A Systematic Review of Single-Layer Versus Double-Layer Intestinal Anastomosis: Is One Better?

INTRODUCTION: To perform a systematic review of randomized controlled trials comparing outcomes from handsewn single-layer and double-layer intestinal anastomosis in adults. METHODS: A literature search was conducted using PubMed, SCOPUS, and Web of Science databases for studies published up to September 14, 2023 using the following keyword search query: ((one) OR (single)) AND ((two) OR (double)) AND (layer) AND ((anastomoses) OR (anastomosis)). RESULTS: In seven of the eight studies, there was no significant difference in anastomotic leakage rate. In one of the eight studies, Moeen et al., double-layer anastomosis was associated with a significantly higher anastomotic leakage rate than single-layer anastomosis (5/100 versus 15/100, P = 0.018). Time to complete single-layer anastomosis was shorter than double-layer anastomosis. CONCLUSIONS: Single-layer and double-layer intestinal anastomosis have similar rates of anastomotic leak, mortality, and hospital stay in adults, with single-layer intestinal anastomosis having the benefit of shorter time to complete.

Navigating a Paradigm Shift Venetoclax Treatment Redefines Landscape of Acute Myeloid Leukemia.

Acute myeloid leukemia (AML) is a heterogeneous disease characterized by the accumulation of malignant myeloid progenitor hematopoietic cells in the bone marrow and peripheral blood. Recent studies have shown promising results with the use of small molecule inhibitors and targeted therapy in the treatment of patients with AML. One such molecule is venetoclax, which has been approved in AML by the FDA in combination with hypomethylating agents or low-dose cytarabine. We thoroughly searched electronic literature related to venetoclax and its role in AML, using databases such as MEDLINE, PubMed, Google Scholar, and PsychInfo, through April 2024. We applied population, intervention, comparison, and outcome criteria, specifically focusing on studies with a population using venetoclax from review articles and clinical trials. All selected studies were required to be in English, and any study that did not involve the use of venetoclax was excluded. A meticulous literature review was conducted to consolidate the current knowledge and new combination therapies on AML. In our review article, we focused on the latest advances in the treatment of patients with AML. Based on the literature, we recommend that physicians prioritize the use of venetoclax in the management of this deadly disease because it has been shown to significantly impact the course of the disease.

Predictors and outcomes of acute pulmonary embolism in COVID-19; insights from US National COVID cohort collaborative.

OBJECTIVES: To investigate whether COVID-19 patients with pulmonary embolism had higher mortality and assess the utility of D-dimer in predicting acute pulmonary embolism. PATIENTS AND METHODS: Using the National Collaborative COVID-19 retrospective cohort, a cohort of hospitalized COVID-19 patients was studied to compare 90-day mortality and intubation outcomes in patients with and without pulmonary embolism in a multivariable cox regression analysis. The secondary measured outcomes in 1:4 propensity score-matched analysis included length of stay, chest pain incidence, heart rate, history of pulmonary embolism or DVT, and admission laboratory parameters. RESULTS: Among 31,500 hospitalized COVID-19 patients, 1117 (3.5%) patients were diagnosed with acute pulmonary embolism. Patients with acute pulmonary embolism were noted to have higher mortality (23.6% vs.12.8%; adjusted Hazard Ratio (aHR) = 1.36, 95% CI [1.20-1.55]), and intubation rates (17.6% vs. 9.3%, aHR = 1.38[1.18-1.61]). Pulmonary embolism patients had higher admission D-dimer FEU (Odds Ratio(OR) = 1.13; 95%CI [1.1-1.15]). As the D-dimer value increased, the specificity, positive predictive value, and accuracy of the test increased; however, sensitivity decreased (AUC 0.70). At cut-off D-dimer FEU 1.8 mcg/ml, the test had clinical utility (accuracy 70%) in predicting pulmonary embolism. Patients with acute pulmonary embolism had a higher incidence of chest pain and history of pulmonary embolism or deep vein thrombosis. CONCLUSIONS: Acute pulmonary embolism is associated with worse mortality and morbidity outcomes in COVID-19. We present D-dimer as a predictive risk tool in the form of a clinical calculator for the diagnosis of acute pulmonary embolism in COVID-19.

Survival tactics of an endangered species Withania coagulans (Stocks) Dunal to arid environments.

