Probiotic set yogurt infused with orange pulp: A multifaceted evaluation of nutritional, antioxidant, and physical attributes.

Fortification of yogurt with orange pulp tends to increase its protein network strength resulting in reduced syneresis. The aim of the current study was to prepare set-type orange yogurt with cow milk, skim milk powder, guar gum, and orange pulp at 0%, 1.0%, 2.0%, 3.0%, and 4.0% concentrations, respectively. The changes in proximate, total soluble solid, antioxidant activity, ascorbic acid, and syneresis were assessed. Yogurt was stored for consecutive three weeks during that duration all attributes were evaluated weekly. Set-type orange pulp incorporated yogurt significantly increased the fat (3.91% to 4.9%), protein (3.90% to 3.94%), moisture (84% to 84.80%), total soluble solids (16.01% to 18.51%), ascorbic acid (16.99% to 20.43%), and syneresis (28.90% to 29.94%), respectively. Overall results indicate that 4% orange pulp-enriched set-type yogurt presented more stable parameters as compared to other formulas.

The Embolization of the Segmental Branch of Hepatic Artery Pseudoaneurysm Following Endoscopic Retrograde Cholangiopancreatography: A Case Report.

Endoscopic retrograde cholangiopancreatography (ERCP) remains the main therapeutic modality towards the management of common bile duct (CBD) stones and dilatation of strictures. It also has varied diagnostic roles including brush biopsy. The procedure still is associated with side effects and increased morbidity and mortality. One side effect is bleeding. This may be associated with procedural trauma or bleeding following post-traumatic pseudoaneurysm delayed-onset bleeding. Although it may be argued that inflammation surrounding the biliary duct area and in particular the pancreas could also contribute to the delayed bleeding along the ampullary region, we present a case of delayed pseudoaneurysm bleeding that was successfully managed post-ERCP via interventional radiology-guided embolization.

Anomalous Right Coronary Artery From Pulmonary Artery Presenting as Inferior Wall Ischemia: A Case Report.

We illustrate the case of a 62-year-old man with a symptomatic anomalous right coronary artery from pulmonary artery (ARCAPA). Our patient had presented with dyspnea on exertion with electrocardiogram showing pronounced inferior Q waves and marked inferolateral ST-T wave changes. The patient had a nuclear stress test which showed inferior wall ischemia. Subsequently, the patient underwent coronary angiography which showed an ARCAPA. The patient underwent surgical repair with reimplantation of the right coronary artery to the ascending aorta which was tolerated well. Our case illustrates ARCAPA presenting late in adulthood with ischemic symptoms that was treated with corrective surgery.

Geographic information system and information visualization capacity building: Successful polio eradication and current and future challenges in the COVID-19 era for the World Health Organization's African region.

Despite a half-century-long global eradication effort, polio continues to have a devastating impact on individuals and communities worldwide, especially in low-income countries affected by conflict or geographic barriers to immunization programs. In response, the World Health Organization (WHO) Global Polio Eradication Initiative (GPEI) employs disease surveillance and vaccination campaigns coordinated through the WHO Regional Office for Africa (AFRO) Geographic Information System (GIS) Centre. Established in 2017, the AFRO GIS Centre played a key role in the eradication of wild-type polioviruses (WPVs) in 2020, but the COVID-19 pandemic, emergence of circulating vaccine-derived polioviruses, and transmission of WPV1 from Central Asia have led to a resurgence of polio in Sub-Saharan Africa. The AFRO GIS comprises a set of mobile device or cloud-based tools for geospatial data collection, analysis, and visualization. Using tools such as Auto-Visual Acute Flaccid Paralysis Detection and Reporting, electronic surveillance, and Integrated Supportive Supervision, GIS personnel collect polio case numbers and locations, track field worker activities, follow the movements of nomadic populations vulnerable to polio and other diseases, and determine needs for further healthcare deployments. The system is location specific and operates in real time, enabling the AFRO GIS to promptly target its responses to polio, COVID-19, Ebola virus disease, and other public health crises and natural disasters. The present review describes the components of the AFRO GIS and how the AFRO GIS Centre coordinated on-the-ground polio eradication efforts to help secure Africa's certification as WPV free. It also examines current and prospective challenges regarding other disease outbreaks in the COVID-19 era and how the AFRO GIS Centre is addressing these ongoing public health needs.

