Pseudoaneurysm of cystic artery stump after laparoscopic cholecystectomy managed successfully with branch hepatic artery embolization using jail technique.

An unusual manifestation caused by cholecystitis, infection, or iatrogenic damage after cholecystectomy is a pseudoaneurysm of the cystic artery. We report this rare illness in a 64-year-old man who visited the emergency room with hematemesis and anemia. The patient initially experienced acute cholecystitis and then underwent a laparoscopic cholecystectomy following which he developed a cystic artery pseudoaneurysm, secondary to infected fluid collection. Based on the patient's history and contrast-enhanced computer tomography abdomen, a diagnosis of pseudoaneurysm of the cystic artery was made. Angioembolization of the hepatic artery branch was performed to occlude the pseudoaneurysm.

Time-related changes in the knowledge of HIV/AIDS among followers of various religions in India.

Background: The public knowledge levels about Human Immunodeficiency-Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) have been assessed in previous studies; however, time-related trends in association with socio-demographic standards among the followers of major religions in India are not known. Objectives: We assessed the 2005-06, 2015-16, and 2019-21 demographic and health survey (DHS) data from India to investigate trends in the levels of knowledge of HIV/AIDS among Hindus, Muslims, and Christians in relation to standard socio-demographic variables over a period of 16 years. Methods: The age range of the population was 15-54 years (n=611,821). The HIV/AIDS-related knowledge was assessed by developing a composite index based on ten questions about several aspects of HIV/AIDS, such as the mode of spread. We applied Chi-square and Kruskal-Wallis tests to investigate whether people had heard about HIV/AIDS and their overall HIV knowledge in relation to several socio-demographic standards. Results: Generally, a higher increase in knowledge level was found between the first and second DHS surveys (2006-2016) as compared to between the second and third DHS surveys (2016-2021). We found the highest increase in the level of HIV/AIDS knowledge among Christian women followed by Hindus, whereas Muslims had the least increase over 16 years. Being a female, uneducated, poor, previously married, or having rural residence were associated with the highest increase in the knowledge of HIV/AIDS. Conclusion: Christian women had the highest increase in HIV/AIDS-related knowledge then came Christian men and followers of other religions. We also found the highest increase in HIV/AIDS-related knowledge among the poorest, uneducated, and rural residents. Our findings may help formulate public health strategies targeting various less knowledgeable groups to reduce the incidence of HIV/AIDS.

The unmet surgical needs of global refugee populations: A perspective review.

The global refugee community, including those forced to flee due to persecution, conflict, or violence, faces significant challenges in accessing healthcare, resulting in a higher prevalence of surgical disease. These challenges have a profound impact on morbidity and mortality rates, particularly in low- and middle-income countries where many immigrants seek refuge. Limited availability of medical facilities, an inadequate surgical workforce, financial constraints and linguistic and cultural barriers all contribute to reduced access to healthcare. Limited access to competent healthcare leads to poor health outcomes, increased morbidity and mortality rates and suboptimal surgical results for refugees. To address these challenges, a multifaceted approach is necessary. This includes increased funding for healthcare initiatives, workforce recruitment and training and improved coordination between aid organisations and local healthcare systems. Strategies for managing surgical conditions in the global refugee community encompass the development of targeted public health programmes, removing legal barriers, establishing healthcare facilities to enhance surgical access and prioritising disease prevention among refugees.

Perioperative prophylactic corticosteroids for cardiac surgery in children: A systematic review and meta-analysis.

OBJECTIVE: Perioperative corticosteroids have been used for pediatric cardiac surgery for decades, but the underlying evidence is conflicting. We aimed to investigate the efficacy and safety of perioperative prophylactic corticosteroids in pediatric heart surgeries. METHODS: We searched electronic databases until March 2023 to retrieve all randomized controlled trials (RCTs) that administered perioperative prophylactic corticosteroids to children undergoing heart surgery. We used RevMan 5.4 to pool risk ratios (RRs) and mean differences (MDs). RESULTS: A total of 12 RCTs (2,209 patients) were included in our review. Corticosteroids administration was associated with a nonsignificant reduction in all-cause mortality (RR 0.62; 95% CI: 0.37-1.02, I2 = 0%; moderate certainty); however, it was associated with a lower duration of mechanical ventilation (MV) (MD -0.63 days; 95% CI: -1.16 to -0.09 days, I2 = 41%; high certainty). Corticosteroids did not affect the length of ICU and hospital stay but significantly reduced the incidence of postoperative low cardiac output syndrome (LCOS) (RR 0.76; 95% CI: 0.60-0.96, I2 = 0%; moderate certainty) and reoperation (RR 0.37; 95% CI: 0.19-0.74, I2 = 0%; moderate certainty). There was no increase in adverse events except a higher risk of hyperglycemia and postoperative insulin use. CONCLUSIONS: The use of perioperative corticosteroids in pediatric heart surgeries is associated with a trend toward reduced all-cause mortality without attaining statistical significance. Corticosteroids reduced MV duration, and probably decrease the incidence of LCOS, and reoperations. The choice of corticosteroid agent and dose is highly variable and further larger studies may help determine the ideal agent, dose, and patient population for this prophylactic therapy.

