Characteristics and clinical outcomes of patients with sarcoidosis admitted for ST-elevation myocardial infarction in the United States: a propensity matched analysis from the National Inpatient Sample.

Introduction: Sarcoidosis is a systemic inflammatory disorder characterised by non-caseating granulomas. Cardiac sarcoidosis (CS) normally causes conduction abnormalities, ventricular arrhythmias, and heart failure. Little is known about the characteristics and impact of sarcoidosis in patients admitted with ST-elevation myocardial infarction (STEMI). This study aims to fill this void. Material and methods: Utilising the National Inpatient Sample (NIS) database (2016-2020), individuals with STEMI were identified and categorised based on sarcoidosis presence whilst adjusting for confounders via logistic regression models. Results: Among 851,290 STEMI patients, 1215 had sarcoidosis. Before propensity matching, sarcoidosis patients were notably different in demographics and comorbidities compared to non-sarcoidosis patients. After propensity score matching (PSM), sarcoidosis patients were found to have a higher incidence of supraventricular tachycardia (SVT) (2.5% vs. 1.3%, p = 0.024) and acute kidney injury (AKI) (23.3% vs. 20.8%, aOR = 1.269, 95% CI: 1.02-1.58, p = 0.033) but a lower incidence of undergoing coronary artery bypass graft (CABG) (5.5% vs. 8.5%, aOR = 0.663; 95% CI: 0.472-0.931, p = 0.018), while no significant disparities were noted in PCI, cardiogenic shock, mortality, or mean length of stay (LOS). Conclusions: Using propensity-matched large real-world data of STEMI patients, sarcoidosis was associated with fewer cases of CABG and a greater incidence of AKI and SVT compared to non-sarcoidosis patients.

Developmental Formulation Principles of Food Preservatives by Nanoencapsulation-Fundamentals, Application, and Challenges.

The role of food additives is to preserve food by extending shelf life and limiting harmful microorganism proliferation. They prevent spoilage by enhancing the taste and safety of food by utilizing beneficial microorganisms and their antimicrobial metabolites. Current advances in food preservation and processing utilize green technology principles for green preservative formulation, enhancing nutrition and supplying essential micronutrients safely, while also improving quality, packaging, and food safety. Encapsulation is gaining attention for its potential to protect delicate materials from oxidative degradation and extend their shelf life, thereby ensuring optimal nutrient uptake. Nanoencapsulation of bioactive compounds has significantly improved the food, pharmaceutical, agriculture, and nutraceutical industries by protecting antioxidants, vitamins, minerals, and essential fatty acids by controlling release and ensuring delivery to specific sites in the human body. This emerging area is crucial for future industrial production, improving the sensory properties of foods like color, taste, and texture. Research on encapsulated bioactive compounds like bacteriocins, LAB, natamycin, polylysine, and bacteriophage is crucial for their potential antioxidant and antimicrobial activities in food applications and the food industry. This paper reviews nanomaterials used as food antimicrobial carriers, including nanoemulsions, nanoliposomes, nanoparticles, and nanofibers, to protect natural food antimicrobials from degradation and improve antimicrobial activity. This review discusses nanoencapsulation techniques for biopreservative agents like nisin, poly lysine, and natamycin, focusing on biologically-derived polymeric nanofibers, nanocarriers, nanoliposomes, and polymer-stabilized metallic nanoparticles. Nanomaterials, in general, improve the dispersibility, stability, and availability of bioactive substances, and this study discusses the controlled release of nanoencapsulated biopreservative agents.

Comparing outcomes of an 'early' versus 'late' diagnosis of cardiac sarcoidosis following a baseline presentation of high-grade atrioventricular block.

