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Evans syndrome (ES) is a rare autoimmune condition of unknown etiology that occurs in a small subset of patients diagnosed, either sequentially or concomitantly, with immune thrombocytopenia (ITP) or warm autoimmune hemolytic anemia (AIHA). Neutropenia is present occasionally. Diagnosis is based on exclusion with a median age of 52 years of age. Here we have a case of a young patient with ES presenting with recurrent infection. ES should be included in differential diagnoses for patients presenting with AIHA, ITP, cytopenias or recurrent infection as the prognosis is more favorable when diagnosis is made early and symptoms are still mild.
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Antennas play a critical role in modern technology. They are used in various devices and applications, including wireless communication, broadcasting, navigation, military, and space. Overall, the importance of antennas in technology lies in their ability to transmit and receive signals, allowing communication and information transfer across various applications and devices. Three-dimensional printing technology creates antennas using multiple materials, including plastics, metals, and ceramics. Some standard 3D printing techniques used to create antennas include Fused Deposition Modeling (FDM), Stereolithography (SLA), and Selective Laser Sintering (SLS). These antennas can be made in various shapes and sizes. 3D printing can help create complex and customized antenna designs that are difficult or impossible to produce using traditional manufacturing methods. 3D-printing technology has many advantages for building antennas, including customization, ease of fabrication, and cost-effectiveness. This review comprehensively evaluates the usage of 3D-printing technology in antenna fabrication.
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Using the linear elastic finite element method, we investigated how defects significantly influence the integrity of 3D-printed parts made from biodegradable material by experimental techniques and numerical simulations. A defective flaw was incorporated into the tensile test dog-bone sample using Computer-Aided Design and processed by slicing software. Three distinct raster angles examine two sets of samples, one featuring intact specimens and the other with the introduced defects. An open-source 3D printer was used to fabricate both sets of samples, utilizing biodegradable PLA material. In finite element analysis, we employed a highly detailed model that precisely accounted for the geometry and dimensions of the extruded 3D-printed filament, accurately replicating the actual configuration of the 3D-printed samples to an extent. Our study involved a thorough comparative analysis between the experimental results and the FEA simulations. Our findings uncovered a consistent trend for the intact and defective samples under tensile load. Specifically, in the intact case, the samples with a zero-degree raster orientation presented the highest resistance to failure and displayed minimal elongation. Remarkably, these conclusions paralleled our observations of the defective samples as well. Finite element analysis revealed that the stresses, including Principal, Max shear, and Von Mises, were remarkably higher at the 3D-printed samples' outer surface than the inner layers, reflecting that the failure starts at the outer surface since they exceeded the theoretical values, indicating a significant discrepancy between the simulated and anticipated values.
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Hematopoietic stem-cell transplantation (HSCT) has emerged as a groundbreaking therapeutic option for acute myeloid leukemia (AML) and specific subtypes of acute lymphoblastic leukemia (ALL). The prognostic significance of the NOD2/CARD15 gene has been explored alongside various factors, encompassing diverse patient cohorts and gene variants. Siblings and unrelated donors used for stem cell transplantation exhibit significant associations between their genetic variations and graft-versus-host disease incidence. The transplantation of stem cells for leukemia patients involves numerous considerations, including patient survival, relapse rates, disease stage, donor and recipient ages, and compatibility. This study delved into research on the NOD2/CARD15 gene and its mutations to assess its suitability as a screening tool. A comprehensive literature search encompassing PubMed, ScienceDirect, and Google Scholar articles yielded 4,840 articles. After removing duplicates and applying inclusion and exclusion criteria, we narrowed the search results to 876 articles. Subsequent screening of abstracts and titles resulted in the selection of 230 relevant articles. Further exclusion of 198 articles unrelated to the research question led to the scrutinizing of 32 full-text articles, which were assessed against inclusion and exclusion criteria. Emphasis was placed on articles that specifically investigated the role of NOD2/CARD15 as a predictive factor for HSCT outcomes, ultimately resulting in the inclusion of 19 articles in this study. Single nucleotide polymorphisms (SNPs) such as NOD2 and CARD15 have demonstrated their potential as reliable genetic markers for predicting post-transplantation relapse and disease outcomes. Patients positive for these genetic markers have exhibited reduced overall survival and event-free survival and increased transplant-related mortality. Interventions with interferon-gamma and muramyl tripeptide phosphatidylethanolamine have been considered to mitigate the inflammatory effects of these SNPs, thus enhancing the influence of natural killer cells on abnormal cells and potentially extending patient survival. NOD2/CARD15 typing may aid in identifying patients at higher risk for relapse and improving their clinical outcomes after allogeneic stem cell transplant, particularly in ALL patients. However, no remarkable change was observed in AML patients. Additionally, this study underscores the pivotal roles of adaptive and innate immune responses and their interplay in stem cell transplant immunology.