Withania coagulans is a valuable medicinal plant with high demand, but its wild growth and local usage pose a threat to its natural habitat. This study aims to understand the plant's growth, anatomy, and physiology in different environmental conditions to aid in conservation and re-vegetation efforts. Fifteen differently adapted populations of Withania coagulans were collected from diverse ecological regions, viz., (i) along the roadside, (ii) hilly areas, (iii) barren land, and (iv) wasteland to unravel the adaptive mechanisms that are responsible for their ecological success across heterogenic environments of Punjab, Pakistan. The roadside populations had high values of photosynthetic pigments, total soluble proteins, root endodermis thickness, stem and leaf cortical thickness, and its cell area. The populations growing in hilly areas showed better growth performance such as vigorous growth and biomass production. Additionally, there was enhanced accumulation of organic osmolytes (glycine betaine and proline), chlorophyll content (chl a/b), and enlarged epidermal cells, cortical cells, vascular bundles, metaxylem vessels, and phloem region in roots. In case of stem area, epidermal thickness, cortical thickness, vascular bundle, and pith area showed improved growth. However, the barren land population showed significant increase in carotenoid contents, vascular bundle area, and metaxylem area in roots, and xylem vessels and phloem area in stems and leaves. The wasteland population surpassed the rest of the populations in having greater root dry weight, higher shoot ionic contents, increased root area, thick cortical, and vascular bundle area in roots. Likewise, cortical thickness and its cell area, and pith area in stems, whereas large vascular bundles, phloem region, and high stomatal density were recorded in leaves. Subsequently, natural populations showed the utmost behavior related to tissue organization and physiology in response to varied environmental conditions that would increase the distribution and survival of species.

Effectiveness of health education intervention on diabetes mellitus among the teachers working in public sector schools of Pakistan.

BACKGROUND: Diabetes Mellitus (DM) is considered as one of the major public health problems globally. Health education strategies can help in managing blood glucose level and complications among DM patients. Health education intervention is effective to manage and control the blood glucose levels among diabetic patients. This study explored the effectiveness of health education intervention on DM among school teachers in public sector schools of Pakistan. METHODS: This was quasi-experimental study where baseline & end line assessments were conducted on teachers of public sector schools of Sindh province, Pakistan, from October to December 2019. Pretested structured questionnaire was used in this study. Participants (n = 136). were randomly selected from the list of government schools registered with district education department An intervention comprised of health education sessions with DM patients was undertaken after conducting baseline assessment followed by end line assessment. The institutional review board of Health Services Academy Pakistan ethically approved this study. RESULTS: All the respondents completed post-test with mean ± SD age of participants being 39.2 ± 1.34 years. Female teachers comprised 65% out of which 70% were living in rural areas. Knowledge on DM pre-test score was 20.03 ± 3.31 that increased in post-test to 49.11 ± 2.21 (p < 0.05). Mean score of information on symptoms and causes of DM was 1.98 ± 0.21 for pre-test whereas for post-test it was 4.78 ± 0.12 (p < 0.05). The effect of intervention was significant on diabetes related complications (p < 0.05), symptoms (p < 0.05), overall score (p < 0.05) and preventive practices (p < 0.05). CONCLUSIONS: The study provides evidence of the importance and effectiveness of health education intervention related to diabetes among school teachers, which has a positive impact on the knowledge and practices. We concluded that the health education session sensitized the teachers and they can bring cogent changes to enhance their knowledge about diabetes and its risks.

Multi-step short-term [Formula: see text] forecasting for enactment of proactive environmental regulation strategies.

Particulate matter is one of the key contributors of air pollution and climate change. Long-term exposure to constituents of air pollutants has exerted serious health implications in both humans and plants leading to a detrimental impact on economy. Among the pollutants contributing to air quality determination, particulate matter has been linked to serious health implications causing pulmonary complications, cardiovascular diseases, growth retardation and ultimately death. In agriculture, crop yield is also negatively impacted by the deposition of particulate matter on stomata of the plant which is alarming and can cause food security concerns. The deleterious impact of air pollutants on human health, agricultural and economic well-being highlights the importance of quantifying and forecasting particulate matter. Several deterministic and deep learning models have been employed in the recent years to forecast the concentration of particulate matter. Among them, deep learning models have shown promising results when it comes to modeling time series data and forecasting it. We have explored recurrent neural networks with LSTM model which shows potential to predict the particulate matter ([Formula: see text]) based on multi-step multi-variate data of two of the most polluted regions of South Asia, Beijing, China and Punjab, Pakistan effectively. The LSTM model is tuned using Bayesian optimization technique to employ the appropriate hyper-parameters and weight initialization strategies based on the dataset. The model was able to predict [Formula: see text] for the next hour with root-mean-square error (RMSE) of 0.1913 (91.5% accuracy) and this error gradually increases with the number of time steps with next 24 hours steps prediction having RMSE of 0.7290. While in case of Punjab dataset with data recorded once a day, the RMSE for the next day forecast is 0.2192. These multi-step short-term forecasts would play a pivotal role in establishing an early warning system based on the air quality index (AQI) calculated and enable the government in enacting policies to contain it.