BACKGROUND: There is a paucity of evidence on impact of a delay in Cardiac Sarcoidosis (CS) diagnosis after high-grade atrioventricular-block (AVB) and this study aims to fill this void. METHODS: Consecutive CS patients (n = 77) with high grade AVB referred to one specialist hospital in London between February 2007 to February 2023 were retrospectively reviewed. The median time from AVB to diagnosing CS (112 days) was used to define the Early (n = 38) and Late (n = 39) cohorts. The primary endpoint was a composite of all-cause mortality, cardiac transplantation, ventricular arrhythmic events or heart failure hospitalisation. Secondary endpoints included difference in maintenance prednisolone dose, need for cardiac device upgrade and device complications. RESULTS: The mean age of the cohort was 54.4 (±10.6) years of whom 64 % were male and 81 % Caucasian. After a mean follow up of 54.9 (±45.3) months, the primary endpoint was reached by more patients from the Late cohort (16/39 vs. 6/38, p = 0.02; multivariable HR 6.9; 95 %CI 1.5-32.2, p = 0.01). Early Group were more likely to have received an Implantable Cardioverter Defibrillator or Cardiac Resynchronisation Therapy-defibrillator as index device after AVB (19/38 vs. 6/39; p < 0.01) and had fewer device upgrades (19/38 vs. 30/39, p = 0.01) and a trend towards fewer device complications (1 vs. 5, p = 0.20). The maintenance dose of prednisolone was significantly higher in Late Group [20.7(±9.7) mg vs. 15.3(±7.9) mg, p = 0.02]. CONCLUSION: A late diagnosis of CS was associated with more adverse events, a greater probability of needing a device upgrade and required higher maintenance steroid dose.

Fungal derived herbicidal metabolite loaded starch-chitosan-gum acacia-agar based bio composite: Preparation, characterization, herbicidal activity, release profile and biocompatibility.

Biocomposites based on starch- gum acacia- agar, chitosan- starch- agar, starch- poly vinyl alcohol- agar were synthesized by simple, green route principles and the various characterization techniques like fourier infrared spectroscopy, SEM revealed the highly stable micro dimenstional that specially interacted with functional groups of polymers -herbicidal metabolites. Respective biocomposite was prepared by mixing equal volume of the selected polymer (1;1;1 ratio) with known concentration (100 mg of in distilled water followed by the addition of reconstituted herbicidal metabolites (100 mg or 0.1 g). Though all the biocomposites were capable of inducing herbicidal effect, notable impact was recorded in chitosan- starch- gum acacia treatment. In this case, the necrotic lesions were initiated at the early incubation period (6 h), progressively developing into dark brownish black lesions with 30.0 mm diameter. Release profile of the metabolites from the respective composite was also under in vitro and soil assay. Release profile study under in vitro and soil condition showed the sustained or controlled manner in distilled water and ethyl acetate treatment. No sign of toxic effect on the soil, parameters plant growth, rhizobacteria and peripheral blood cells clearly revealed the best biocompatibility of the presently proposed biocomposite.

Predictors of outcome in a contemporary cardiac sarcoidosis population: Role of brain natriuretic peptide, left ventricular function and myocardial inflammation.

AIMS: Cardiac sarcoidosis (CS) is a potentially fatal condition that varies in its clinical presentation. Here, we describe baseline characteristics at presentation along with prognosis and predictors of outcome in a sizable and deeply phenotyped contemporary cohort of CS patients. METHODS AND RESULTS: Consecutive CS patients seen at one institution were retrospectively enrolled after undergoing laboratory testing, electrocardiogram, echocardiography, cardiac magnetic resonance (CMR) imaging and 18 F-flourodeoxyglucose positron emission tomography (FDG-PET) at baseline. The composite endpoint consisted of all-cause mortality, aborted sudden cardiac death, major ventricular arrhythmic events, heart failure hospitalization and heart transplantation. A total of 319 CS patients were studied (67% male, 55.4 ± 12 years). During a median follow-up of 2.2 years (range: 1 month-11 years), 8% of patients died, while 33% reached the composite endpoint. The annualized mortality rate was 2.7% and the 5- and 10-year mortality rates were 6.2% and 7.5%, respectively. Multivariate analysis showed serum brain natriuretic peptide (BNP) levels (hazard ratio [HR] 2.41, 95% confidence interval [CI] 1.34-4.31, p = 0.003), CMR left ventricular ejection fraction (LVEF) (HR 0.96, 95% CI 0.94-0.98, p < 0.0001) and maximum standardized uptake value of FDG-PET (HR 1.11, 95% CI 1.04-1.19, p = 0.001) to be independent predictors of outcome. These findings remained robust for different patient subgroups. CONCLUSION: Cardiac sarcoidosis is associated with significant morbidity and mortality, particularly in those with cardiac involvement as the first manifestation. Higher BNP levels, lower LVEF and more active myocardial inflammation were independent predictors of outcomes.

Biocompatible green technology principles for the fabrication of food packaging material with noteworthy mechanical and antimicrobial properties-- A sustainable developmental goal towards the effective, safe food preservation strategy.

