Unusual manifestations of Takayasu arteritis: A diagnostic challenge.

Key Clinical Message: Timely recognition of atypical Takayasu arteritis is crucial. Unusual presentations, such as pericardial effusion, can complicate diagnosis. CT angiogram aids in precise diagnosis, guiding targeted immunosuppressive therapy. Multidisciplinary collaboration is vital for comprehensive management, improving patient outcomes in this challenging condition. Abstract: This case study highlights the diagnostic challenges posed by atypical presentations of Takayasu arteritis (TA), focusing on a 42-year-old male presenting with pericardial effusion. Despite inconclusive initial investigations, a CT angiogram revealed large vessel vasculitis, confirming TA. Management with immunosuppressive therapy led to clinical improvement. This case emphasize the importance of recognizing unusual manifestations of TA for timely diagnosis and appropriate treatment, emphasizing the role of multidisciplinary collaboration in optimizing patient outcomes.

Neonatal lupus with complete heart block and long term follow up.

We present the case of a 27-year-old pregnant woman, newly diagnosed with Systemic Lupus Erythematosus (SLE) during pregnancy. The patient delivered a newborn at 38 weeks gestation, who, on the first day of life, manifested complete heart block. This case underscores the clinical challenges associated with neonatal lupus, emphasizing the need for collaborative, multidisciplinary management.

Successful revascularization of inferior ST-segment elevation myocardial infarction with positive "Dead Man Sign": A case report.

This case report outlines the management of a 43-year-old male with no past medical history presenting with inferior ST-segment elevation myocardial infarction and a positive "Dead Man Sign." Prompt administration of antiplatelet therapy and emergent percutaneous coronary intervention led to successful revascularization of the occluded right coronary artery and left anterior descending artery. The patient remained asymptomatic throughout hospitalization and was discharged home with instructions for monthly follow-up for 1 year. Subsequent assessments demonstrated normal echocardiography and Electrocardiography (ECG) findings, indicating favorable cardiac recovery. This case emphasizes the critical importance of rapid recognition and intervention in ST-segment elevation myocardial infarction cases, as well as the significance of the Dead Man Sign as a predictor of the occluded culprit coronary vessels, demonstrating favorable outcomes achievable with timely revascularization strategies.

Rib fracture secondary to cough-induced trauma.

Early identification of rib fractures, even in young patients without chronic diseases, is essential. Prompt diagnosis facilitates appropriate management, aiding in pain control and addressing underlying causes such as persistent coughing. Additionally, vigilance for complications such as pneumothorax and rib displacement is crucial for optimizing patient care.

Single-dose ibuprofen induced Stevens-Johnson Syndrome.

Key Clinical Message: Ibuprofen single dose may rarely induce Stevens-Johnson Syndrome, emphasizing the vital need for heightened vigilance in healthcare and public awareness for safer medication practices. Abstract: Stevens-Johnson Syndrome (SJS) is a severe and potentially life-threatening skin disorder associated with certain medications, including ibuprofen. We present a case of a 45-year-old woman who developed SJS following a single dose of ibuprofen. Despite its rarity, this case underscores the importance of heightened vigilance in healthcare and public awareness regarding the potential risks of commonly used medications. Prompt recognition of SJS symptoms and immediate medical intervention are crucial for patient outcomes. Healthcare providers should exercise caution when prescribing ibuprofen, particularly in patients with a history of adverse drug reactions. This case emphasizes the need for ongoing monitoring, patient education, and informed decision-making to promote medication safety and optimal patient care.

De Winter syndrome in action: Captured on defibrillator.

De Winter syndrome, though rare, demands heightened clinical suspicion. Recognizing its electrocardiographic subtleties is crucial, as prompt diagnosis allows for life-saving interventions such as percutaneous coronary intervention or thrombolysis.

Congenital diaphragmatic hernia in patient with 1p36 deletion.

