Uncommon Manifestation: Thrombotic Thrombocytopenic Purpura Presenting Solely as Petechial Rash.

Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening disorder typically presenting with a classic pentad of symptoms: thrombocytopenia, microangiopathic hemolytic anemia, neurological abnormalities, renal dysfunction, and fever. This report explores an unusual presentation of TTP in a 47-year-old female with a medical history of hypertension, hyperlipidemia, and chronic TTP, who exhibited only petechial rashes, generalized weakness, and headache. Notably, the petechial rash, a less common manifestation of TTP, became a pivotal clue for the diagnosis, underscoring the necessity for vigilance even when classic symptoms are absent. This case reinforces the imperative of a high suspicion index for TTP, especially in patients with thrombocytopenia and hemolytic anemia, irrespective of other traditional signs. Plasmapheresis remains the treatment cornerstone, removing autoantibodies and replenishing ADAMTS13, as evidenced by the patient's initial response. The administration of rituximab, targeting B cells to mitigate autoantibody production against ADAMTS13, featured prominently in her management, aligning with its recognized role in refractory or relapsing TTP cases. Despite an encouraging response to rituximab, a subsequent decline in platelet count indicated the unpredictable nature of TTP and the necessity for multi-pronged therapeutic strategies. The patient's medical background and persistently low ADAMTS13 levels hinted at a chronic relapsing trajectory associated with increased morbidity and mortality. This necessitates ongoing vigilance and treatment flexibility. Highlighting this atypical TTP presentation, the report calls for immediate, robust intervention, serving as a critical reminder of the heterogeneity of TTP manifestations and the complexities in its management, thereby contributing to broader clinical awareness and improved patient prognoses.

Long-term clinical outcomes of intravascular imaging-guided percutaneous coronary intervention versus angiography-guided percutaneous coronary intervention in complex coronary lesions: a systematic review and meta-analysis.

Background: In this study, we aim to discuss the long-term clinical outcomes of intravascular ultrasound imaging-guided percutaneous intervention (IVUS-PCI) versus angiography-guided percutaneous coronary intervention (PCI) in complex coronary lesions over a mean period of 2 years. Methods: A systematic search and meta-analysis were conducted to assess the efficacy of using intravascular ultrasound or optical coherence tomography guidance in coronary artery stenting compared to angiography. Results: A total of 11 randomized controlled trials with 6740 patients were included. For the primary outcome, a pooled analysis (3.2 vs 5.6%). For secondary outcomes, the risk was significantly low in image-guided percutaneous intervention compared with angiography. Conclusion: Intravascular imaging-guided PCI is significantly more effective than angiography-guided PCI in reducing the risk of target lesion revascularization, target vessel revascularization, cardiac death, major adverse cardiovascular events and stent thrombosis.

Mitochondrial electron transport chain in macrophage reprogramming: Potential role in antibacterial immune response.

Macrophages restrain microbial infection and reinstate tissue homeostasis. The mitochondria govern macrophage metabolism and serve as pivot in innate immunity, thus acting as immunometabolic regulon. Metabolic pathways produce electron flows that end up in mitochondrial electron transport chain (mtETC), made of super-complexes regulating multitude of molecular and biochemical processes. Cell-intrinsic and extrinsic factors influence mtETC structure and function, impacting several aspects of macrophage immunity. These factors provide the macrophages with alternate fuel sources and metabolites, critical to gain functional competence and overcoming pathogenic stress. Mitochondrial reactive oxygen species (mtROS) and oxidative phosphorylation (OXPHOS) generated through the mtETC are important innate immune attributes, which help macrophages in mounting antibacterial responses. Recent studies have demonstrated the role of mtETC in governing mitochondrial dynamics and macrophage polarization (M1/M2). M1 macrophages are important for containing bacterial pathogens and M2 macrophages promote tissue repair and wound healing. Thus, mitochondrial bioenergetics and metabolism are intimately coupled with innate immunity. In this review, we have addressed mtETC function as innate rheostats that regulate macrophage reprogramming and innate immune responses. Advancement in this field encourages further exploration and provides potential novel macrophage-based therapeutic targets to control unsolicited inflammation.