Structured Long Interview and Clinical Examination (SLICE) as Formative Assessment Tool in Clinical Clerkship: Medical Students Perspective.

OBJECTIVE: To evaluate medical students' views about undertaking structured long interview and clinical examination as a formative assessment. METHODS: The qualitative, exploratory study was conducted from February to July 2019 at the Islamic International Medical College, Riphah International University, Islamabad, Pakistan, and comprised final year medical students having undertaken formative assessment through structured long interview and clinical examination during their clerkship rotation in Paediatrics, General Medicine, General Surgery and Gynaecology and Obstetrics. Four sets of focus group discussions were conducted according to the relevant clerkship module. Each recorded FGD was transcribed verbatim. Thematic analysis was conducted manually. RESULTS: Of the 32 students, there were 8(25%) in each of the four groups. Five major themes and five-sub-themes emerged, with the main themes being: Purpose, Learning, Timing, Relevancy and Fairness of the structured long interview and clinical examination. CONCLUSIONS: The students generally thought that the structured long interview and clinical examination was effective in enhancing their clinical skills learning and should be conducted more frequently with minor adjustments.

Decreased bone mineral density and associated risk factors in hospital visiting people of Islamabad.

OBJECTIVE: TBesides aging there are multiple factors involved in decreasing Bone Mineral Density. Knowing the burden of the diseaseand its related factors in our population can help better treat this. Therefore, our objective was to identify subjects with low Bone Mineral Density (BMD) and its risk factors in hospital visiting people in Islamabad. METHODS: Descriptive cross sectional study was conducted atRawal Institute of Health Sciences, Islamabad in 3rd week of June, 2014. Total 300 persons including patients, attendants and hospital staff were selected.Calcaneus BMD was measured usingultrasound bone densitometer. T-score was calculated.Specific questionnaire form was filled to identify risk factors. Prevalence and prevalence ratio was calculated. RESULTS: Out of 300 study sample, 178 (59.3%) are females. Mean age of the study population is 37.34 (SD=12.93). Overall, prevalence of osteopaenia and osteoporosis in the study population is 107 (35.7%) and 5 (1.7%) respectively. Prevalence of osteopaenia is seen more in elderly subjects, females, people with low Body Mass Index (BMI), people who are usually not exposed to sunlight and who are mostly bound to houses. CONCLUSIONS: Decreased BMD is associated with increasing age, female gender, low BMI, little exposure to sun light and being restrained to homes. It is not affected by daily milk intake, parity of females, cola drinking and smoking in our part of the world.

Bacterial Infections in Patients Living with HIV.

Pneumonia, as well as other types of acute and chronic lung injuries, remain the leading causes of death in individuals living with HIV. Individuals with HIV who are on antiretroviral therapy continue to have a greater risk for pneumonia, including bacterial and mycobacterial infections. Alveolar macrophages and lung epithelial cells constitute the first line of host defense against invading pathogens. The predisposition of individuals living with HIV to infections despite ante-retroviral therapy is mechanistically related to HIV pro-viruses integrating into host cells, including airway epithelial cells and alveolar macrophages. Alveolar macrophages harbor latent HIV even when individuals appear to have complete suppression on ART. In parallel, pneumonia can irreversibly impair lung function in HIV-infected individuals. Cells that Macrophages exposed to HIV or HIV-related proteins have been shown to secrete exosomes that contain miRNAs. These exosomes can regulate several innate and acquired immune functions by stimulating cytokine production and inflammatory responses. Furthermore, these secreted exosomal miRNAs can shuttle between cells, causing cellular dysfunction in the case of epithelial cells; they disrupt lung epithelial barrier dysfunction, which leads to a predisposition to bacterial infections. We discuss the common bacterial infections that occur in patients living with HIV and provide mechanistic insights into how the intercellular communication of miRNAs results in cellular dysfunction.

Breast cancer's hidden partner: meningoencephalitis as a paraneoplastic revelation: a rare presentation of invasive ductal carcinoma of breast: a case report.