Biocompatible, eco-friendly, highly economical packaging methods should be needed as conventional packaging is known to cause undesirable effects. As food packaging is the major determining factor of food safety, the selection or methods of packaging materials plays a pioneering role. With this scope, modern food technology seeks unique sustainable approaches for the fabrication of package materials with notable desired properties. The principles, features, and fabrication methodology of modern food packaging are briefly covered in this review. We extensively revealed improved packaging (nanocoating, nanolaminates, and nano clay), active packaging (antimicrobial, oxygen scavenging, and UV barrier packaging), and intelligent/smart packaging (O2 indicator, CO2 indicator, Time Temperature Indicator, freshness indicator, and pH indicator). In particular, we described the role of nanomaterials in the fabrication of packaging material. Methods for the evaluation of mechanical, barrier properties, and anti-microbial assays have been featured. The present studies suggest the possible utilization of materials in the fabrication of food packaging for the production, utilization, and distribution of safe foods without affecting nutritional values.

Metastatic Hepatocellular Carcinoma Masquerading as an Expansile Osteolytic Lesion in Scapula: A Rare Case of Isolated Appendicular Skeletal Metastatic Involvement of Hepatocellular Carcinoma at Initial Presentation.

Hepatocellular carcinoma (HCC) is known to be the most common primary tumor of the liver and is also the fifth most common cancer in the world. Chronic hepatitis B and C along with type 2 diabetes mellitus and alcoholic liver disease are quite well-known risk factors for HCC, and it is uncommon in the noncirrhotic liver. HCC favors spreading as multifocal intrahepatic lesions and potential vascular invasion, and extrahepatic spread is uncommon. Skeletal metastasis from HCC occurs infrequently compared to other cancers and is common in the axial skeleton. Metastatic involvement of the appendicular skeleton is a rare entity, and the initial presentation of HCC as metastatic involvement of the appendicular skeleton is even rarer. We report a case of HCC with incidentally detected cirrhosis and chronic hepatitis B infection presenting with pain in the left shoulder.

Utilization of PET/CT Scan in Head and Neck Carcinoma: A Tertiary Care Hospital Experience.

Objective: PET/CT scan has been increasingly used in assessment of Head and Neck cancer prior to treatment for evaluation and for surveillance. In this study we aim to assess the utilization of PET/CT scan at a tertiary care hospital. Methods: Retrospectively data was reviewed of all patients of Head and Neck cancer who underwent PET/CT scan for workup or for follow-up between July 2018 and December 2019. PET/CT scan done in the pre-treatment assessment and post-treatment surveillance were analyzed for its utility. Results: A total of 145 patients were included. The main indication for pre-treatment PET/CT scan was loco-regionally advanced disease (62 of 90 patients, 68.8%). No specific indication was noted in 19 patients (21%). A significant change in treatment decision was seen in pre-treatment patients based on M stage following a PET/CT scan. However, no change was noted on the basis of T or N stage. In the post-treatment surveillance there was a significant correlation of type of recurrence with clinical assessment and indication for PET/CT scan. 37 out of 87 patients (42.5%) underwent PET/CT scan for no specific reason, of which, 07 patients (18.9%) were detected to have distant metastasis. Conclusion: Role of PET/CT in the pre-treatment assessment is very limited and maybe confined to advanced local or regional disease. Post-treatment surveillance with PET/CT scan has a promising role and must be done as a baseline during 1st follow up at 03 months in all patients who have advanced disease and have undergone multi-modality treatment for the same.

Biocompatible formulation of cationic antimicrobial peptide Polylysine (PL) through nanotechnology principles and its potential role in food preservation - A review.

Food preservation using biopreservative agents mainly microbial based metabolites have gained more attention in the modern food sector due to their broad spectrum anti-microbial efficacy with high biocompatibility. However, the effectiveness of these biopreservatives is highly dependent on suitable formulation which will enhance the desired efficacy without affecting the nutritional value of the foods. Polylysine-actinomycete derived anti-microbial metabolite is used as biopreservative agent in various food products. This review provides a valuable insight into the formulation of polylysine with nanotechnology principles for enhanced antimicrobial efficacy against food spoilage organisms. This review highlighted the diverse methods of polylysine nanoformulation preparation. Formulation of polylysine as functionalised nanomaterials can be prepared via green science or green technology principles was extensively studied in this review. This study also revealed the methods for the determination of anti-microbial assays and biocompatibility tests in vitro and in vivo biocompatibility tests. Future prospects of nanoformulated polylysine in bio preservation can be extended to safe processing of canned and ready-to-eat food products without affecting the nutritional value of the foods.