Ultralong Stability of Ti3 C2 Tx -MXene Dispersion Through Synergistic Regulation of Storage Environment and Defect Capping with Tris-HCl Buffering.

Aqueous MXene dispersion suffers from a bottleneck issue of oxidation, leading to its gradual deterioration and ultimately compromised physicochemical characteristics. Herein, Tris-HCl buffer is employed to stabilize the diluted Ti3 C2 Tx -MXene dispersion (0.05 mg mL-1 ) through the synergy of its potent pH-regulation capability and capping effect toward oxidation-susceptible defects/edges. Tris-HCl functionalized Ti3 C2 Tx maintained its original morphology, structure, and favorable dispersity even after 150 days of aging under naturally aerated conditions. The pH-regulation nature of Tris-HCl is elucidated through solution monitoring of Ti3 C2 Tx dispersion, while the adsorption of Tris-HCl onto defects/edges is revealed by spectral analysis and multi-scale simulations. Tris-HCl at the neutral pH can bind to the negatively charged basal plane of Ti3 C2 Tx via + HTris moiety, while the other moiety (Tris) interacts with the exposed edge-based Ti atoms and/or intrinsic defects, forming a Ti─N bond that prevents MXene from attack by H2 O and O2 . Besides, Tris-HCl stabilized Ti3 C2 Tx exhibited nearly identical capacitive characteristics to its freshly-etched counterpart, indicating the minimal impact of Tris-HCl on electrochemical performance of Ti3 C2 Tx during long-term storage. This study provides practical guidance for stabilizing MXene in their native aqueous dispersion without compromising the inherent properties.

Cardiovascular outcomes post bariatric surgery in patients with metabolic dysfunction-associated steatotic liver disease - A systematic review and meta-analysis.

BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease (NAFLD), is linked with an increased risk of adverse cardiovascular events. Studies have suggested an association between the reduction of incident cardiovascular events in patients with MASLD after bariatric surgery. This systematic review and meta-analysis were performed to assess the influence of bariatric surgery on cardiovascular outcomes in patients with diagnosed MASLD by identifying all available cohort studies and pooling their data. METHODS: PubMed and Google Scholar databases were searched till July 2023 for published studies that assessed the effect of bariatric surgery on cardiovascular outcomes in MASLD patients. Using a random effects model, hazard ratios (HRs) with 95 % confidence intervals (CIs) were pooled. RESULTS: The systematic review identified three cohort studies. The analysis of 240,516 MASLD patients found a significantly reduced incidence of cardiovascular events. (HR 0.51; 95 % CI 0.48 to 0.54, P value <0.00001). CONCLUSION: Bariatric surgery in MASLD patients significantly reduced the incidence of cardiovascular events, suggesting that bariatric surgery is an effective therapeutic tool among MASLD patients compared to non-surgical interventions.

ß-Catenin Elicits Drp1-Mediated Mitochondrial Fission Activating the Pro-Apoptotic Caspase-1/IL-1ß Signalosome in Aeromonas hydrophila-Infected Zebrafish Macrophages.

Canonical Wnt signaling plays a major role in regulating microbial pathogenesis. However, to date, its involvement in A. hydrophila infection is not well known. Using zebrafish (Danio rerio) kidney macrophages (ZKM), we report that A. hydrophila infection upregulates wnt2, wnt3a, fzd5, lrp6, and ß-catenin (ctnnb1) expression, coinciding with the decreased expression of gsk3b and axin. Additionally, increased nuclear ß-catenin protein accumulation was observed in infected ZKM, thereby suggesting the activation of canonical Wnt signaling in A. hydrophila infection. Our studies with the ß-catenin specific inhibitor JW67 demonstrated ß-catenin to be pro-apoptotic, which initiates the apoptosis of A. hydrophila-infected ZKM. ß-catenin induces NADPH oxidase (NOX)-mediated ROS production, which orchestrates sustained mitochondrial ROS (mtROS) generation in the infected ZKM. Elevated mtROS favors the dissipation of the mitochondrial membrane potential (ΔΨm) and downstream Drp1-mediated mitochondrial fission, leading to cytochrome c release. We also report that ß-catenin-induced mitochondrial fission is an upstream regulator of the caspase-1/IL-1ß signalosome, which triggers the caspase-3 mediated apoptosis of the ZKM as well as A. hydrophila clearance. This is the first study suggesting a host-centric role of canonical Wnt signaling pathway in A. hydrophila pathogenesis wherein ß-catenin plays a primal role in activating the mitochondrial fission machinery, which actively promotes ZKM apoptosis and helps in containing the bacteria.