Introduction and importance: Paraneoplastic neurologic syndromes encompass a group of neurologic disorders arising from pathological processes unrelated to metastasis, metabolic disturbances, infections, coagulopathy, or treatment-related side effects. These syndromes can affect various regions of the nervous system, resulting in diverse clinical manifestations. Case presentation: The authors present a rare case of anti-amphiphysin-associated meningoencephalitis in a South Asian Pakistani woman. Initially, the patient was managed for suspected infectious meningitis, but empirical treatment failed to yield improvement. Subsequent investigations unveiled a paraneoplastic syndrome secondary to breast cancer. Discussion: Diagnosing these clinical entities is challenging due to their multifaceted presentations, often leading to delayed identification, increased patient suffering, economic burdens, and preventable complications. Conclusion: Anti-amphiphysin-associated meningoencephalitis is a rare manifestation of paraneoplastic syndromes. It is crucial to raise awareness among healthcare professionals about the diverse presentations of paraneoplastic syndromes.

Surviving the desert's grasp: Decipherment phreatophyte Tamarix aphylla (L.) Karst. Adaptive strategies for arid resilience.

Phreatophytes play an important role in maintaining the ecological services in arid and semi-arid areas. Characterizing the interaction between groundwater and phreatophytes is critical for the land and water management in such areas. Therefore, the identification of key traits related to mitigating desertification in differently adapted T. aphylla populations was the focus. Fifteen naturally adapted populations of the prominent phreatophyte T. aphylla from diverse ecological regions of Punjab, Pakistan were selected. Key structural and functional modifications involved in ecological success and adaptations against heterogeneous environments for water conservation include widened metaxylem vessels in roots, enlarged brachy sclereids in stems/leaves, tissues succulence, and elevated organic osmolytes and antioxidants activity for osmoregulation and defense mechanism. Populations from hot and dry deserts (Dratio: 43.17-34.88) exhibited longer roots and fine-scaled leaves, along with enlarged vascular bundles and parenchyma cells in stems. Populations inhabiting saline deserts (Dratio: 38.59-33.29) displayed enhanced belowground biomass production, larger root cellular area, broadest phloem region in stems, and numerous large stomata in leaves. Hyper-arid populations (Dratio: 33.54-23.07) excelled in shoot biomass production, stem cellular area, epidermal thickness, pith region in stems, and lamina thickness in leaves. In conclusion, this research highlights T. aphylla as a vital model for comprehending plant resilience to environmental stresses, with implications for carbon sequestration and ecosystem restoration.

Exploring the sensing potential of Fe-decorated h-BN toward harmful gases: a DFT study.

Gas sensing technology has a broad impact on society, ranging from environmental and industrial safety to healthcare and everyday applications, contributing to a safer, healthier, and more sustainable world. We studied pure and Fe-decorated hexagonal boron nitride (h-BN) gas sensor for monitoring of carbon-based gases using density functional theory (DFT). The calculations utilized the Generalized Gradient Approximation with the Perdew-Burke-Ernzerhof (GGA-PBE) exchange-correlation functional. The novelty of our study lies in the investigation of the adsorption of harmful gases such as carbonyl sulfide, carbinol, carbimide, and carbonyl fluoride on both pure and Fe-decorated h-BN. The deviation in structural, electronic, and adsorption properties of h-BN due to Fe decoration has been studied along with the sensing ability to design said material towards carbon monoxide (CO), carbon dioxide (CO2), carbonyl sulfide (COS), carbinol, (CH4O), carbimide (CH2N2), and carbonyl fluoride (CF2O) gases. Gases such as CO, COS, CH2N2, and CF2O exhibited chemisorption, while CO2, and CH4O exhibited physisorption behavior. The introduction of Fe altered the semiconductor properties of h-BN and rendered it metallic. Enhanced electronic properties were observed due to a robust hybridization occurring between the d-orbitals of Fe-decorated BN and the gas molecules. The extended recovery periods observed for gases, aside from CO2, indicate their adhesive interactions with Fe-decorated h-BN. The reduction in desorption duration as temperature rises allows Fe-decorated h-BN to function as a reversible gas sensor. This research opens up a novel pathway for the synthesis and advancement of cost-effective, environmentally friendly double-atom catalysts with high sensitivity for capturing and detecting molecules such as CO, COS, CH2N2, CO2, CH4O, and CF2O.

Appendicitis in the Neutropenic Patient: A Systematic Review.