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Since the Fourth Industrial Revolution, three-dimensional (3D) printing has become a game changer in manufacturing, particularly in bioengineering, integrating complex medical devices and tools with high precision, short operation times, and low cost. Antimicrobial materials are a promising alternative for combating the emergence of unforeseen illnesses and device-related infections. Natural antimicrobial materials, surface-treated biomaterials, and biomaterials incorporated with antimicrobial materials are extensively used to develop 3D-printed products. This review discusses the antimicrobial mechanisms of different materials by providing examples of the most commonly used antimicrobial materials in bioengineering and brief descriptions of their properties and biomedical applications. This review will help researchers to choose suitable antimicrobial agents for developing high-efficiency biomaterials for potential applications in medical devices, packaging materials, biomedical applications, and many more.
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Anti-Infecciosos , Materiais Biocompatíveis , Materiais Biocompatíveis/farmacologia , Impressão Tridimensional , Bioengenharia , Engenharia Biomédica , Anti-Infecciosos/farmacologia , Anti-Infecciosos/uso terapêuticoRESUMO
Introduction: Herpes simplex virus (HSV) is associated with one of the lethal diseases, Herpes simplex encephalitis (HSE). Diagnosis is confirmed using MRI and CT scan imaging techniques and more sensitive DNA PCR from cerebrospinal fluid analysis and brain biopsy.Case presentation: However, after four days, the patient's HSE diagnosis was confirmed by the detection of herpes simplex virus type 1 (HSV1) via polymerase chain reaction (PCR) testing. This case highlights the importance of utilizing multiple diagnostic aids and not solely relying on initial test results, as infections may not appear in CSF analysis or MRI scans initially. Furthermore, this case also emphasizes the necessity of initiating empirical treatment based on clinical signs and symptoms, even in cases where diagnostic tests initially appear negative. Prompt and efficient diagnosis and treatment are crucial in managing HSE and preventing long-term neurological damage.Conclusion: This case of HSE underscores the significance of a multifaceted diagnostic approach and timely intervention in managing this potentially severe and life-threatening condition. As mentioned, sometimes the infection does not appear in CSF analysis initially, nor does its effects appear in MRI. HSV PCR remains the golden test to confirm the diagnosis of HSE.
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In recent years, carbon fiber has experienced a significant surge in popularity attributed to its exceptional properties, including its high-temperature resistance, mechanical strength, and cost-effectiveness. Many industries have been attracted to the prevalent use of carbon-fiber-reinforced polymers or plastics (CFRP). However, the increasing demand for carbon fiber has created a waste recycling problem that needs to be addressed. This research aimed to develop a recycled composite using PET waste as a solution to the growing demand for both materials. The recycled carbon fibers were processed chemically and mechanically to generate power for this process. Various samples were tested with different proportions of CF (10%, 20%, 30%, and 40%) to analyze their mechanical properties. The recycled composites are examined under tensile test conditions to further explore the waste carbon reinforcement's effect on polymers' characteristics. Scanning electron microscopy was also utilized for mechanical morphology evaluations. After analyzing the data, it was found that samples containing 20% CF had the highest elastic modulus value among all the mixes. This is attributed to the reinforcing effect of the fibers. The Elasticity Modulus of the filaments increased with the concentration of CF, reaching its peak at 20% before decreasing. This trend is also apparent in the visual representations. When compared to recycling, the Elasticity Modulus value of 20% CF filament increased by 97.5%. The precise value for CF with a 20% filament is 4719.3 MPa. Moreover, the composite samples were analyzed using SEM to characterize them, and it was discovered that the incorporation of 20% CF/PET filler produced the composition with the highest strength.