Influence of sustainable environmental exercises in the green restaurant industry.

The restaurant business is gaining popularity for its capacity to alleviate numerous adverse environmental influences to achieve a competitive edge. Green restaurants can employ a distinctive brand strategy. Nevertheless, additional research is necessary to better understand customer behavior in this subject. This study explores the relationship between brand awareness and brand image, and brand performance from the consumer's perspective. However, it is unknown how this connection is affected by the attitude of green restaurant brands. This research aims to address the research gaps by determining the structure and function of brand attitudes. This study handles the quantitative data analysis to fit the study problem. The data was collected through a questionnaire form, and the questionnaire was collected from the customers from twelve restaurants in Karachi city of Pakistan by utilizing random sampling. In sum, 290 samples were obtained and interpreted with SPSS (Statistical Package for the Social Sciences) and PLS (Partial Least Squares) to come up with the results of the study. According to the findings, restaurant customers' observed brand awareness and brand image positively impact brand attitude. The results of the structural equation analysis revealed that brand awareness and brand image have a substantial impact on brand performance, whereas brand attitude has a profound effect on meditation. The adaptation of brand attitude to brand management has sparked a lot of interest in the incredibly competitive restaurant business. There is a good likelihood that green restaurants will ultimately find value in using the measuring tools and suggestions offered in this research to analyze and lead their marketing efforts. In practice, it is recommended that green restaurant management cultivate familiar brand awareness and preserve the brand image to create brand attitude and performance.

Natural oxidation of Ti3C2Tx to construct efficient TiO2/Ti3C2Tx photoactive heterojunctions for advanced photoelectrochemical biosensing of folate-expressing cancer cells.

The rapid-charge carrier recombination and low conductivity are critical in devising an efficient photoelectrochemical (PEC) sensor. Herein, we propose partial oxidation of few-layered MXene (Ti3C2Tx) to construct a photo-active TiO2/Ti3C2Tx platform that could be configured for PEC sensing of folate receptors (FR), particularly, FR-expressing breast cancer cells (MDA-MB-231). MXene-Ti3C2Tx dispersion was oxidized in natural-open air conditions, where continuous exposure for six (06) days allowed for homogeneous in-situ growth of TiO2 over MXenes nanosheets (MX-06). This exposure enabled partial oxidation of MXene-sheets with a balanced TiO2 to MXene content that could exhibit improved photoresponsive characteristics owing to the synergism of redox-active TiO2 and highly conductive underlying Ti3C2Tx. The photoelectrode was then adapted for biorecognition by conjugating chitosan and folic acid (FA) networks, which permitted selective detection of FR-expressed cells with significant antifouling capabilities against common proteins such as bovine serum album (BSA), hemoglobin, and immunoglobulin G. (Ig G). The detection mechanism relies on FA's strong affinity for cancer cell folate receptors, which proportionally inhibited the photoelectrodes PEC oxidation response to ascorbic acid (AA)(mediator). The proposed inhibition strategy enabled sensitive detection of FR-expressed MDA-MB-231 cells in the concentration range of 1 × 102 to 2 × 107 cells/mL with a detection limit of 1.01 cells/mL (S/N = 3).

Hierarchical NiMn-LDH Hollow Spheres as a Promising Pseudocapacitive Electrode for Supercapacitor Application.