Key Clinical Message: This case underscores the atypical presentation of late-onset congenital diaphragmatic hernia in a 9-old with 1p36 deletion syndrome. Recognition of respiratory distress and abdominal symptoms is crucial for intervention. Abstract: Congenital Diaphragmatic Hernia (CDH) is a condition characterized by the protrusion of abdominal contents into the thoracic cavity due to a defect in the diaphragm. While typically observed in the neonatal period, CDH can present in later life. This case report describes the presentation, diagnosis, and management of a nine-year-old boy with 1p36 deletion syndrome who presented with respiratory distress, abdominal pain, vomiting, and anorexia. The initial diagnosis was tension pneumothorax, and thus the patient underwent chest tube placement. However, a high-resolution CT scan revealed a left hemidiaphragmatic hernia, and the patient eventually underwent an emergency laparotomy due to acute-onset respiratory distress. Intraoperatively, a diagnosis of Bochdalek hernia with gastric perforation was made, and the CDH and gastric perforations were resolved successfully. This case highlights the importance of considering late-presenting CDH as a possible diagnosis in pediatric patients with similar symptoms and the radiological findings suggestive of tension pneumothorax. Early recognition and prompt surgical intervention can lead to successful management of such cases.

Assessment of the Effect of Different Irrigation Protocols on the Penetration of Irrigation Solution into Simulated Lateral Canals (In Vitro Study).

OBJECTIVE: To compare the effectiveness of lateral canal irrigation penetration by conventional needle, passive ultrasonic, sonic endo activator, and Erbium laser (2780nm). METHODS: A total of 40 palatal roots of human maxillary first molars were collected and instrumented at a working length of 12 mm by an X1-X4 rotary Protaper Next system (Dentsply, Maillefer, Ballaigues, Switzerland) using the crown-down technique. Artificial lateral canals were made at 2, 4, and 6 mm from the apex on mesial and distal sides using an ISO rotary reamer (Dentsply, Maillefer, Ballaigues, Switzerland; #10 for mesial, #08 for distal). The samples were then cleared using methyl salicylate. A solution of black ink and normal saline was used as an irrigant for the root canal. The percentages of the penetration of the ink into the lateral canals were measured using a stereomicroscope (Q-Scope, Arnhem, The Netherlands) with the aid of program Image J. The Tukey test is used to assess the significant difference between intragroup and intergroup comparisons of different thirds, and the T-test is used to assess the significant difference between every two groups and for the mesial and distal sides of each group. The level of significance was set at 0.05. RESULTS: Results showed that none of the activation techniques used resulted in complete lateral canal penetrations; however, on both sides at all thirds, the Erbium laser (2780 nm) achieved the highest results with a highly significant statistical difference (p=0.05) with all other groups, and the least penetration was in the conventional needle group. CONCLUSION: The size of the lateral canal is a restricting factor for all activation methods; the best results can be achieved by laser. Conventional needles cannot be used alone to disinfect complex canal anatomy; however, passive ultrasonic and sonic endo activator activations can produce comparable results.

Outbreak investigation of NDM-producing Burkholderia cepacia causing neonatal sepsis in Pakistan.

Aim: To investigate the outbreak of Burkholderia cepacia complex (BCC), mortality, antimicrobial resistance and associated risk factors in the neonatal intensive care unit. Method: Eighteen blood culture samples from neonates and twenty swab samples from different neonatal intensive care unit surfaces were collected. The VITEK 2 was used to confirm the isolates and generate the antibiogram. PCR was used to identify blaNDM. Results: Eighteen samples tested positive for BCC, and 10/18 (55.5%) of the neonates died. 13/18 (72%) of the neonates had late-onset neonatal sepsis, and 10/18 (55%) had low birth weight. Resistance to minocycline and chloramphenicol was 100%, 72.2% to meropenem; 72.2% NDM gene was found in neonates and was 20% from the environment. Conclusion: Outbreak of NDM-producing BCC resulting in high neonatal mortality in NICU.

Neonatal septicemia, or blood poisoning, is a dangerous illness in newborns. It is caused by bacteria or other infections entering the blood and spreading. Pregnancy, labor, delivery and exposure after birth can result in infection of the newborn. Neonatal septicemia kills 700,000 babies worldwide, mostly in low- and middle-income countries. Burkholderia cepacia complex bacteria can cause infections in people with weaker immune systems or other disorders. They are particularly dangerous in hospitals, as they can cause chronic lung problems. This study collected blood samples from newborns with blood poisoning. Most samples that contained Burkholderia cepacia complex were not susceptible to drugs. Four of the newborns carried the same bacteria, indicating that hospital staff should practice hand washing and equipment and environmental cleaning to prevent the spread of the bacteria.

On Indoor Localization Using WiFi, BLE, UWB, and IMU Technologies.

