Synthesis and characterizations of conocarpus- and azadirachta-derived activated carbons as wastewater recycling material.

Water being the most important fluid supporting the life as well as industry is getting sparse and polluted day by day. Activated carbon (AC) can be utilized in various applications of significant environmental impact and sustainable living such as carbon dioxide sensing and capturing, air purification, and water recycling. However, in the wake of the recent corona pandemic which resulted in global lockdown and took the entire world by shock, a cost-effective and simple synthesis of such a useful material remains dire need of time. Therefore, this paper describes a simple and cost-effective synthesis of activated carbon (AC) of high porosity and surface area derived from the pruning of conocarpus and azadirachta trees. In reference to the study under consideration, alongside numerous others, a furnace was employed to synthesize activated carbon. However, our approach utilized a more conventional methodology wherein the environmental parameters were not optimized. In furnace-based procedures, factors such as temperature, pressure, and humidity are meticulously regulated, contrasting with the conventional methodologies where such parameters lack optimal control. Consequently, employing a furnace does not constitute a cost-effective approach for the physical activation of organic samples thus proving a furnace is not imperative for physical activation. The synthesis was carried out by physical activation in the form of carbonization followed by chemical activation with potassium hydroxide (KOH). The influence of activated carbon from each pruning over filtration of water containing industrial dye was investigated. Activation temperature and impregnation ratio of 600-800 °C and 1:5 were selected respectively. X-ray diffraction patterns (XRD) for all AC samples indicted the appearance of broad peaks at 2θ value of 20-30° which confirms the presence of carbon in the sample. The physical morphology arrangement by SEM analysis showed uneven arrangement of pores of conocarpus which indicated higher iodine number and hence higher adsorption capacity of 442.13 mg/g.

Evaluation of Right-Side Filling Pressure in Patients With Obesity With Heart Failure Using Handheld Ultrasound Score.

The goal of this investigation is to evaluate the accuracy of handheld ultrasound score in assessing right atrial (RA) pressure in patients with obesity with heart failure. We prospectively studied 123 patients with heart failure referred for right-sided cardiac catheterization. Handheld ultrasound was performed before catheterization to evaluate volume status by estimating RA pressure using end-expiratory inferior vena cava (IVC) dimension, IVC respiratory collapsibility, and right internal jugular (RIJ) vein respiratory collapsibility. A 3-point simple score was created using multiple logistic regression. The patients were divided into 2 groups based on body mass index. The performance of this score was assessed using the receiver operating characteristics curve in each subgroup and was compared with the performance of the 2-point score (expiratory IVC dimension, IVC respiratory collapsibility). Median age was 58 years (interquartile range 48 to 65), and 37% were women. The 3-point score including RIJ performed better than did the 2-point score in patients with obesity (area under the curve 0.84 [0.74 to 0.95] vs 0.69 [0.58 to 0.81], p = 0.001). The performance of the scores did not differ in patients without obesity (area under the curve 0.85 [0.74 to 0.95] vs 0.82 [0.71 to 0.93], p = 0.49). In patients with obesity, the 3-point score had a specificity of 100% and sensitivity of 21% (11% to 31%) for elevated RA pressure ≥10 mm Hg. In conclusion, a 3-point score including both RIJ and IVC assessment performed better in patients with obesity with heart failure and highlights the importance of comprehensive evaluation in patients with obesity to achieve an accurate, noninvasive assessment of volume status.

Echocardiography in Percutaneous Left Atrial Appendage Occlusion and Related Complications.

Atrial fibrillation (AF) is a devastating disease with a large global prevalence. The left atrial appendage (LAA) is a major source of thrombi in patients with AF. Echocardiography plays an important role in identifying LAA thrombi and has become an invaluable imaging tool in planning for LAA occlusion (LAAO) in patients intolerant to anticoagulation. This review article will discuss the role of echocardiography in selecting patients for LAAO, intraprocedural monitoring, and identifying procedure-related complications.

Securing healthcare information system through fuzzy based decision-making methodology.