Layered double hydroxides (LDH) are regarded as attractive pseudocapacitive materials due to their impressive capacitive qualities that may be adjustable to their morphological features. However, the layered structure of LDH renders them susceptible to structural aggregation, which inhibits effective electrolyte transport and limits their practical applicability after limited exposure to active areas. Herein, we propose a simple template-free strategy to synthesize hierarchical hollow sphere NiMn-LDH material with high surface area and exposed active as anode material for supercapacitor application. The template-free approach enables the natural nucleation of Ni-Mn ions resulting in thin sheets that self-assemble into a hollow sphere, offering expended interlayer spaces and abundant redox-active active sites. The optimal NiMn-LDH-12 achieved a specific capacitance of 1010.4 F g-1 at a current density of 0.2 A g-1 with capacitance retention of 70% at 5 A g-1 after 5000 cycles with lower charge transfer impedance. When configured into an asymmetric supercapacitors (ASC) device as NiMn-LDH//AC, the material realized a specific capacitance of 192.4 F g-1 at a current density of 0.2 A g-1 with a good energy density of 47.9 Wh kg-1 and a power density of 196.8 W kg-1. The proposed morphological-tuning route is promising for designing template-free NiMn-LDHs spheres with practical pseudocapacitive characteristics.

Proficient exclusion of pesticide using humic acid-modified magnetite nanoparticles from aqueous solution.

Extensive dispersal of the pesticides to shield the different types of vegetation from pests has increased the production but at the same it has resulted in an increase in environmental pollution. Consequently, it is necessary to eliminate these undesired pollutants from the environment. The current investigation offers the synthesis of humic acid-coated magnetite nanoparticles towards effective removal of the most common insecticide, imidacloprid, from aqueous solution using a batch adsorption method. These synthesized nanoparticles were characterized with the help of several analytical and spectroscopic techniques. To acquire the maximum conceivable adsorption, effects of different influencing parameters like pH of the solution, time of contact, concentration of pesticide solution, amount of adsorbent and temperature were also examined. Moreover, the kinetic studies were found to be in good agreement with a pseudo-second-order kinetic model supporting the occurrence of chemisorption phenomenon. Additionally, isotherm modeling proved that the adsorption process was in accordance with the Langmuir model of isotherm. Thermodynamic parameters depicted the endothermic and spontaneous behavior of the adsorption process. Desorption studies were also carried out to examine the reusability of these nano-adsorbents. These verdicts confirmed that the surface modified magnetite nanoparticles may be treated as proficient material for exclusion of imidacloprid from the aqueous solution.

TLR22-Induced Pro-Apoptotic mtROS Abets UPRmt-Mediated Mitochondrial Fission in Aeromonas hydrophila-Infected Headkidney Macrophages of Clarias gariepinus.

Toll-like receptors (TLRs) are epitomized as the first line of defense against pathogens. Amongst TLRs, TLR22 is expressed in non-mammalian aquatic vertebrates, including fish. Using headkidney macrophages (HKM) of Clarias gariepinus, we reported the pro-apoptotic and microbicidal role of TLR22 in Aeromonas hydrophila infection. Mitochondria act as a central scaffold in the innate immune system. However, the precise molecular mechanisms underlying TLR22 signaling and mitochondrial involvement in A. hydrophila-pathogenesis remain unexplored in fish. The aim of the present study was to investigate the nexus between TLR22 and mitochondria in pro-apoptotic immune signaling circuitry in A. hydrophila-infected HKM. We report that TLR22-induced mitochondrial-Ca2+ [Ca2+]mt surge is imperative for mtROS production in A. hydrophila-infected HKM. Mitigating mtROS production enhanced intracellular bacterial replication implicating its anti-microbial role in A. hydrophila-pathogenesis. Enhanced mtROS triggers hif1a expression leading to prolonged chop expression. CHOP prompts mitochondrial unfolded protein response (UPRmt) leading to the enhanced expression of mitochondrial fission marker dnml1, implicating mitochondrial fission in A. hydrophila pathogenesis. Inhibition of mitochondrial fission reduced HKM apoptosis and increased the bacterial burden. Additionally, TLR22-mediated alterations in mitochondrial architecture impair mitochondrial function (ΔΨm loss and cytosolic accumulation of cyt c), which in turn activates caspase-9/caspase-3 axis in A. hydrophila-infected HKM. Based on these findings we conclude that TLR22 prompts mtROS generation, which activates the HIF-1α/CHOP signalosome triggering UPRmt-induced mitochondrial fragmentation culminating in caspase-9/-3-mediated HKM apoptosis and bacterial clearance.

