hypereosinophilia, with statistical differences between the two groups. The study reveals that plastinated tissues, after 5 years of plastination, maintain their histological architecture well, with some exceptions. Plastinated tissues can be utilized in future microscopic and immunological studies and will be beneficial for teaching and research.

Real-world effectiveness and safety of insulin glargine 100 U/mL plus lixisenatide in adults with type 2 diabetes: An international, multicentre, 12-month, prospective observational study.

AIM: To assess the impact of insulin glargine (100 U/mL) and lixisenatide (iGlarLixi) fixed-ratio combination therapy on the overall management of glycaemia in patients with type 2 diabetes (T2D), previously inadequately controlled with oral antidiabetic drugs ± basal insulin or glucagon-like peptide-1 receptor agonists (GLP-1 RAs). MATERIALS AND METHODS: This 12-month, international, multicentre, prospective, observational study included patients (age ≥ 18 years) with T2D who had initiated iGlarLixi within 1 month prior to study inclusion. Data were collected at study inclusion, month 3, month 6 and month 12 from patient diaries, self-measured plasma glucose, and questionnaires. The primary endpoint was change in HbA1c from baseline to month 6. RESULTS: Of the 737 eligible participants (mean age: 57.8 [standard deviation: 11.2] years; male: 49%), 685 had baseline and post-baseline HbA1c data available. The least squares mean change in HbA1c from baseline to month 6 was -1.4% (standard error [95% confidence interval (CI)]: 0.05 [-1.5, -1.3]). The absolute change from baseline at month 12 was -1.7% ± 1.9% (95% CI: -1.9, -1.5). There were 72 hypoglycaemia events reported during the study period, with a very low incidence of severe hypoglycaemia (two participants [rate: 0.003 events per patient-year]). CONCLUSIONS: This real-world observational study shows that initiation of iGlarLixi in people with T2D inadequately controlled on oral antidiabetic drugs ± basal insulin or GLP-1 RAs improves glycaemic control with a low incidence of hypoglycaemia.