The purpose of the healthcare Information System (HIS) is to replace the conventional method of data gathering and organization in hospitals into a modern method of systematic data collection, maintenance and dissemination. There has been an unprecedented rise in the malware and cyber-attacks on HIS recently. Cyber-attacks have become a major crisis for the healthcare industry. To address this scenario, the present paper conducts a study on the security factors integral to the healthcare information system and conducts the performance analysis of these factors. For this intent, the study has employed the Fuzzy Analytic Hierarchy Process (F.AHP) integrated with Technique Order Preference by Similarity to Ideal Solution (TOPSIS) integrated framework for evaluating the performance of each factor. Thereafter, the factors that play a vital role in healthcare data security breaches have been prioritized as per their security weights. Furthermore, the validity of the results obtained by the stated methodology has been established by conducting the sensitivity analysis and comparison of results with the other methods by using the same data set. Based on results thus obtained, the access control and software security have been identified as the most promising security factors.

Accurate Estimation of Right-Filling Pressure Using Handheld Ultrasound Score in Patients with Heart Failure.

INTRODUCTION: This study aims to evaluate the accuracy of bedside assessment of inferior vena cava (IVC) and right internal jugular (RIJ) vein in predicting right atrial (RA) pressure in heart failure patients. METHODS: We prospectively studied 124 heart failure patients who were referred to our catheterization laboratory for right heart catheterizations to assess hemodynamics and to guide heart failure management. Just prior to the procedure, a handheld ultrasound examination was performed in each patient. The volume status was assessed by estimating RA pressure using end-expiratory IVC dimension, IVC respiratory collapsibility, and RIJ respiratory collapsibility. Patients were divided into 2 groups based on invasive RA pressure value. Multiple logistic regression models were used to identify factors associated with RA ≥10 mm Hg; a 3-point simple score was then created. The performance of this score was assessed using the receiver operating characteristics curve. RESULTS: In this study 124 heart failure patients were included; median age was 59 years (interquartile range 48-65), and 40% were female. RIJ respiratory collapsibility <50%, end-expiratory IVC dimension ≥21 mm, and respiratory collapsibility <50% were significantly associated with elevated RA pressure, and were used to build the score. The area under the receiver operating characteristics curve (AUC) for the 3-point score was 0.84 (0.77-0.92), and it performed better than 2-point score using IVC characteristics alone (AUC 0.84 [0.77-0.92] vs 0.75 [0.67-0.83]; P = .003). Of 124 patients, 90 patients (72.5%) had concordant RA pressure and pulmonary capillary wedge pressure. CONCLUSION: Concomitant ultrasound assessment of RIJ and IVC correlated better with RA pressure than IVC alone. A simple 3-point score can provide a useful and easily accessible tool to estimate volume status, and further guide management of heart failure patients.

Protective effects of apigenin against edifenphos-induced genotoxicity and cytotoxicity in rat hepatocytes.

Edifenphos (EDF) is an organophosphorus pesticide with antifungal and anti-insecticidal properties. However, EDF accumulates in various agricultural products and causes potential hazards to human health. Although numerous reports have indicated EDF accumulation in agricultural products, toxic effects on cellular system is poorly understood. In the present study, we investigated the cytotoxicity and genotoxicity of EDF in rat hepatocytes and its amelioration by apigenin (a dietary flavonoid). Results showed that EDF inhibited the cell viability, induced oxidative stress, DNA damage, loss of mitochondrial membrane potential (ΔΨm) and caspase-9/-3 activation in rat hepatocytes. Incubation of hepatocytes with N-acetyl cysteine (ROS scavenger) significantly abrogated the ROS generation and apoptosis caused by EDF. In addition, this study also showed that apigenin significantly suppressed the toxic effects of EDF by quenching ROS production thereby abrogating the caspase-9/-3 and apoptosis activation in hepatocytes. Taken together, the findings of this study demonstrate that EDF induces cytotoxicity and DNA damage in hepatocytes, and apigenin can be considered as an effective dietary anti-oxidant regimen against EDF- induced toxicity in cellular system.Communicated by Ramaswamy H. Sarma.