Cross border project in China-Pakistan economic corridor and its influence on women empowerment perspectives.

The China-Pakistan Economic Corridor (CPEC) is a significant and inaugural project of the "Belt and Road" initiative which is considered as structure and manifesto for panoramic and fundamental collaboration between China and Pakistan. The CPEC project was initiated to develop economic growth and facilitate free trade between both countries. However, it has generated immense employment opportunities, education facilities, and improved quality of life for local citizens, specifically women, as well as international overreach. This study investigates and examines the benefits of CPEC project and its influence on women empowerment. Based on the background of the CPEC, this study has been carried out by applying a mixture of qualitative and quantitative methods to fill the gap. Data was aggregated with the help of a survey questionnaire and interviews from the residents of the Thar region of Pakistan, which comes under CPEC route. In total, 306 samples were acquired and analysed using different statistical tools such as SPSS (Statistical package for social sciences) and PLS (Partial least squares) to formulate the study results. The findings revealed that the development of CPEC has remarkably improved the quality of life for women by providing enormous employment opportunities, education facilities, skills enhancement programs, and training facilities. The analyzed results will guide government policymakers and officials to promote operational activities in the region, develop new educational institutions, and create employment opportunities for the local community and women to obtain further development of CPEC projects.

Th1-Th2 and M1-M2 interplay sculpt Aeromonas hydrophila pathogenesis in zebrafish (Danio rerio).

Aeromonas hydrophila is an important aquatic zoonotic pathogen that causes septicemia, necrotizing fasciitis and gastroenteritis in various aquatic and non-aquatic animals. However, the pathogenesis of A. hydrophila is not fully understood. Here, we examined the pathogenicity and histopathology of A. hydrophila in the zebrafish (Danio rerio) model system. We found that the intensity of symptoms and mortality is dose-dependent. Bacterial colonization studies demonstrated that A. hydrophila never cleared out from the fish body but stayed in a state of inactivity till it enters a fresh host. Reinfection studies showed that exposure to A. hydrophila provides immunity against future infection and hence improves fish survival. Gene expression studies revealed the crosstalk between T-helper cell and macrophage responses in fish immune system in response to A. hydrophila and infection memory. Histopathological studies showed that symptoms of tissue damage and inflammation lasted for less duration with less intensity in immunized fish when compared to non-immunized fish. Together, our results suggest that the zebrafish model is a useful system in studying the interplay between A. hydrophila pathogenesis, persistence and immunity.

Ni Nanoparticles Embedded Ti3C2Tx-MXene Nanoarchitectures for Electrochemical Sensing of Methylmalonic Acid.

MXenes-Ti3C2Tx, based on their versatile surface characteristics, has rapidly advanced as an interactive substrate to develop electrochemical sensors for clinical applications. Herein, Ni embedded Ti3C2Tx (MX-Ni) composites were prepared using a self-assembly approach where Ti3C2Tx sheets served as an interactive conductive substrate as well as a protective layer to nickel nanoparticles (Ni NPs), preventing their surface oxidation and aggregation. The composite displayed a cluster-like morphology with an intimate interfacial arrangement between Ni, Ti3C2Tx and Ti3C2Tx-derived TiO2. The configuration of MX-Ni into an electrochemical sensor realized a robust cathodic reduction current against methylmalonic acid (MMA), a biomarker to vitamin B12 deficiency. The synergism of Ni NPs strong redox characteristics with conductive Ti3C2Tx enabled sensitive signal output in wide detection ranges of 0.001 to 0.003 µM and 0.0035 to 0.017 µM and a detection sensitivity down to 0.12 pM of MMA. Importantly, the sensor demonstrated high signal reproducibility and excellent operational capabilities for MMA in a complex biological matrix such as human urine samples.