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INTRODUCTION: The evidence about the optimal revascularization strategy in patients with left main coronary artery (LMCA) disease and impaired renal function is limited. Thus, we aimed to compare the outcomes of LMCA disease revascularization (percutaneous coronary intervention [PCI] vs. coronary artery bypass grafting [CABG]) in patients with and without impaired renal function. METHODS: This retrospective cohort study included 2,138 patients recruited from 14 centers between 2015 and 2,019. We compared patients with impaired renal function who had PCI (n= 316) to those who had CABG (n = 121) and compared patients with normal renal function who had PCI (n = 906) to those who had CABG (n = 795). The study outcomes were in-hospital and follow-up major adverse cardiovascular and cerebrovascular events (MACCE). RESULTS: Multivariable logistic regression analysis showed that the risk of in-hospital MACCE was significantly higher in CABG compared to PCI in patients with impaired renal function (odds ratio [OR]: 8.13 [95% CI: 4.19-15.76], p < 0.001) and normal renal function (OR: 2.59 [95% CI: 1.79-3.73]; p < 0.001). There were no differences in follow-up MACCE between CABG and PCI in patients with impaired renal function (HR: 1.14 [95% CI: 0.71-1.81], p = 0.585) and normal renal function (HR: 1.12 [0.90-1.39], p = 0.312). CONCLUSIONS: PCI could have an advantage over CABG in revascularization of LMCA disease in patients with impaired renal function regarding in-hospital MACCE. The follow-up MACCE was comparable between PCI and CABG in patients with impaired and normal renal function.
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Doença da Artéria Coronariana , Intervenção Coronária Percutânea , Humanos , Intervenção Coronária Percutânea/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/cirurgia , Rim/cirurgiaRESUMO
Novel strategies and materials have gained the attention of researchers due to the current pandemic, the global market high competition, and the resistance of pathogens against conventional materials. There is a dire need to develop cost-effective, environmentally friendly, and biodegradable materials to fight against bacteria using novel approaches and composites. Fused filament fabrication (FFF), also known as fused deposition modeling (FDM), is the most effective and novel fabrication method to develop these composites due to its various advantages. Compared to metallic particles alone, composites of different metallic particles have shown excellent antimicrobial properties against common Gram-positive and Gram-negative bacteria. This study investigates the antimicrobial properties of two sets of hybrid composite materials, i.e., Cu-PLA-SS and Cu-PLA-Al, are made using copper-enriched polylactide composite, one-time printed side by-side with stainless steel/PLA composite, and second-time with aluminum/PLA composite respectively. These materials have 90 wt.% of copper, 85 wt.% of SS 17-4, 65 wt.% of Al with a density of 4.7 g/cc, 3.0 g/cc, and 1.54 g/cc, respectively, and were fabricated side by side using the fused filament fabrication (FFF) printing technique. The prepared materials were tested against Gram-positive and Gram-negative bacteria such as Escherichia coli (E. coli), Staphylococcus aureus (S. aureus), Pseudomonas aeruginosa (P. aeruginosa), Salmonella Poona (S. Poona), and Enterococci during different time intervals (5 min, 10 min, 20 min, 1 h, 8 h, and 24 h). The results revealed that both samples showed excellent antimicrobial efficiency, and 99% reduction was observed after 10 min. Hence, three-dimensional (3D) printed polymeric composites enriched with metallic particles can be utilized for biomedical, food packaging, and tissue engineering applications. These composite materials can also provide sustainable solutions in public places and hospitals where the chances of touching surfaces are higher.