Salmonella infective endocarditis in a young diabetic lady with device closure of PDA and VSD: A rare case report.

The risk of infective endocarditis remains a major concern in patients with congenital heart disease; nevertheless, use of devices and prostheses in corrective surgery may have contributed to an increased incidence. Infective endocarditis due to Salmonella species are infrequently reported, therefore, their clinical presentations, prognosis and optimal treatment guideline are poorly described in literature. Here, we report a case of an 18-year-old diabetic lady with history of device closure of Patent ductus arteriosus and closure of peri-membranous small Ventricular septal defect in the year of 2005 and 2018 respectively who presented to us with high-grade fever for 10 days without any focal symptom. She was initially diagnosed as a case of Enteric fever based on serological tests for Salmonella species, later Transesophageal echocardiography confirmed infective endocarditis. The patient was treated with combination of antibiotics for a total 6-week duration. Although very rare, Salmonella have a predilection for the heart valves, particularly mitral and aortic valves. Diagnosis may be difficult, blood culture is often negative and a Transesophageal echocardiography should be performed without delay particularly in high risk patients. In most cases Salmonella endocarditis can be successfully treated with antimicrobials alone.

High gain multi-band circularly polarized wearable leaky wave zipper MIMO antenna.

A miniaturized, multi-band, four-port wearable Multiple Input Multiple Output (MIMO) antenna is proposed, which contains a leaky wave textile antenna (LWTA) on denim (εr = 1.6, tanδ = 0.006) as substrate and Shieldit Super Fabric as conductor textile. The concept in this work involves incorporating the metal and plastic zipper into the garment to function as an antenna worn on the body. Simulations and measurements have been conducted to explore this idea. The LWTA has dimensions of 40 × 30 × 1 mm³. Every two ports are separated by a zipper with two different kinds of materials: Acetal Polymer Plastic (APP) and 90 % brass to improve the isolation, gain, and Impedance bandwidth. The antenna operates in the frequency ranges covering the L, C, S, and X bands. Additionally, diversity performance is evaluated using the Envelope Correlation Coefficient (ECC) and diversity gain (DG). Simulation and measurement findings agree well, with a maximum gain of 12.15 dBi, low Specific Absorption Rate (SAR) based on the standards, DG greater than 9.65 dB, circular polarization (CP), and strong isolation (<-23 dB) between each port. Since the antenna's characteristics do not change significantly under bending and when the zipper is opened, the proposed antenna is a viable candidate for body-centric wireless communications on the battlefield. For example, it can facilitate communication covering wireless local area network (WLAN) and fifth-generation (5G) communications.

Development of a Consolidated Health Facility Masterlist Using Data From Polio Electronic Surveillance in the World Health Organization African Region.

Geospatial data reporting from surveillance and immunization efforts is a key aspect of the World Health Organization (WHO) Global Polio Eradication Initiative in Africa. These activities are coordinated through the WHO Regional Office for Africa Geographic Information Systems Centre. To ensure the accuracy of field-collected data, the WHO Regional Office for Africa Geographic Information Systems Centre has developed mobile phone apps such as electronic surveillance (eSURV) and integrated supportive supervision (ISS) geospatial data collection programs. While eSURV and ISS have played a vital role in efforts to eradicate polio and control other communicable diseases in Africa, disease surveillance efforts have been hampered by incomplete and inaccurate listings of health care sites throughout the continent. To address this shortcoming, data compiled from eSURV and ISS are being used to develop, update, and validate a Health Facility master list for the WHO African region that contains comprehensive listings of the names, locations, and types of health facilities in each member state. The WHO and Ministry of Health field officers are responsible for documenting and transmitting the relevant geospatial location information regarding health facilities and traditional medicine sites using the eSURV and ISS form; this information is then used to update the Health Facility master list and is also made available to national ministries of health to update their respective health facility lists. This consolidation of health facility information into a single registry is expected to improve disease surveillance and facilitate epidemiologic research for the Global Polio Eradication Initiative, as well as aid public health efforts directed at other diseases across the African continent. This review examines active surveillance using eSURV at the district, country, and regional levels, highlighting its role in supporting polio surveillance and immunization efforts, as well as its potential to serve as a fundamental basis for broader public health initiatives and research throughout Africa.