The Longest Documented Postoperative Survivor of a Brock Procedure 63 Years Later.

An infant with critical pulmonary valve stenosis underwent a Brock procedure in 1957 with subsequent repair of pulmonary stenosis and an atrial septal defect at age 6. At age 17 she underwent repair for paradoxical embolization secondary to a residual atrial septal defect. She presented 54 years later with recurrent pulmonary stenosis and a symptomatic 6.2-cm pulmonary artery aneurysm repaired with a 23-mm aortic homograft. This patient is the longest reported postoperative survivor after a Brock procedure. She continues to do well 63 years after her initial surgery.

Comparison of Echocardiographic Variables in Patients With Severe Aortic Stenosis and Preserved Ejection Fraction Grouped by Flow and Gradient.

The pathophysiology of severe aortic stenosis (AS) is complex with vascular, valvular, and myocardial components. To better define this process, we compared echocardiographic and clinical variables in patients with severe AS and preserved EF according to flow and gradient. We retrospectively studied the clinical and echocardiographic data of 287 patients (mean age 76 ± 11 years, 57% men) from 2012 to 2017 with severe AS (indexed aortic valve area <0.6 cm2/m2) and preserved ejection fraction (>50%). Patients were divided into 4 groups based on flow (stroke volume index < or ≥35 ml/m2) and mean aortic pressure gradient (< or ≥40 mm Hg): normal flow, high gradient (NFHG), normal flow, low gradient (NFLG), low flow, high gradient (LFHG) and low flow, low gradient (LFLG). Among patients with severe AS, 23% had NFHG, 44% had NFLG, 10% had LFHG, and 23% had LFLG. Only diabetes was marginally significantly different among the clinical variables. Aortic valve area index was largest in NFLG and smallest in LFHG (p < 0.001 for pairwise comparisons). Valvuloarterial impedance was highest in LFHG (p < 0.01 for pairwise comparisons). Systemic arterial compliance was lower and systemic vascular resistance was higher in low flow compared with normal flow groups. In conclusion, LFHG had the smallest valve area index along with markers of increased vascular resistance combined with high gradients, which suggests a unique pathophysiology in this group of severe AS patients with preserved EF.

Non-bacterial thrombotic endocarditis and coronary thrombectomy in a patient with metastatic small cell lung carcinoma.

A 66-year-old Caucasian man was initially admitted with a metastatic small cell lung carcinoma, hyponatraemia and obstructive pneumonia. His transthoracic echocardiogram (TTE) was normal. Ten days after admission, he was diagnosed with a non-ST segment elevation myocardial infarction (MI). Both a repeated TTE and a transoesophageal echocardiogram identified thickened, myxomatous mitral valve leaflet tips with small, mobile masses identified as vegetations, and new, eccentric, severe mitral regurgitation. Subsequent cardiac catheterisation recorded thrombotic occlusion of the right coronary artery. Successful coronary thrombectomy was carried out, but the patient died. A diagnosis of non-bacterial thrombotic endocarditis leading to coronary embolisation and MI was made. The clinical course and treatment choices are discussed.

Ensuring data integrity of healthcare information in the era of digital health.

Data integrity continues to be a persistent problem in the current healthcare sector. It ensures that the data is correct and has not even in any manner been improperly changed. Incorrect data might become significant health threats for patients and a big responsibility for clinicians, resulting in problems such as scam, misconduct, inadequate treatment and data theft. This sort of endangering scenario causes tremendous difficulty in handling healthcare data. This research intends to describe the threat plot of data integrity in healthcare through numerous attack statistics from around the world and Saudi Arabia and identify the criticality in Saudi Arabia in particular. A literature review by descriptive analysis, unit analysis and rating analysis to achieve the planned systematic literature review goal is outlined. The outcome of ranking analysis using a fuzzy analytical hierarchy process methodology offers a route for Saudi Arabian researchers to promote medical records or data security in Arabic healthcare. It is suggested that blockchain is the most prioritized method for regular use and adaptation across Saudi Arabia in all data integrity management techniques. To address the challenges of data integrity and future path, the authors critically examine the challenges posed by data integrity in the healthcare sector.