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Antibacterianos , Anti-Infecciosos , Animais , Antibacterianos/farmacologia , Cobre , Escherichia coli , Bactérias Gram-Negativas , Bactérias Gram-Positivas , Staphylococcus aureus , Aves , Anti-Infecciosos/farmacologia , Impressão TridimensionalRESUMO
Natural fibers or their derivatives have gained significant attention as green fillers or reinforcement materials due to their abundant availability, environment-friendly nature and biodegradability for sustainable development. Despite the availability of modern alternatives such as concrete, glass-fiber/resin composites, steel, and plastics, there is still considerable demand for naturally occurring based materials for different applications due to their low cost, durability, strength, heat, sound, and fire-resistance characteristics. 3D printing has provided a novel approach to the development and advancement of natural fiber-based composite materials, as well as an important platform for the advancement of biomass materials toward intelligentization and industrialization. The features of 3D printing, particularly fast prototyping and small start-up, allow the easy fabrication of materials for a wide range of applications. This review highlights the current progress and potential commercial applications of 3D printed composites reinforced with natural fibers or biomass. This study discussed that 3D printing technology can be effectively utilized for different applications, including producing electroactive papers, fuel cell membranes, adhesives, wastewater treatment, biosensors, and its potential applications in the automobile, building, and construction industries. The research in the literature showed that even if the field of 3D printing has advanced significantly, problems still need to be solved, such as material incompatibility and material cost. Further studies could be conducted to improve and adapt the methods to work with various materials. More effort should be put into developing affordable printer technologies and materials that work with these printers to broaden the applications for 3D printed objects.
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[This corrects the article DOI: 10.1155/2023/6608279.].
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OBJECTIVE: To determine the relative efficacy of structured named diet and health behaviour programmes (dietary programmes) for prevention of mortality and major cardiovascular events in patients at increased risk of cardiovascular disease. DESIGN: Systematic review and network meta-analysis of randomised controlled trials. DATA SOURCES: AMED (Allied and Complementary Medicine Database), CENTRAL (Cochrane Central Register of Controlled Trials), Embase, Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and ClinicalTrials.gov were searched up to September 2021. STUDY SELECTION: Randomised trials of patients at increased risk of cardiovascular disease that compared dietary programmes with minimal intervention (eg, healthy diet brochure) or alternative programmes with at least nine months of follow-up and reporting on mortality or major cardiovascular events (such as stroke or non-fatal myocardial infarction). In addition to dietary intervention, dietary programmes could also include exercise, behavioural support, and other secondary interventions such as drug treatment. OUTCOMES AND MEASURES: All cause mortality, cardiovascular mortality, and individual cardiovascular events (stroke, non-fatal myocardial infarction, and unplanned cardiovascular interventions). REVIEW METHODS: Pairs of reviewers independently extracted data and assessed risk of bias. A random effects network meta-analysis was performed using a frequentist approach and grading of recommendations assessment, development and evaluation (GRADE) methods to determine the certainty of evidence for each outcome. RESULTS: 40 eligible trials were identified with 35 548 participants across seven named dietary programmes (low fat, 18 studies; Mediterranean, 12; very low fat, 6; modified fat, 4; combined low fat and low sodium, 3; Ornish, 3; Pritikin, 1). At last reported follow-up, based on moderate certainty evidence, Mediterranean dietary programmes proved superior to minimal intervention for the prevention of all cause mortality (odds ratio 0.72, 95% confidence interval 0.56 to 0.92; patients at intermediate risk: risk difference 17 fewer per 1000 followed over five years), cardiovascular mortality (0.55, 0.39 to 0.78; 13 fewer per 1000), stroke (0.65, 0.46 to 0.93; 7 fewer per 1000), and non-fatal myocardial infarction (0.48, 0.36 to 0.65; 17 fewer per 1000). Based on moderate certainty evidence, low fat programmes proved superior to minimal intervention for prevention of all cause mortality (0.84, 0.74 to 0.95; 9 fewer per 1000) and non-fatal myocardial infarction (0.77, 0.61 to 0.96; 7 fewer per 1000). The absolute effects for both dietary programmes were more pronounced for patients at high risk. There were no convincing differences between Mediterranean and low fat programmes for mortality or non-fatal myocardial infarction. The five remaining dietary programmes generally had little or no benefit compared with minimal intervention typically based on low to moderate certainty evidence. CONCLUSIONS: Moderate certainty evidence shows that programmes promoting Mediterranean and low fat diets, with or without physical activity or other interventions, reduce all cause mortality and non-fatal myocardial infarction in patients with increased cardiovascular risk. Mediterranean programmes are also likely to reduce stroke risk. Generally, other named dietary programmes were not superior to minimal intervention. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016047939.