A rare case of delayed anaplasma phagocytophilum-induced pancytopenia: A diagnostic conundrum.

INTRODUCTION: Human granulocytic anaplasmosis (HGA) is a potentially fatal tick-borne disease caused by the obligate intracellular bacterium Anaplasma phagocytophilum. It is most commonly found in the Northeastern and Midwestern parts of the United States especially during spring and summer months. The clinical picture of anaplasmosis is varied ranging from common symptoms such as fever, headache and myalgia to rarer presentations such as pancytopenia. CASE PRESENTATION: We present a case of a 62 year old male who presented with watery diarrhea, fever, and pancytopenia. Although there is a broad differential for pancytopenia, a thorough history provides clues regarding the diagnosis. In our patient, a recent history of camping in Upstate New York was suggestive of an infectious etiology from a tick borne illness. CLINICAL DISCUSSION: A tick-borne panel guided us to identify the diagnosis of HGA. Although the exact underlying pathogenesis of tick-borne illnesses leading to pancytopenia is still unknown, the pancytopenia is postulated to be due to a multi-nodal mechanism involving immune and non immune platelet destruction, global bone marrow suppression, hemophagocytic lymphohistiocytosis and myelosuppressive chemokines release. CONCLUSION: We hope that this case report elucidates the importance of obtaining a meticulous history in guiding clinicians towards prompt diagnosis, even in instances where there may be an evolving clinical picture.

F-18 fluorodeoxyglucose positron emission tomography/computed tomography in conjunctival melanoma with recurrence.

Ocular melanoma is classified under the category of noncutaneous melanomas. Noncutaneous melanomas are relatively rare. Ocular melanoma commonly arises from choroid. Conjunctival melanoma is a rare but potentially lethal form of ocular melanoma. It can invade locally. Systemic spread is seen in up to 25% of cases, often associated with lymph node involvement. Metastatic sites include the lungs, liver, gastrointestinal tract, and the central nervous system. F-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET-CT) scanning is indicated for staging cutaneous melanoma patients. However, few studies have evaluated its role in the management of conjunctival melanoma. This case highlights the use of F-18 FDG PET/CT for imaging, preoperative staging, and evaluation for metastasis in conjunctival melanoma.

Microsecond Simulation of the Proteoglycan-like Region of Carbonic Anhydrase IX and Design of Chemical Inhibitors Targeting pH Homeostasis in Cancer Cells.

Carbonic anhydrase IX (CAIX) is a membrane-bound enzyme associated with tumor hypoxia and found to be over expressed in various tumor conditions. Targeting CAIX catalytic activity is proven to be efficient modality in modulating pH homeostasis in cancer cells. Proteoglycan-like (PG) region is unique to CAIX and is proposed to serve as an antenna enhancing the export of protons in conjunction with facilitated efflux of lactate ions via monocarboxylate transporters. Moreover, the PG region is also reported to contribute to the assembly and maturation of focal adhesion links during cellular attachment and dispersion on solid supports. Thus, drug targeting of this region shall efficiently modulate pH homeostasis and cell adhesion in cancer cells. As the PG region is intrinsically disordered, the complete crystal structure is not elucidated. Hence, in this study, we intend to sample the conformational landscape of the PG region at microsecond scale simulation in order to sample the most probable conformations that shall be utilized for structure-based drug design. In addition, the sampled conformations were subjected to high-throughput virtual screening against NCI and Maybridge datasets to identify potential hits based on consensus scoring and validation by molecular dynamics simulation. Further, the identified hits were experimentally validated for efficacy by in vitro and direct enzymatic assays. The results reveal 5-(2-aminoethyl)-1,2,3-benzenetriol to be the most promising hit as it showed significant CAIX inhibition at all levels of in silico and experimental validation.

Computational modeling of novel inhibitory peptides targeting proteoglycan like region of carbonic anhydrase IX and in vitro validation in HeLa cells.