Outcome of long-term biliary stenting for stones in the 2010s: beware the cholecystectomised!

Objective: Endoscopic retrograde cholangiopancreatography (ERCP) is the mainstay of management for most patients with common bile duct stones (CBDS). Duct clearance at initial ERCP may not be achieved in a third of patients, many of whom may be elderly with multiple comorbidities rendering them at potentially high risk for further procedures. We aimed to quantify the rate of biliary sequelae and mortality among a large cohort undergoing a single ERCP with sphincterotomy and stent insertion without having undergone complete ductal clearance (permanent stent insertion, PSI), and to examine factors that may predispose to adverse outcomes. Design/method: Outcomes of all ERCPs undertaken on the intact papilla between February 2010 and January 2020 were distilled to identify a cohort who had undergone PSI for initially irretrievable CBDS. These were subjected to retrospective follow-up until the development of biliary sequelae, death or survival into 2023. Results: There were 2175 index ERCPs for CBDS, of whom 114 met the PSI criteria. Eleven did not survive their index hospitalisation, leaving 103 for follow-up. Of these, 25 (24%) developed late biliary sequelae, 19 (18%) required at least one further ERCP and 8 (8%) died from biliary sequelae. Adverse outcomes were found to be more common among those who had undergone cholecystectomy prior to ERCP, and those with periampullary diverticula. Conclusions: Long-term biliary stenting following sphincterotomy remains a valid option for selected patients with initially irretrievable bile duct stones who could be at high risk from repeat procedures.

Recurrent Spontaneous Pneumothorax Secondary to Marijuana and Tobacco Abuse.

Primary spontaneous pneumothorax occurs in patients without apparent clinical lung disease, with a higher incidence in tall, thin males between the ages of 10 and 30. Tension pneumothorax is a life-threatening condition that can develop within minutes due to progressive air accumulation in the pleural space; mechanical pressure can lead to significant cardiorespiratory compromise. Tobacco association with a higher incidence of spontaneous pneumothorax has been well documented, but marijuana and spontaneous pneumothorax connection has not been well studied. However, it has been observed that patients who use marijuana and tobacco simultaneously have a higher incidence of spontaneous tension and larger pneumothoraces, as well as longer postoperative stay and higher recurrence than cigarette-only users. We present a case of a 26-year-old young male with a history only significant for excessive tobacco and marijuana smoking who developed multiple recurrent spontaneous pneumothorax and had to undergo right-sided video-assisted thoracoscopic surgery (VATS) with minimally invasive thoracotomy and had a prolonged hospital stay. With our case report, we hope to add to the evidence the effects of combined marijuana and tobacco smoking on bullous lung disease and pneumothorax while emphasizing the importance of conducting a detailed substance use history in patients with spontaneous pneumothorax.

Expert eValuation of Efficacy and Rationality of Vildagliptin "EVER-Vilda": An Indian Perspective.

Vildagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor is effective in reducing HbA1c levels in patients with type 2 diabetes (T2DM) when administered as monotherapy, dual or triple combination therapy. In India, Vildagliptin is commonly prescribed in T2DM patients because it reduces mean amplitude of glycemic excursion (MAGE), has lower risk of hypoglycemia and is weight neutral. Early combination therapy with vildagliptin and metformin is effective and well-tolerated in patients with T2DM, regardless of age or ethnicity. In view of already existing data on vildagliptin and the latest emerging clinical evidence, a group of endocrinologists, diabetologists and cardiologists convened for an expert group meeting to discuss the role and various combinations of vildagliptin in T2DM management. This practical document aims to guide Physicians and Specialists regarding the different available strengths and formulations of vildagliptin for the initiation and intensification of T2DM therapy.