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Doenças Cardiovasculares , Infarto do Miocárdio , Acidente Vascular Cerebral , Humanos , Doenças Cardiovasculares/prevenção & controle , Metanálise em Rede , Fatores de Risco , Infarto do Miocárdio/prevenção & controle , Acidente Vascular Cerebral/prevenção & controle , Dieta com Restrição de GordurasRESUMO
Methods: We report the case of a 73-year-old Saudi female who presented with severe thrombocytopenia and mild autoimmune hemolytic anemia associated with brucellosis. The coexistence of published cases of two hematological disorders with brucellosis is rare. Results: Despite the initial treatment with eltrombopag and intravenous immunoglobulin (IVIG), our patient's platelets count remained low and significantly improved after initiation of brucellosis treatment in the form of rifampicin and doxycycline. Discussion. We conclude by reviewing the case that in many parts of Saudi Arabia, brucellosis remains a prevalent infection. Hence, it should be considered as a possible diagnosis in febrile individuals with no localizing indications and the presence of severe thrombocytopenia in acute febrile illness. Although it is a rare association, it could be related to brucellosis. Conclusion: This is our region's first published case of severe thrombocytopenia and mild autoimmune hemolytic anemia associated with brucellosis. It contributes to the literature on the successful use of rifampicin and doxycycline to treat hematological disorders associated with brucellosis.
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AIMS: The impact of left ventricular dysfunction on clinical outcomes following revascularization is not well established in patients with unprotected left main coronary artery disease (ULMCA). In this study, we evaluated the impact of left ventricular ejection fraction (LVEF) on clinical outcomes of patients with ULMCA requiring revascularization with percutaneous coronary intervention (PCI) compared with coronary artery bypass graft (CABG). METHODS: The details of the design, methods, end points, and relevant definitions are outlined in the Gulf Left Main Registry: a retrospective, observational study conducted between January 2015 and December 2019 across 14 centres in 3 Gulf countries. In this study, the data on patients with ULMCA who underwent revascularization through PCI or CABG were stratified by LVEF into three main subgroups; low (l-LVEF <40%), mid-range (m-LVEF 40-49%), and preserved (p-LVEF ≥50%). Primary outcomes were hospital major adverse cardiovascular and cerebrovascular events (MACCE) and mortality and follow-up MACCE and mortality. RESULTS: A total of 2137 patients were included; 1221 underwent PCI and 916 had CABG. During hospitalization, MACCE was significantly higher in patients with l-LVEF [(10.10%), P = 0.005] and m-LVEF [(10.80%), P = 0.009], whereas total mortality was higher in patients with m-LVEF [(7.40%), P = 0.009] and p-LVEF [(7.10%), P = 0.045] who underwent CABG. There was no mortality difference between groups in patients with l-LVEF. At a median follow-up of 15 months, there was no difference in MACCE and total mortality between patients who underwent CABG or PCI with p-LVEF and m-LVEF. CONCLUSION: CABG was associated with higher in-hospital events. Hospital mortality in patients with l-LVEF was comparable between CABG and PCI. At 15 months' follow-up, PCI could have an advantage in decreasing MACCE in patients with l-LVEF.