IL-27 Modulates the Cytokine Secretion in the T Cell-Osteoclast Crosstalk During HIV Infection.

In People with HIV (PWH), chronic immune activation and systemic inflammation are associated with increased risk to develop comorbidities including bone loss. Numerous cells of the immune system, namely, T cells are involved in the regulation of the bone homeostasis and osteoclasts (OCs) activity. IL-27, a cytokine that belongs to the IL-12 family can regulate the secretion of pro- and anti-inflammatory cytokines by T cells, however its role in the setting of HIV is largely unknown. In the present study, we determined the impact of OCs in T cell secretion of cytokines and whether IL-27 can regulate this function. We found that the presence of OCs in the T cell cultures significantly enhanced secretion of IFNγ, TNFα, IL-17, RANKL, and IL-10 in both PWH and healthy controls. In PWH, IL-27 inhibited IL-17 secretion and downregulated surface expression of RANKL in CD4 T cells. All together these results suggest that in the context of HIV infection IL-27 may favor IFNγ and TNFα secretion at the sites of bone remodeling.

IL-27 induces IFN/STAT1-dependent genes and enhances function of TIGIT+ HIVGag-specific T cells.

HIV-specific T cells have diminished effector function and fail to control/eliminate the virus. IL-27, a member of the IL-6/IL-12 cytokine superfamily has been shown to inhibit HIV replication. However, whether or not IL-27 can enhance HIV-specific T cell function is largely unknown. In the present manuscript, we investigated the role of IL-27 signaling in human T cells by evaluating the global transcriptional changes related to the function of HIV-specific T cells. We found that T cells from people living with HIV (PLWH), expressed higher levels of STAT1 leading to enhanced STAT1 activation upon IL-27 stimulation. Observed IL-27 induced transcriptional changes were associated with IFN/STAT1-dependent pathways in CD4 and CD8 T cells. Importantly, IL-27 dependent modulation of T-bet expression promoted IFNγ secretion by TIGIT+HIVGag-specific T cells. This new immunomodulatory effect of IL-27 on HIV-specific T cell function suggests its potential therapeutic use in cure strategies.

Effects of Neodymium-Doped Yttrium Aluminium Garnet (Nd:YAG) Laser Capsulotomy on Visual Outcomes From a Lower-Middle Income Country.

Objective Neodymium-doped yttrium aluminium garnet (Nd: YAG) laser is a non-invasive and effective means to deal with posterior capsule opacification. Although it is safe, it may have some complications. The purpose of this study was to evaluate the efficacy of Nd: YAG laser capsulotomy in terms of visual outcomes. Methodology This retrospective study was carried out at the eye department of Shaheed Mohtarma Benazir Bhutto Medical College, Lyari and Sindh Government Lyari General Hospital, Karachi, by using a convenient sampling technique. The duration of the study was six months from 1st January 2020 to 30th June 2020. 50 eyes of patients older than 20 years of age of either gender with posterior capsule opacification after cataract surgery for more than 6 months of duration, capsular fibrosis, and visual distortion due to wrinkling were included in the study.  Results Our results show that in a total of 50 patients, the mean age was 59.08±5.84 years, of which, 20 (40%) were males. Out of 50 patients, 22 right while 28 left eyes were selected for Nd: YAG laser capsulotomy. None of the patients showed elevated intraocular pressure (IOP) after the 1st week. Mean IOP was 16.84±3.63 mm of Hg on the 1st day and mean IOP after 1st week was 12.48±2.01 mm of Hg. Iritis was observed in 5 (10.0%) patients on the 1st day and 4 (8.0%) patients on the 1st week. Raised IOP was observed in 10 (20.0%) cases whereas cystoid macular edema was observed in only 1 (2%) patients on the 1st day and 1st week after laser therapy. Conclusion The study predicted that Nd: Yag laser posterior capsulotomy gives excellent results in terms of visual acuity. Complications that were associated with the Nd: Yag laser capsulotomy was a rise in intraocular pressure, cystoid macular edema, iritis, and IOL pitting.