Low-Loss Paper-Substrate Triple-Band-Frequency Reconfigurable Microstrip Antenna for Sub-7 GHz Applications.

In this paper, a low-cost resin-coated commercial-photo-paper substrate is used to design a printed reconfigurable multiband antenna. The two PIN diodes are used mainly to redistribute the surface current that provides reconfigurable properties to the proposed antenna. The antenna size of 40 mm × 40 mm × 0.44 mm with a partial ground, covers wireless and mobile bands ranging from 1.91 GHz to 6.75 GHz. The parametric analysis is performed to achieve optimized design parameters of the antenna. The U-shaped and C-shaped emitters are meant to function at 2.4 GHz and 5.9 GHz, respectively, while the primary emitter is designed to operate at 3.5 GHz. The proposed antenna achieved peak gain and radiation efficiency of 3.4 dBi and 90%, respectively. Simulated and measured results of the reflection coefficient, radiation pattern, gain, and efficiency show that the antenna design is in favorable agreement. Since the proposed antenna achieved wideband (1.91-6.75 GHz) using PIN diode configuration, using this technique the need for numerous electronic components to provide multiband frequency is avoided.

Preventive Saline Irrigation of the Bile Duct to Reduce the Rate of Residual Common Bile Duct Stones Without Intraductal Ultrasonography: A Systematic Review and Meta-Analysis.

Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST) has been proven efficacious in the removal of CBD stones. Even after endoscopic stone removal, recurring cholangitis due to a residual common bile duct (CBD) stone is prevalent in clinical practice with a residual recurrence rate of 4-24% after successful stone retrieval. This comprehensive study and meta-analysis aimed to determine if preventive saline irrigation of the bile duct (PSIB) reduces the amount of residual CBD stones. Through a comprehensive search of PubMed, EMBASE, Cochrane Library, and Web of Science until November 20, 2022, we identified 164 articles comparing the efficacy of PSIB and non-PSIB post-endoscopic CBD stone removal. After stringent selection, three studies were included for meta-analysis using ReviewManager (ReVman version 5.4.1; Cochrane, London, UK). Using a random effect (RE) model, we derived a pooled odds ratio (OR) with confidence interval (CI) (95%CI). A total of three studies have been included in the analysis. Out of which, two are randomized controlled trials (RCTs) and one is a non-randomized study. Out of 323 patients, 157 underwent PSIB after an endoscopic stone removal of CBD stones to reduce the residual of CBD stones, whereas 166 did not undergo saline irrigation (non-PSIB). In our analysis, PSIB significantly reduced the risk of residual stones (OR: 0.22, 95%CI: 0.11-0.45). However, there was no notable link between PSIB and post-irrigation cholangitis (OR: 1.08, 95%CI: 0.21-2.21). Although not statistically significant, PSIB showed a trend toward lowered risks of post-procedural pancreatitis (OR: 0.65), bleeding (OR: 0.68), and other complications (OR: 0.64). PSIB effectively reduces residual CBD stones after endoscopy, offering a cost-effective alternative to invasive procedures such as intraductal ultrasound (IDUS). However, larger RCTs are needed to validate its definitive role.

Understanding the Nuances of Hepatic Portal Venous Gas in Pneumatosis Intestinalis: An Indication of Bowel Ischemia?

Pneumatosis intestinalis (PI) is a relatively rare gastrointestinal finding that has a wide variety of causes - ranging from benign to life-threatening. It is described as the pathological presence of gas within the bowel wall with multiple hypotheses emerging as to the likely mechanism. An important indicator of a life-threatening source of PI is the presence of gas within the hepatic portal vein, referred to as hepatic portal venous gas (HPVG). While non-specific for isolated PI, HPVG has been reported in PI patients to be associated with bowel ischemia and is thereby considered an indication for emergent management. Herein we report a case involving an atypical presentation of altered mental status in which the patient was found to have PI with contemporaneous HPVG. These findings have been reported to have a high mortality rate. Our patient rapidly deteriorated during their hospital course, expiring shortly after being deemed a poor surgical candidate due to their severe co-morbidity burden. Through this case, we review evidence supporting the management of patients with PI and concurrent HPVG from an extensive review of available literature. While PI is a non-specific finding and commonly a source of diagnostic confusion, a better understanding of its natural course and potentially unorthodox sequela may afford more directed and crucial care for critically ill patients, in which time is often a precious commodity.