Indoor localization is a key research area and has been stated as a major goal for Sixth Generation (6G) communications. Indoor localization faces many challenges, such as harsh wireless propagation channels, cluttered and dynamic environments, non-line-of-sight conditions, etc. There are various technologies that can be applied to address these issues. In this paper, four major technologies for implementing an indoor localization system are reviewed: Wireless Fidelity (Wi-Fi), Ultra-Wide Bandwidth Radio (UWB), Bluetooth Low Energy (BLE), and Inertial Measurement Units (IMU). Sections on Data Fusion (DF) and Machine Learning (ML) have been included as well due to their key role in Indoor Positioning Systems (IPS). These technologies have been categorized based on the techniques that they employ and the associated errors in localization. A brief comparison between these technologies is made based on specific performance metrics. Finally, the limitations of these techniques are identified to aid future research.

Correction: Che et al. Indoor Positioning System (IPS) Using Ultra-Wide Bandwidth (UWB)-For Industrial Internet of Things (IIoT). Sensors 2023, 23, 5710.

There was an error in the original publication [...].

Indoor Positioning System (IPS) Using Ultra-Wide Bandwidth (UWB)-For Industrial Internet of Things (IIoT).

The integration of the physical and digital world has become increasingly important, and location-based services have become the most sought-after application in the field of the Internet of Things (IoT). This paper delves into the current research on ultra-wideband (UWB) indoor positioning systems (IPS). It begins by examining the most common wireless communication-based technologies for IPSs followed by a detailed explanation of UWB. Then, it presents an overview of the unique characteristics of UWB technology and the challenges still faced by the IPS implementation. Finally, the paper evaluates the advantages and limitations of using machine learning algorithms for UWB IPS.

Design and Application of Intelligent Reflecting Surface (IRS) for Beyond 5G Wireless Networks: A Review.

The existing sub-6 GHz band is insufficient to support the bandwidth requirement of emerging data-rate-hungry applications and Internet of Things devices, requiring ultrareliable low latency communication (URLLC), thus making the migration to millimeter-wave (mmWave) bands inevitable. A notable disadvantage of a mmWave band is the significant losses suffered at higher frequencies that may not be overcome by novel optimization algorithms at the transmitter and receiver and thus result in a performance degradation. To address this, Intelligent Reflecting Surface (IRS) is a new technology capable of transforming the wireless channel from a highly probabilistic to a highly deterministic channel and as a result, overcome the significant losses experienced in the mmWave band. This paper aims to survey the design and applications of an IRS, a 2-dimensional (2D) passive metasurface with the ability to control the wireless propagation channel and thus achieve better spectral efficiency (SE) and energy efficiency (EE) to aid the fifth and beyond generation to deliver the required data rate to support current and emerging technologies. It is imperative that the future wireless technology evolves toward an intelligent software paradigm, and the IRS is expected to be a key enabler in achieving this task. This work provides a detailed survey of the IRS technology, limitations in the current research, and the related research opportunities and possible solutions.

Response of Aphid Parasitoids to Volatile Organic Compounds from Undamaged and Infested Brassica oleracea with Myzus persicae.

Headspace solid microextraction (HS-SPME) and GC-MS were used to investigate volatile organic compounds (VOCs) from cabbage plants infested and uninfested with green peach aphid Myzus persicae. The HS-SPME combined with GC-MS analysis of the volatiles described the differences between the infested and uninfested cabbage. Overall, 28 compounds were detected in infested and uninfested cabbage. Some VOCs released from infested cabbage were greater than uninfested plants and increased the quantity of the composition from infested plants. According to the peak area from the GC-MS analysis, the VOCs from infested cabbage consisted of propane, 2-methoxy, alpha- and beta pinene, myrcene, 1-hexanone, 5-methyl-1-phenyl-, limonene, decane, gamma-terpinen and heptane, 2,4,4-trimethyl. All these volatiles were higher in the infested cabbage compared with their peak area in the uninfested cabbage. The results of the study using a Y-shape olfactometer revealed that the VOCs produced by infested cabbage attracted Myzus persicae substantially more than uninfested plants or clean air. The percentage of aphid choice was 80% in favor of infested cabbage; 7% were attracted to the clean air choice and uninfested plants. A total of aphids 7% were attracted to clean air. Comparing between infested and uninfested cabbage plants, the aphid was attracted to 63% of the infested cabbage, versus 57% of the uninfested cabbage. The preferences of Aphidus colemani and Aphelinus abdominalis to the infested or uninfested plants with M. persicae and compared with clean air indicated that parasitoids could discriminate the infested cabbage. Both parasitoids significantly responded to the plant odor and were attracted to 86.6% of the infested cabbage plants.