Echocardiographic evaluation of the Athlete's heart.

Cardiac response to prolonged, intense exercise induces phenotypic and physiologic adaptive changes that improve myocardial ability to meet oxygen demands. These adaptations, termed "athletes' heart," have been extensively studied. The importance of this entity arises from the increasing numbers of athletes as well as the drive for physical fitness in the general population leading to adaptive cardiac changes that need to be differentiated from life-threatening cardiovascular diseases. A number of pathologic entities may share phenotypic changes with the athletes' heart such as hypertrophic cardiomyopathy, dilated cardiomyopathy, Marfan's syndrome, and arrhythmogenic right ventricular cardiomyopathy. Cardiologists need to be cognizant of these overlapping findings to appropriately diagnose diseases and prevent catastrophic outcomes especially in young and healthy individuals who may not show any symptoms until they engage in intense exercise. It is equally important to recognize and distinguish normal, exercise-adaptive cardiac changes to provide accurate screening and guidance to young elite athletes. Echocardiography is a valuable modality that allows comprehensive initial evaluation of cardiac structures, function, and response to exercise. Several different echocardiographic techniques including M-Mode, 2D echo, Doppler, tissue Doppler, color tissue Doppler, and speckle tracking have been used in the evaluation of cardiac adaptation to exercise. The following discussion is a review of literature that has expanded our knowledge of the athlete's heart.

Recurrent COVID-19 in Hemodialysis: A Case Report of 2 Possible Reinfections.

Patients receiving in-center hemodialysis are at high risk for infections due to relative immunosuppression, limited ability to physically distance, and frequent encounters with the health care setting. This has been particularly evident during the coronavirus disease 2019 (COVID-19) pandemic. We describe 2 patients with suspected recurrent COVID-19 infection, each with documented clearance of virus between episodes. The duration between a negative reverse-transcription polymerase chain reaction test result for severe acute respiratory syndrome coronavirus 2 and symptomatic reinfection was 31 and 55 days, respectively, in the 2 patients. A higher risk for infection with COVID-19 and poor outcomes if infected, including ≥20% short-term mortality risk, is worrisome in this patient population. Continued measures such as infection prevention, community outreach, and early testing may play a role in establishing protocols to protect the vulnerable dialysis population.

Toxicity assessment of carmine and its interaction with calf thymus DNA.

Carmine (CRM) is a colouring agent, extensively used in a variety of foods, beverages, cosmetics and pharmaceuticals. A battery of in vitro toxicity tests and chemical interaction studies of CRM with calf thymus DNA (ctDNA) have been conducted. Hemolysis assay clearly revealed the cytotoxic potential of CRM while Allium cepa and seed germination tests for phytotoxicity of CRM were also positive. DNA binding studies withplasmid nicking assay, clearly affirmed the genotoxic potential of CRM. The formation of CRM-ctDNA complex was suggested by UV-visible absorption and fluorescence spectra. The binding constant of CRM-ctDNA complex determined by ITC was found to be 1.72 x 106M-1. It also revealed the negative ΔH and ΔS values, indicating the role of hydrogen bonds and Van der Waals interactions in the formation of CRM-ctDNA complex. A remarkable (43.4%) displacement of Hoechst as compared to acridine orange (100%) suggests probable disruption of groove which might be possible due to the large size of CRM. Intercalatory mode of CRM binding was further confirmed by significant increase in double helix melting temperature of ctDNA and changes it's in circular dichroism spectra. Molecular docking also supported the notion that DNA binding involved both modes i.e. intercalatory as well as groove binding; moreover, it is consistent with the binding energies determined from ITC. In a nutshell, CRM is significantly cytotoxic to human and plant systems with its remarkable genotoxic potential too, wherein it targets DNA as a partial intercalator and ultimately break its backbone.Communicated by Ramaswamy H. Sarma.

Two in One: Echocardiographic Features of Right-Ventricular Diverticulum and Left-Ventricular Aneurysm in the Same Patient.