Quad Element MIMO Antenna for C, X, Ku, and Ka-Band Applications.

This article presents a quad-element MIMO antenna designed for multiband operation. The prototype of the design is fabricated and utilizes a vector network analyzer (VNA-AV3672D) to measure the S-parameters. The proposed antenna is capable of operating across three broad frequency bands: 3-15.5 GHz, encompassing the C band (4-8 GHz), X band (8-12.4 GHz), and a significant portion of the Ku band (12.4-15.5 GHz). Additionally, it covers two mm-wave bands, specifically 26.4-34.3 GHz and 36.1-48.9 GHz, which corresponds to 86% of the Ka-band (27-40 GHz). To enhance its performance, the design incorporates a partial ground plane and a top patch featuring a dual-sided reverse 3-stage stair and a straight stick symmetrically placed at the bottom. The introduction of a defected ground structure (DGS) on the ground plane serves to provide a wideband response. The DGS on the ground plane plays a crucial role in improving the electromagnetic interaction between the grounding surface and the top patch, contributing to the wideband characteristics of the antenna. The dimensions of the proposed MIMO antenna are 31.7 mm × 31.7 mm × 1.6 mm. Furthermore, the article delves into the assessment of various performance metrics related to antenna diversity, such as ECC, DG, TARC, MEG, CCL, and channel capacity, with corresponding values of 0.11, 8.87 dB, -6.6 dB, ±3 dB, 0.32 bits/sec/Hz, and 18.44 bits/sec/Hz, respectively. Additionally, the equivalent circuit analysis of the MIMO system is explored in the article. It's worth noting that the measured results exhibit a strong level of agreement with the simulated results, indicating the reliability of the proposed design. The MIMO antenna's ability to exhibit multiband response, good diversity performance, and consistent channel capacity across various frequency bands renders it highly suitable for integration into multi-band wireless devices. The developed MIMO system should be applicable on n77/n78/n79 5G NR (3.3-5 GHz); WLAN (4.9-5.725 GHz); Wi-Fi (5.15-5.85 GHz); LTE5537.5 (5.15-5.925 GHz); WiMAX (5.25-5.85 GHz); WLAN (5.725-5.875 GHz); long-distance radio telecommunication (4-8 GHz; C-band); satellite, radar, space communications and terrestrial broadband (8-12 GHz; X-band); and various satellite communications (27-40 GHz; Ka-band).

Design and Analysis of Modified U-Shaped Four Element MIMO Antenna for Dual-Band 5G Millimeter Wave Applications.

A novel compact-slotted four element multiple input multiple output (MIMO) planar monopole antenna is proposed for 5G mmWave N257/N258 and N262 band applications. The antenna, with dimensions of 12 mm × 11.6 mm × 0.508 mm (1.036λo ×1.001λo×0.043λo where λo is computed at lowest cutoff frequency), is fabricated on a Rogers RT/duroid 5880 (tm) substrate with a relative permittivity of 2.2 and a dielectric loss tangent of 0.0009. The suggested antenna consists of four U-shaped radiating elements (patches) on top of the dielectric material and a slotted ground on the bottom. The radiating elements are fed by a 50-ohm microstrip line feed. To improve the impedance performance of the MIMO antenna, a rectangular strip of 1.3 mm × 0.2 mm and a couple of rectangular slots are added to each radiating element. The first operating band at 27.1 GHz, ranging from 25.9 GHz to 27.8 GHz, is achieved by using slotted U-shaped radiating elements. The second operating band at 48.7 GHz, ranging from 47.1 GHz to 49.9 GHz, is obtained by etching hexagonal slots on the ground. The antenna design achieves an isolation of >27 dB through the orthogonal positioning of radiating elements and slots on the ground. The designed antenna operates at 27 GHz (N257/N258) and 48.7 GHz (N262) bands, exhibiting stable radiation patterns, a peak gain of >5.95 dBi, radiation efficiency of >90%, an envelope correlation coefficient of <10-6, a total active reflection coefficient of ≤-10 dB, channel capacity losses of <0.03 bits/s/Hz, and a mean effective gain of ≤-3 dB. The simulated and measured results of the antenna show good agreement, making it well-suited for 5G mmWave communication applications.