The molecular basis of extensively drug-resistant Salmonella Typhi isolates from pediatric septicemia patients.

Sepsis is a syndromic response to infections and is becoming an emerging threat to the public health sector, particularly in developing countries. Salmonella Typhi (S. Typhi), the cause of typhoid fever, is one primary cause of pediatric sepsis in typhoid endemic areas. Extensively drug-resistant (XDR) S. Typhi is more common among pediatric patients, which is responsible for over 90% of the reported XDR typhoid cases, but the majority of antibiotic resistance studies available have been carried out using S. Typhi isolates from adult patients. Here, we characterized antibiotic-resistance profiles of XDR S. Typhi isolates from a medium size cohort of pediatric typhoid patients (n = 45, 68.89% male and 31.11% female) and determined antibiotic-resistance-related gene signatures associated with common treatment options to typhoid fever patients of 18 XDR S. Typhi representing all 45 isolates. Their ages were 1-13 years old: toddlers aging 1-2 years old (n = 9, 20%), pre-schoolers aging 3-5 years old (n = 17, 37.78%), school-age children aging 6-12 years old (n = 17, 37.78%), and adolescents aging 13-18 years old (n = 2, 4.44%). Through analyzing blaTEM1, dhfR7, sul1, and catA1genes for multidrug-resistance, qnrS, gyrA, gyrB, parC, and parE for fluoroquinolone-resistance, blaCTX-M-15 for XDR, and macAB and acrAB efflux pump system-associated genes, we showed the phenotype of the XDR S. Typhi isolates matches with their genotypes featured by the acquisitions of the genes blaTEM1, dhfR7, sul1, catA1, qnrS, and blaCTX-M-15 and a point mutation on gyrA. This study informs the molecular basis of antibiotic-resistance among recent S. Typhi isolates from pediatric septicemia patients, therefore providing insights into the development of molecular detection methods and treatment strategies for XDR S. Typhi.

Evaluation of Aphicidal Effect of Essential Oils and Their Synergistic Effect against Myzus persicae (Sulzer) (Hemiptera: Aphididae).

The insecticidal activities of essential oils obtained from black pepper, eucalyptus, rosemary, and tea tree and their binary combinations were investigated against the green peach aphid, Myzus persicae (Aphididae: Hemiptera), under laboratory and glasshouse conditions. All the tested essential oils significantly reduced and controlled the green peach aphid population and caused higher mortality. In this study, black pepper and tea tree pure essential oils were found to be an effective insecticide, with 80% mortality when used through contact application. However, for combinations of essential oils from black pepper + tea tree (BT) and rosemary + tea tree (RT) tested as contact treatment, the mortality was 98.33%. The essential oil combinations exhibited synergistic and additive interactions for insecticidal activities. The combination of black pepper + tea tree, eucalyptus + tea tree (ET), and tea tree + rosemary showed enhanced activity, with synergy rates of 3.24, 2.65, and 2.74, respectively. Essential oils formulation was effective on the mortality of aphids. Fourier Transform Infrared Spectroscopy (FTIR) analysis showed that stability of a mixture of essential oils was not affected by store temperature (15, 25, and 35 °C) and the functional groups were not changed during storage. Based on our results, the essential oils can be used as a commercial insecticide against M. persicae.

Device Free Detection in Impulse Radio Ultrawide Bandwidth Systems.

In this paper, an analytical framework is presented for device detection in an impulse radio (IR) ultra-wide bandwidth (UWB) system and its performance analysis is carried out. The Neyman-Pearson (NP) criteria is employed for this device-free detection. Different from the frequency-based approaches, the proposed detection method utilizes time domain concepts. The characteristic function (CF) is utilized to measure the moments of the presence and absence of the device. Furthermore, this method is easily extendable to existing device-free and device-based techniques. This method can also be applied to different pulse-based UWB systems which use different modulation schemes compared to IR-UWB. In addition, the proposed method does not require training to measure or calibrate the system operating parameters. From the simulation results, it is observed that an optimal threshold can be chosen to improve the ROC for UWB system. It is shown that the probability of false alarm, PFA, has an inverse relationship with the detection threshold and frame length. Particularly, to maintain PFA<10-5 for a frame length of 300 ns, it is required that the threshold should be greater than 2.2. It is also shown that for a fix PFA, the probability of detection PD increases with an increase in interference-to-noise ratio (INR). Furthermore, PD approaches 1 for INR >-2 dB even for a very low PFA i.e., PFA=1×10-7. It is also shown that a 2 times increase in the interference energy results in a 3 dB improvement in INR for a fixed PFA=0.1 and PD=0.5. Finally, the derived performance expressions are corroborated through simulation.