Ventricular diverticulum is a rare congenital heart defect that is usually found incidentally upon imaging, such as 2-dimensional transthoracic echocardiogram. We report a case in which an isolated right-ventricular diverticulum and a left-ventricular aneurysm were both found on transthoracic echocardiogram in the setting of a pulmonary embolism. This case highlights how to distinguish between an aneurysm and a diverticulum based on wall motion on echocardiogram, as well as potential complications that may arise from either anomaly.

La présence d'un diverticule ventriculaire est une malformation cardiaque congénitale rare qui est habituellement détectée par accident lors d'un examen d'imagerie, par exemple une échocardiographie transthoracique bidimensionnelle. Nous exposons le cas d'une patiente présentant un diverticule ventriculaire droit isolé et un anévrisme ventriculaire gauche qui ont été décelés lors d'une échocardiographie transthoracique en contexte d'embolie pulmonaire. Nous expliquons comment faire la distinction entre un anévrisme et un diverticule en se fondant sur le déplacement de la paroi à l'échocardiographie, ainsi que les complications qui peuvent découler de ces deux anomalies.

Acute infective endocarditis masquerading as septic shock with acute respiratory distress syndrome.

Any new pulmonary edema warrants an urgent rule out of acute cardiac dysfunction. Because sepsis protocols emphasize rapid stabilization and treatment over etiologic evaluation, some cases of endocarditis may be missed as sepsis with acute respiratory distress syndrome.

Validation of left ventricular volume and ejection fraction measurements by high-definition blood flow imaging: Comparisons with cardiac magnetic resonance imaging and contrast echocardiography.

BACKGROUND: We recently reported the efficacy of High-definition blood flow imaging (HDI) in the assessment of left ventricular (LV) function and demonstrated that the results are comparable to those obtained by contrast echocardiography (CE). The present study validates HDI in measurements of LV volumes and ejection fraction (EF) by simultaneous comparisons with CE and cardiac magnetic resonance imaging (CMR). METHODS: Eighteen patients (age range 25-79 years) with limited echocardiographic images had measurements of LV end-diastolic volume (EDV, mL), end-systolic volume (ESV, mL), and EF (%) by HDI, CE, and CMR. RESULTS: Using the three techniques, measurements of EDV, ESV, and EF correlated well with correlation coefficients (r) ranging from .91 to .98 in comparisons between HDI and CMR, and .89 to .97 in comparisons between CE and CMR. The limits of agreement for the inter-methods comparisons by Bland-Altman analysis (mean ± 1.96 SD) between HDI and CMR were 4.92 ± 16.87% for EF, 21.53 ± 32.18 mL for EDV, and 10.69 ± 36.12 mL for ESV, between CE and CMR, the agreement limits were 2.48 ± 18.52% (LVEF), 24.58 ± 47.41 mL (EDV), and 14.09 ± 43.55 mL (ESV). CONCLUSIONS: Measurements of LV volumes and EF by HDI and CE correlated well with CMR. Using CMR as the gold standard, the agreements in measurements of LV volumes were superior for HDI compared to CE. In measurements of EF, CE showed less mean difference when compared to HDI. HDI measurements compared well with those obtained by CMR.

Scientific appraisal of Unani concept of islah-e-advia (rectification/purification of drugs) and its importance.