Carbonic anhydrase IX (CAIX) is a tumour-associated, hypoxia-induced, membrane-bound metallo-enzyme which catalyzes the reversible hydration of carbon dioxide (CO2) to bicarbonate (HCO3-) and proton (H+) ions. Over expression of CAIX is observed in cancers of colon, lung, kidney, breast, etc. CAIX plays a vital role in maintaining favourable intracellular pH for tumour cell growth and extracellular acidification which in-turn leads to drug resistance and spread of factors influencing tumour invasion. The N-terminal proteoglycan (PG) - like fragment of CAIX is unique to this isoform and is considered as potential druggable hotspot. Recently, M75 monoclonal antibody targeting the LPGEEDLPG epitope of PG like region has been proposed to reduce cellular adhesion in cancer cells. LPGEEDLPG fragment in complex with M75 has been crystallized and it serves as a strong base for development of peptide inhibitors based on interacting interfaces. Thus, in this study, an in-depth analysis of intermolecular interactions in LPGEEDLPG-M75 complex was carried out by implementing extensive molecular dynamics simulations, binding free energy calculations so as to infer the major determinant fragments of M75 that can be used as peptide inhibitors targeting PG region. Based on these analyses, 3 peptides (Pep1, Pep2 and Pep3) were synthesized and validated by in vitro assays involving cytotoxicity assessment, CAIX inhibition analysis through Direct and Indirect functional assays, and inhibition of Cell adhesion in HeLa cells. The results reveal Pep1 to be a promising inhibitor as it could efficiently modulate CAIX mediated pH homeostasis and cell adhesion in cancer cells.Communicated by Ramaswamy H. Sarma.

Methods of phenotypic identification of non-tuberculous mycobacteria.

Non-tuberculous mycobacteria (NTM) are composed of mycobacterial species other than the Mycobacterium tuberculosis complex. Initially thought to be mere contaminants when isolated from clinical specimens, literature is increasing by the day showing NTM as proven pathogens. Due to the difference in antimicrobial susceptibility of different species, it becomes imperative for the microbiology laboratory to identify them to the species level. Molecular methods are available for rapid and accurate identification, but in a resource limited nation, phenotypic methods, albeit time consuming, are of paramount importance. By means of this article, the authors intend provide a concise summary of the basic biochemical reactions which can be done to identify most commonly isolated NTM.

Hematoma in Urinary Bladder Masquerading as Neoplastic Mass.

The most common reason for intraluminal urinary bladder hematoma is trauma. However in gynecological and pelvic malignancies, the pelvic irradiation can affect non targeted organs resulting in urogenital complications like hematoma. Small size hematoma can be easily diagnosed in ultrasound. Large hematoma can mimic as neoplastic mass in imaging modalities. We present here an intresting image of intraluminal urinary bladder mass, where FDG PET CT was helpful to diagnose it as a non neoplastic mass.

Dacroscintigraphy by Pediatric Dropper Technique: A User-friendly Instillation Procedure of Radiotracer.

CONTEXT: Instillation or application of the radiotracer over the tear film is one of the important parts of dacroscintigraphy. Our study explains the value of an improvised dropper technique so that desired amount of radioactivity in desired volume can be instilled over the tear film. AIM: The aim of the study is to introduce a simple and convenient instillation method based on dropper technique for performing dacroscintigraphy. This improvised dropper technique can be used so that desired amount of radioactivity in desired volume can be instilled over the tear film. The objectives of this experiment are to measure the volume and activity of each drop from the dropper. SETTINGS AND DESIGN: Experiment of volume and activity measurement standardization was carried out in two parts. In the first part, we calculated the volume of each drop indirectly to standardize the volume of drop. In the second part, we standardized the activity in each drop by measuring it in a dose calibrator. SUBJECTS AND METHODS: In this study, we used a common pediatric dropper of approximately 1 ml capacity, radioactivity (99mTcO4 pertechnetate), sample vial (container), vial holder, a pair of nonsterile gloves, dose calibrator, etc., Experiments of volume and radioactivity standardization were carried out in two parts. The first part of experiment calculated volume of each drop indirectly, and in the second, we standardized the activity in each drop by measuring it in dose calibrator. Statistical analysis used: Analysis of variance test was used to calculate the correlation of readings by same individual as well as among the three individuals. RESULTS: After analysis of result obtained, it was understood that there was no significant difference found in volume and activity of each drop in the readings recorded by same individual as well as among the three individuals. The calculated activity and observed activity were 86.64 and 79.16 µCi, respectively. The difference was only 8.63% lying within acceptable limits.