Neutropenia increases the complexity of surgical decision-making in cases of acute appendicitis. In this systematic review, we discuss medical vs surgical management and timing of appendectomy in the neutropenic adult patient. We queried databases utilizing the key words "neutropenia" and "appendicitis." The search identified 999 articles of which 481 articles were reviewed after duplicates were removed. Studies with pediatric patients, single case studies, and abdominal pain in neutropenic patients not caused by appendicitis were excluded. Seven studies remained in this review accounting for 130 patients, of which 28 were diagnosed with neutropenic appendicitis, and were included for final analysis. Four of the 7 articles were case reports, demonstrating the relative paucity of literature on this subject. Studies referred to the high risk of morbidity and mortality after surgical intervention in the neutropenic population, and attempting medical management first was common but not universal, reserving appendectomy for failure of medical management. Three studies suggested medical therapy as first-line management while 2 studies suggested surgical management and 2 studies did not distinguish a precedence. Both medical and surgical management have been successfully used in treating appendicitis in neutropenic patients. In most patients, medical management was attempted first (n = 16/28) vs immediate appendectomy (n = 7/28). Appendectomy was performed when medical management failed (n = 2/28) or after correction of neutropenia (n = 1/28). Timing or performance of appendectomy was unclear in 2 patients. With the increasing use of immunosuppressive medications, broad-spectrum antibiotics, and recent data from the CODA (Comparison of Outcomes of Antibiotic Drugs and Appendectomy) trial, medical management as a first-line treatment for most patients with neutropenia and appendicitis is warranted, and identifying a protocol for such patients would be of value.

Nuclear Medicine-A Name for Now and the Future.

ABSTRACT: Our article addresses the prevailing trend of new terminology introduced alongside the progress being made in nuclear medicine. Our article provides a historic, current, and future perspective.

Supervised Machine Learning Based Noninvasive Prediction of Atrial Flutter Mechanism from P-to-P Interval Variability under Imbalanced Dataset Conditions.

Atrial flutter (AFL) is a common arrhythmia with two significant mechanisms, namely, focal (FAFL) and macroreentry (MAFL). Discrimination of the AFL mechanism through noninvasive techniques can improve radiofrequency ablation efficacy. This study aims to differentiate the AFL mechanism using a 12-lead surface electrocardiogram. P-P interval series variability is hypothesized to be different in FAFL and MAFL and may be useful for discrimination. 12-lead ECG signals were collected from 46 patients with known AFL mechanisms. Features for a proposed classifier are extracted through descriptive statistics of the interval series. On the other hand, the class ratio of MAFL and FAFL was 41 : 5, respectively, which was highly imbalanced. To resolve this, different data augmentation techniques (SMOTE, modified-SMOTE, and smoothed-bootstrap) have been applied on the interval series to generate synthetic interval series and minimize imbalance. Modification is introduced in the classic SMOTE technique (modified-SMOTE) to properly produce data samples from the original distribution. The characteristics of modified-SMOTE are found closer to the original dataset than the other two techniques based on the four validation criteria. The performance of the proposed model has been evaluated by three linear classifiers, namely, linear discriminant analysis (LDA), logistic regression (LOG), and support vector machine (SVM). Filter and wrapper methods have been used for selecting relevant features. The best average performance was achieved at 400% augmentation of the FAFL interval series (90.24% sensitivity, 49.50% specificity, and 76.88% accuracy) in the LOG classifier. The variation of consecutive P-wave intervals has been shown as an effective concept that differentiates FAFL from MAFL through the 12-lead surface ECG.

Suppression of endoplasmic reticulum stress reverses hindlimb unloading-induced hepatic cellular processes in mice.

BACKGROUND: The Hindlimb unloaded mouse, an animal model of simulated microgravity demonstrates significant metabolic and hepatic derangements. However, cellular and molecular mechanisms driving liver dysfunction in Hindlimb unloaded mice are poorly characterized. METHODS: We investigated the possible contribution of dysregulated protein homeostasis by endoplasmic reticulum, endoplasmic reticulum stress, to liver dysfunction during HU. C57BL/6j male mice were grouped into ground-based controls or Hindlimb unloaded groups treated daily with vehicle or 4-phenylbutyrate (4-PBA), a potent inhibitor of endoplasmic reticulum stress. Following three weeks of HU, mice were sacrificed, and liver tissues were dissected for further analysis. RESULTS: Hindlimb unloaded was associated with hepatic atrophy and elevated endoplasmic reticulum stress, which was restored by 4-PBA treatment. The Gene Ontology analysis revealed the downregulation of genes primarily involved in liver metabolic and Wingless-related integration site (WNT) signaling pathways, while those related to cytochrome P450, and liver fibrosis were upregulated. The Kyoto Encyclopedia of Genes and Genomes pathway analysis revealed downregulation of several genes involved in metabolic pathways following treatment with 4-PBA, induced by HU. CONCLUSIONS: We report several differential and uniquely expressed genes associated with microgravity-induced elevated ER stress and liver injury. Our data has translational potential in unraveling novel molecular targets for pharmaceutical therapies of liver diseases. GENERAL SIGNIFICANCE: Our novel findings show a pathogenic role for elevated ER stress in liver injury in microgravity conditions.