Nucleotide-free structures of KIF20A illuminate atypical mechanochemistry in this kinesin-6.

KIF20A is a critical kinesin for cell division and a promising anti-cancer drug target. The mechanisms underlying its cellular roles remain elusive. Interestingly, unusual coupling between the nucleotide- and microtubule-binding sites of this kinesin-6 has been reported, but little is known about how its divergent sequence leads to atypical motility properties. We present here the first high-resolution structure of its motor domain that delineates the highly unusual structural features of this motor, including a long L6 insertion that integrates into the core of the motor domain and that drastically affects allostery and ATPase activity. Together with the high-resolution cryo-electron microscopy microtubule-bound KIF20A structure that reveals the microtubule-binding interface, we dissect the peculiarities of the KIF20A sequence that influence its mechanochemistry, leading to low motility compared to other kinesins. Structural and functional insights from the KIF20A pre-power stroke conformation highlight the role of extended insertions in shaping the motor's mechanochemical cycle. Essential for force production and processivity is the length of the neck linker in kinesins. We highlight here the role of the sequence preceding the neck linker in controlling its backward docking and show that a neck linker four times longer than that in kinesin-1 is required for the activity of this motor.

Formulation and characterization of thiolated chitosan/polyvinyl acetate based microneedle patch for transdermal delivery of dydrogesterone.

Microneedle patches are promising transdermal drug delivery platforms with minimal invasiveness in a painless manner. Microneedle patch could be a promising alternate route for delivery of drugs having poor solubility and low bioavailability. This research work therefore, aimed to develop and characterize microneedle patch of thiolated chitosan (TCS) and polyvinyl acetate (PVA) for the systemic delivery of dydrogesterone (DYD). TCS-PVA-based microneedle patch was fabricated with 225 needles having a length of 575 µm with the sharp pointed end. Different ratios of TCS-PVA-based patch were employed to investigate the effects of mechanical tensile strength and percentage elongation. The scanning electron microscopy (SEM) revealed intact sharp-pointed needles. In vitro dissolution studies of microneedle patch (MN-P) were carried out by modified Franz-diffusion cell revealing the sustained release of DYD 81.45 ± 2.768 % at 48 hrs as compared to pure drug that showed 96.7 ± 1.75 % at 12 hrs. The transport of DYD (81%) across skin reaching the systemic circulation was evaluated through ex vivo permeation studies of MN-P. The skin penetration study through the parafilm M method showed good penetration with no deformation and breakage of needles along with no visible signs of skin irritation. Histological study of mice skins clearly showed the deeper penetration of needles into the skin. In summary, as-prepared MN-P show potential in developing an effective transdermal delivery system for DYD.

Circulating follicle stimulating hormone levels influence body growth in pre-menarcheal girls in a latitude-dependent manner.

Introduction: Age at menarche is an essential determinant of reproductive life of a woman. Latitude is an important driver of age at menarche, however the contributions of circulating follicle stimulating hormone (FSH) and socio-economic status (SES) to age at menarche in a latitude-dependent manner is not known. Methods: This population-based cross-sectional study is a component of our major cohort of 10,050 schoolgirls aged 8-16 years from 35 schools across 10 districts. The selected districts were categorised into high and low latitudes by applying a cut-off point at latitude 31.5°N. We evaluated the physical parameters, SES, circulating FSH, and growth hormone (GH) levels in pre-menarche girls (N = 252) at different latitudes. Results: Self-reported age at menarche of girls residing at different latitudes in Pakistan showed that higher latitude is associated with delayed age at menarche. Higher latitude was associated with reduced circulating FSH levels, as well as lower parameters of physical growth including body mass index (BMI), waist-hip ratio and, waist-height ratio (all p < 0.05) in the pre-menarcheal girls. However, circulating GH levels were not affected by latitude. On the other hand, lower SES was associated with reduced GH levels and lower BMI, which are considered as probably the primary determinants of physical growth. Conclusions: Taken together, we show that higher latitude may delay the sexual maturation, while poor SES may delay the physical growth in girls.

Photoacoustic imaging for characterization of radiofrequency ablated cardiac tissues.