Dual-Band, Wide-Angle, and High-Capture Efficiency Metasurface for Electromagnetic Energy Harvesting.

A dual-band metasurface (MS) with a wide reception angle operating at Wi-Fi bands (2.4 GHz and 5.4 GHz) is presented for electromagnetic (EM) energy harvesting applications. The MS unit cell comprises a subwavelength circular split ring resonator printed on the low-loss substrate. An air layer is sandwiched between two low-loss substrates to enhance the harvesting efficiency at operating frequencies. One of the main advantages of the proposed MS is that it uses only one harvesting port (via) to channel the captured power to the optimized load (50 Ω), which simplifies the design of a combined power network. According to the results of full-wave EM simulations, the proposed MS has a near-unity efficiency of 97% and 94% at 2.4 GHz and 5.4 GHz, respectively, for capturing the power of incident EM waves with normal incidence. Furthermore, the proposed MS harvester achieves good performance at up to 60° oblique incidence. To validate simulations, the MS harvester with 5 × 5-unit cells is fabricated and tested, and its EM properties are measured, showing good agreement with the simulation results. Because of its high efficiency, the proposed MS harvester is suitable for use in various microwave applications, such as energy harvesting and wireless power transfer.

Lamin A/C cardiomyopathy presenting as high-grade atrioventricular (AV) block, atrial fibrillation, heart failure and ventricular tachycardia in a single-family cluster.

Mutations in the lamin A/C (LMNA) gene have been associated with both cardiac and skeletal muscle abnormalities. Cardiac manifestations in LMNA cardiomyopathy have a variable age of onset and range from mild to life-threatening. We describe a case series illustrating manifestations of LMNA mutation in a single family with an extensive history of cardiac disease, including sudden cardiac death, and the implications for diagnosis and management. This discussion highlights potential presentations of LMNA mutations and the importance of genetic testing in patients with a family history of conduction abnormalities.

A Compact MIMO Multiband Antenna for 5G/WLAN/WIFI-6 Devices.

This research work presents a compact design of a Multiple-Input Multiple-Output (MIMO) multiband antenna along with high-isolation characteristics. The presented antenna was designed for 3.50 GHz, 5.50 GHz, and 6.50 GHz frequencies for 5G cellular, 5G WiFi, and WiFi-6, respectively. The fabrication of the aforementioned design was undertaken using FR-4 (1.6 mm thickness) substrate material with a loss tangent and relative permittivity of about 0.025 and 4.30, respectively. The two-element MIMO multiband antenna was miniaturized to 16 × 28 × 1.6 mm3, making it desirable for devices operating in 5G bands. High isolation (>15 dB) was attained with thorough testing without employing a decoupling scheme in the design. Laboratory measurements resulted in a peak gain of 3.49 dBi and an efficiency of around 80% in the entire operating band. The evaluation of the presented MIMO multiband antenna was carried out in terms of the envelope correlation coefficient (ECC), diversity gain (DG), total active reflection coefficient (TARC), and Channel Capacity Loss (CCL). The measured ECC was less than 0.04, and the DG was well above 9.50. The observed TARC was also lower than -10 dB, and the CCL was below 0.4 bits/s/Hz in the entire operating band. The presented MIMO multiband antenna was analyzed and simulated using CST Studio Suite 2020.

Correction: Recurrent Brain Metastasis Versus Radiation-Induced Necrosis: A Case Report and Literature Review.

[This corrects the article DOI: 10.7759/cureus.34400.].