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Doença da Artéria Coronariana , Stents Farmacológicos , Intervenção Coronária Percutânea , Humanos , Volume Sistólico , Intervenção Coronária Percutânea/efeitos adversos , Estudos Retrospectivos , Função Ventricular Esquerda , Resultado do Tratamento , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Sistema de RegistrosRESUMO
In this study, silica in the form of raw local natural sand was added to high-density-polyethylene (HDPE) in order to develop a composite material in the form of sheets that could have potential applications in thin film industries, such as packaging, or recycling industries, such as in 3D printing. The silica/HDPE composite sheets were developed using a melt extruder followed by using a hot press for compression molding. The impact of two different particle sizes (25 µm and 5 µm) of the silica particles on selected properties such as toughness, elastic modulus, ductility, and composite density were analyzed. A considerable increase in the toughness and elastic modulus was observed from 0 wt% to 20 wt% with a 25 µm filler size. However, a general decreasing trend was observed in the material's toughness and elastic modulus with decreasing particle size. A similar trend was observed for the ductility and the tensile strength of the sheets prepared from both filler particle sizes. In terms of the composite density, as the filler was increased from 20 wt% to 50 wt%, an increase in the composite densities was noticed for both particle sizes. Additionally, the sheets developed with 25 µm particle size had a slightly higher density than the 5 µm particle size, which is expected as the size can account for the higher weight. Results from this work aim to analyze the use of local sand as a filler material that can contribute towards maximizing the potential of such composite materials developed in extrusion industries.
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Due to the prevailing existence of the COVID-19 pandemic, novel and practical strategies to combat pathogens are on the rise worldwide. It is estimated that, globally, around 10% of hospital patients will acquire at least one healthcare-associated infection. One of the novel strategies that has been developed is incorporating metallic particles into polymeric materials that neutralize infectious agents. Considering the broad-spectrum antimicrobial potency of some materials, the incorporation of metallic particles into the intended hybrid composite material could inherently add significant value to the final product. Therefore, this research aimed to investigate an antimicrobial polymeric PLA-based composite material enhanced with different microparticles (copper, aluminum, stainless steel, and bronze) for the antimicrobial properties of the hybrid composite. The prepared composite material samples produced with fused filament fabrication (FFF) 3D printing technology were tested for different time intervals to establish their antimicrobial activities. The results presented here depict that the sample prepared with 90% copper and 10% PLA showed the best antibacterial activity (99.5%) after just 20 min against different types of bacteria as compared to the other samples. The metallic-enriched PLA-based antibacterial sheets were remarkably effective against Staphylococcus aureus and Escherichia coli; therefore, they can be a good candidate for future biomedical, food packaging, tissue engineering, prosthetic material, textile industry, and other science and technology applications. Thus, antimicrobial sheets made from PLA mixed with metallic particles offer sustainable solutions for a wide range of applications where touching surfaces is a big concern.
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Anti-Infecciosos , Tratamento Farmacológico da COVID-19 , Alumínio , Antibacterianos/farmacologia , Anti-Infecciosos/farmacologia , Cobre , Escherichia coli , Humanos , Pandemias , Poliésteres , Polímeros , Impressão Tridimensional , Aço InoxidávelRESUMO
OBJECTIVE: To evaluate the impact of repair of uterovaginal prolapse using sacrospinous hysteropexy on female sexual function. METHODS: A cross-sectional study was conducted at the Urogynecology Clinic of the Suez Canal University Hospital from May 2014 to April 2019. Twenty-seven women with a diagnosis of uterovaginal prolapse and wishing to preserve their uteri were recruited. Sacrospinous ligament fixation was done. Sexual symptoms were assessed using the female sexual function index (FSFI) questionnaire just before and 6 months after the operation. RESULTS: The mean age of the participants was 36.5 ± 4 years. Sacrospinous hysteropexy only was performed for three women. Additional procedures included anterior colporrhaphy (12), posterior colporrhaphy (9), and perineorrhaphy (15). There was a significant improvement in pre- and postoperative patients' orgasm (3.1 ± [0.8] vs. 3.7 ± [1.1]; p value = 0.03) and satisfaction (3.4 ± [0.6] vs. 4.2 ± [0.8]; p value < 0.001) while there was worsening of pain (4.3 ± [1.5] vs. 3.2 ± [1.6]; p value = 0.017). There was insignificant improvement in the other three domains as well as total score of FSFI, with all patients having sexual dysfunction. CONCLUSION: Sacrospinous hysteropexy was associated with significant improvement orgasm and satisfaction domains of FSFI and significant worsening of pain.