Magnetic molecularly imprinted polymer nanoparticles for the extraction and clean-up of thiamethoxam and thiacloprid in light and dark honey.

In this work, new selective and sensitive dual-template molecularly imprinted polymer nanoparticles (MIPs) were synthesized and characterized. Sorbent MIPs were investigated for simultaneous extraction and clean-up of thiamethoxam and thiacloprid from light and dark honey samples. In this study, ultra-high-performance liquid chromatography-tandem mass spectrometry triple-quadrupole (UHPLC-MS/MS) (QQQ) was used to detect and quantify the pesticides. The kinetic model with adsorption kinetics of sorbent was investigated. The optimal adsorption conditions were 80 mg of polymer MIPs, a 30-min extraction time, and a pH of 7. The detection limit (LOD) and the quantification limit (LOQ) varied from 0.045 to 0.070 µg kg-1 and from 0.07 to 0.10 µg kg-1, respectively. The intra-day and inter-day precision (RSD, %) ranged from 1.3 to 2.0% and from 8.2 to 12.0%, respectively. The recovery of thiamethoxam and thiacloprid ranged from 96.8 to 106.5% and 95.3 to 104.4%, respectively, in light and dark honey samples.

A Survey of Autonomous Vehicles: Enabling Communication Technologies and Challenges.

The Department of Transport in the United Kingdom recorded 25,080 motor vehicle fatalities in 2019. This situation stresses the need for an intelligent transport system (ITS) that improves road safety and security by avoiding human errors with the use of autonomous vehicles (AVs). Therefore, this survey discusses the current development of two main components of an ITS: (1) gathering of AVs surrounding data using sensors; and (2) enabling vehicular communication technologies. First, the paper discusses various sensors and their role in AVs. Then, various communication technologies for AVs to facilitate vehicle to everything (V2X) communication are discussed. Based on the transmission range, these technologies are grouped into three main categories: long-range, medium-range and short-range. The short-range group presents the development of Bluetooth, ZigBee and ultra-wide band communication for AVs. The medium-range examines the properties of dedicated short-range communications (DSRC). Finally, the long-range group presents the cellular-vehicle to everything (C-V2X) and 5G-new radio (5G-NR). An important characteristic which differentiates each category and its suitable application is latency. This research presents a comprehensive study of AV technologies and identifies the main advantages, disadvantages, and challenges.

Role of hematological parameters in the stratification of COVID-19 disease severity.

OBJECTIVE: COVID-19 virus involves respiratory as well as other body systems including cardiovascular, gastrointestinal, neurological, immunological and hematopoietic system. Patient of covid-19 pneumonia presents with wide range of hemostatic abnormalities. These hemostatic abnormalities in COVID-19 are related with disease progression, severity and mortality. The Objective of our study is to evaluate the role of hematological parameters in determination of COVID-19 disease severity. MATERIAL AND METHOD: This was a retrospective study, conducted in Department of Pathology and Department of medicine, FMH college of Medicine and Dentistry from May 2020 to July 2020. Total of 101, confirmed cases of covid-19 disease, both genders between 17 and 75-year age were included. Hematological parameters were compared in mild, moderate, severe and critical disease group. Continuous variables were analyzed by using non parametric, Kruskal Wallis test while categorical variables were analyzed by chi-square test. RESULTS: Out of 101 patients, 20.8%, 51.8%,19.8% and 7.9% were in mild, moderate, severe and critical group respectively. Median (IQR) values of WBCs (p-value 0.004), ANC (p-value 0.002), NLR (p-value 0.001), D-dimer level (p-value 0.001), ferritin (0.0001), LDH (0.0001) were significantly increased in patients with critical disease. Median (IQR) values of APTT (p-value 0.003) and CRP (p- value 0.0001) were suggestively higher in patients with severe disease. Other parameters like Hemoglobin, MCV, HCT, ALC, Platelet count, prothrombin time did not show statistically significant association with severity of disease. CONCLUSION: The study concluded that Leukocytosis, neutrophilia, elevated Neutrophil to lymphocyte ratio, APTT, D-dimer, LDH and serum ferritin and CRP are associated with severity of covid-19 disease.