Photoacoustic (PA) imaging is an emerging technique being explored for various clinical applications. PA imaging offers a portable, inexpensive, stand-alone modality for evaluating optical contrast agents. PA signals are well-correlated with tissue physical parameters and can quantify various physiological variables (e.g., oxygenation of hemoglobin). Moreover, radiofrequency (RF) ablation is a promising treatment for certain cardiac arrhythmias. Assessment of RF-ablated lesions is of clinical importance. The purpose of this study is to elaborate the PA imaging to characterize RF-ablated cardiac tissues. Specifically, we describe the application of PA imaging to identify, characterize, and quantify cardiac RF lesions, highlighting the fundamental principles and unique benefits of this optical imaging technique. Potential future clinical application of PA imaging that reveals additional information about structural damage in RF-treated cardiac tissue are also anticipated.

Characterization of cervical tissue using Mueller matrix polarimetry.

The cervix is composed of layers of squamous epithelium and connective tissue. The main component of the cervical connective tissue is collagen, which has specific orientations in different parts of the cervix and provides mechanical strength. Cervical pathologies such as cervical intraepithelial neoplasia (CIN), cancer, pregnancy, and spontaneous preterm birth (sPTB) allow for structural remodeling of both squamous epithelium and connective tissue. Mueller matrix (MM) polarimetry is an optical imaging technique that uses polarized light to characterize the morphologic changes in pathological cervix. In this study, advances in MM polarimetry in characterizing cervical tissue and associated pathologies were reviewed. In particular, the basic structure of the MM polarimeter is described. The interaction of polarized light with cervical tissue in terms of polarimetric parameters such as depolarization and birefringence is discussed. The assessment of cervical pathologies including CIN, cancer, pregnancy, and sPTB with MM polarimetry and the underlying reasons that produce the contrast in optical imaging are outlined. The clinical implementation of MM polarimetry, especially the Müller polarimetry colposcope, is also discussed. Finally, the challenges for MM polarimetry in cervical clinics are also speculated.

Corrigendum to "Guided self-help Urdu version of the living life to the full intervention for secondary school adolescents with low mood and anxiety in Pakistan: A feasibility study" [Heliyon 8 (7) (2022) e9809].

[This corrects the article DOI: 10.1016/j.heliyon.2022.e09809.].

An empirical study of physical activity and sports affecting mental health of university students.

Physical activity (PA) and sports are extremely essential elements for physical and mental health among adolescents. Around 30% of 16 years old and above in Malaysia have mental health issues. For this purpose, 512 university students from Malaysia were surveyed through social media, with 74% response rate. Structural equation model partial least square (SEM-PLS) was used to examine the effect of PA and sports on mental health. The results revealed that both PA (b = 0.402, p < 0.001) and sports (b = 0.330, p < 0.001) significantly predict mental health among university students. The model explained 35.8% variance in mental health. The study suggests that PA and sports activity need to be promoted among university students to control prevailing mental health issues in adolescents.

Guided self-help Urdu version of the living life to the full intervention for secondary school adolescents with low mood and anxiety in Pakistan: A feasibility study.

There is limited evidence on the efficacy of Cognitive Behavioral Therapy (CBT) based guided self-help programs to improve low mood and anxiety in Pakistani adolescents. The aims of the current study were to assess the effectiveness of an eight week low intensity CBT-based guided self-help program, Living Life to the Full (LLTTF) on depression, anxiety and social functioning among secondary school adolescents in Pakistan. Fifty-six participants were randomly allocated to immediate (n = 28) and delayed access (n = 28) groups. Measures of depression, anxiety and social functioning were collected at baseline, post intervention and three months follow-up. There were significant improvements in measures of depression (t = -3.47, p < 0.01; d = 1.0), anxiety (t = -6.55, p < 0.001; d = 1.91) and social functioning (t = -4.28, p < 0.001) between immediate access and delayed access groups. These differences remained significant at three months follow-up. The study suggests that the Urdu LLTTF book course delivered in classes is effective for reducing depression and anxiety as well as improving social function among adolescents in Pakistan.

Acute Immune Thrombocytopenia (ITP) Following COVID-19 Vaccination in a Patient With Previously Stable ITP.

Immune thrombocytopenia (ITP) is an autoimmune condition associated with multiple risk factors including viral infections (hepatitis B virus/hepatitis C virus/cytomegalovirus, HIV, and recently severe acute respiratory syndrome coronavirus 2) and vaccines. Though immune mechanisms have been proposed to explain the pathogenesis of acute ITP, autoimmunity with the coronavirus disease 2019 (COVID-19) vaccine is still unclear and needs further research. We report a case of acute ITP after administration of the Pfizer-BioNTech mRNA COVID-19 vaccine in a patient with previously stable ITP.

Caught Between External Pressures and Internal Battles: Psychosocial Factors Affecting Gestational Weight Gain - A Scoping Review.