ETHNOPHARMACOLOGICAL RELEVANCE: Unani system of medicine uses drugs from plants, minerals and animals (Mawaleed-e-salasa) origin. Most of the drugs used are believed to be safe, but some drugs may have toxins and produce harmful effects, so it is very important to remove the toxins or to minimize their harmful effects before using, so as to increase their therapeutic values and make easy for use. AIM OF THE STUDY: To explore the concept, aims and objectives of islah-e-advia (rectification/purification of drugs) in Unani system of medicine. MATERIALS AND METHODS: A through literature survey was undertaken using the various online bibliographic databases like Pub Med, Google Scholar, Science Direct, Web of Science and Scopus. Classical Unani literature books which are translated in Urdu by CCRUM were used for Unani references. The keywords used for the search included "Tadbeer-e-Advia", "Islah-e-advia", Mudabbar process, detoxification and purification of drug. RESULTS: The ancient Unani physicians were well aware of toxicity of the drugs and have divided drugs into four degrees (1°, 2°, 3° and 4°) according to the Mizaj (temperament) of drugs. The fourth degree drugs produce so strong effects that the physiological functions of the body get disturbed; such drugs are also considered to be poisonous drugs. Different methods of purification have been mentioned for drugs belonging to the third and fourth degree temperament and always recommended their use after subjecting them to certain Tadbeer (rectification/purification). Otherwise these drugs may destroy the physiological function of the body. After purification process the drugs become physically and chemically pure, therapeutically more effective and less toxic. Very few pharmacological and toxicity studies have been conducted. CONCLUSION: Third and fourth degree drugs and its formulations have been claimed by Unani scholars to be useful in the management of various diseases of the body. After purification toxicity has been reduced in comparison crude drug. However, further elaborate and comprehensive studies are required to validate such claims.

Eustachian valve, interatrial shunt, and paradoxical embolism.

Randomized clinical trials demonstrate that percutaneous closure of the patent oval foramen is a safe and effective treatment for secondary prevention of cryptogenic stroke in selected patients. The Eustachian valve is generally considered an incidental finding without any significant pathophysiological consequences in adults. However, a persistent Eustachian valve, particularly a prominent one, is significantly more prevalent in patients with patent oval foramen and cryptogenic stroke, and is associated with adverse outcomes following percutaneous closure. Therefore, the Eustachian valve may not be an incidental finding or an innocent bystander. By directing the blood flow from the inferior caval vein to the interatrial septum, the persistence of a Eustachian valve may prevent spontaneous closure of the oval foramen, and predispose to paradoxical embolism during adulthood. The Eustachian valve should be considered an adjunctive risk factor for paradoxical embolism in patients with patent oval foramen. Furthermore, the Eustachian valve has been included in several risk prediction models to identify patients at the highest risk of paradoxical embolism and such patients may benefit the most from an intervention.

Three-dimensional echocardiography assessment of carcinoid valvular heart disease: Images of each and all.

A 54-year-old male was found to have neuroendocrine carcinoma with hepatic metastasis. Two-dimensional (2D) transthoracic echocardiography (TTE) demonstrated dilated right ventricle and right atrium, and severe tricuspid and pulmonary regurgitation. Three-dimensional (3D) TTE en-face views showed thickened, retracted, and fixed tricuspid valve and pulmonic valve which remained widely open throughout the cardiac cycle. 3D TTE, particularly en-face views, demonstrates incremental value over 2D TTE by providing precise valvular anatomic details comparable to surgical findings. 3D TTE also offers a unique opportunity to assess all four valves simultaneously with en-face views to delineate their relationships with surrounding structures.

Acute and sub-acute bisphenol-B exposures adversely affect sperm count and quality in adolescent male mice.

Bisphenol-B (BPB), an analogue of bisphenol-A is used in the plastic industry. It has been found to leach from plastic containers leading to its contamination in canned food products. Moreover, it has also been detected in human samples such as sera and urine. BPB is recognized as a potential endocrine disrupting chemical owing to its estrogenic and anti-androgenic nature. Therefore, it was pertinent to study the effect of BPB exposure during the adolescence age (5-6 weeks old) in male mice. Weekly intraperitoneal injections of 5, 10 and 15% LD50 of BPB were given for 2 weeks to acute exposure groups and for 4 weeks to sub-acute exposure groups. BPB exposure induces change in enzymatic and non-enzymatic oxidative stress markers in sperm samples. DNA damage was also observed in sperm cells on acute and sub-acute exposures. Furthermore, BPB exposure led to a marked decline in sperm count and compromised sperm morphology. Computer assisted sperm analysis (CASA) revealed a significant decrease in sperm quality and progressive motility. Thus, both the acute and sub-acute exposures of adolescent male mice to BPB adversely affect the sperms' quality, functions and morphology.