Many physical factors (including maternal comorbidities) affecting gestational weight gain (GWG) have been widely studied; however, the psychosocial aspects pertaining to this need to be put under the microscope, especially in countries characterized by low indicators of socioeconomic development. Gaining and maintaining an adequate amount of weight during pregnancy is important to prevent premature deliveries, fetal demise, fetal macrosomia, shoulder dystocia during delivery, emergency cesarean sections, postpartum weight retention, childhood obesity, etc. A scoping review of the articles published in the last five years has revealed that perinatal outcomes like gestational weight are influenced by certain psychosocial factors, including, but not limited to, intimate partner violence, lack of social support and recognition, financial distress, household food insecurity, chronic stress and depression related to pregnancy, eating pathologies, and low self-esteem. Employing a multi-disciplinary approach, which involves seeking the help of psychiatrists/psychologists, obstetricians, nutritionists, and public health specialists, can help us mitigate undesirable outcomes related to inadequate and excessive weight gain during pregnancy. More intervention-based research focusing on psychosocial factors relating to GWG is needed in regions like South Asia, which is associated with low indicators of socioeconomic development.

Atomic Force Microscopy Investigation of the Interactions between the MCM Helicase and DNA.

The MCM (minichromosome maintenance) protein complex forms an hexameric ring and has a key role in the replication machinery of Eukaryotes and Archaea, where it functions as the replicative helicase opening up the DNA double helix ahead of the polymerases. Here, we present a study of the interaction between DNA and the archaeal MCM complex from Methanothermobacter thermautotrophicus by means of atomic force microscopy (AFM) single molecule imaging. We first optimized the protocol (surface treatment and buffer conditions) to obtain AFM images of surface-equilibrated DNA molecules before and after the interaction with the protein complex. We discriminated between two modes of interaction, one in which the protein induces a sharp bend in the DNA, and one where there is no bending. We found that the presence of the MCM complex also affects the DNA contour length. A possible interpretation of the observed behavior is that in one case the hexameric ring encircles the dsDNA, while in the other the nucleic acid wraps on the outside of the ring, undergoing a change of direction. We confirmed this topographical assignment by testing two mutants, one affecting the N-terminal ß-hairpins projecting towards the central channel, and thus preventing DNA loading, the other lacking an external subdomain and thus preventing wrapping. The statistical analysis of the distribution of the protein complexes between the two modes, together with the dissection of the changes of DNA contour length and binding angle upon interaction, for the wild type and the two mutants, is consistent with the hypothesis. We discuss the results in view of the various modes of nucleic acid interactions that have been proposed for both archaeal and eukaryotic MCM complexes.

Aesthetic Evaluation Of The Lower Third Of The Face Comparing Cephalometric And Photographic Analysis Considering Nasolabial And Labiomental Angles In Young Adult Pakistani Population.

BACKGROUND: Although the results derived from orthodontic treatment are focused at attaining an aesthetically pleasing soft tissue profile as directed by Angle's paradigm, however hard tissue including bone and tooth dimensions also play a pivotal role in attaining the set goal. This study was focused on evaluating the comparison of photographs and cephalometric radiographic images to dictate the differences that might occur when the same aesthetic evaluation technique is applied. A cross sectional comparative study was carried out at Frontier college of dentistry, Abbottabad and Sharif Medical and Dental College, Lahore from June to November 2020. METHODS: In this cross-sectional study, 60 subjects were incorporated as part of the study amongst which lateral cephalometric radiographic images and photographs, other diagnostic records such as dental casts were procured. The same analysis was applied to assess the lower third of the face in both the photographs and the radiographs with focus on the Labiomental and nasolabial angles for comparison. RESULTS: The normal value of Nasolabial angle 102.10°±3.126° (NLA2) indicates the relationship of nose and upper lip which is within the normal range for the age group selected. No significant difference was found between the nasolabial angles measured by two separate methods (p-value is 0.67). Mean labiomental angle was found to be 120.70°±6.46°(LNA1) and 121.60°±5.386 degrees °(LMA2) respectively, which was within the normal range for the age group selected. CONCLUSIONS: There is no significant difference in the assessment of lower facial height and aesthetics between lateral cephalometric radiographic images and photographs taken from the camera.

Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Induced by Long-Term Use of Citalopram and Short-Term Use of Naproxen.

BACKGROUND Use of selective serotonin reuptake inhibitors (SSRIs) has been reported to be associated with the syndrome of inappropriate antidiuretic hormone (SIADH), although it is uncommon. Nonsteroidal anti-inflammatory drugs (NSAIDs), as a sole agent, are an even rarer cause of SIADH. Despite being documented in the literature, the understanding of the mechanism of both agents is limited. Here, we report a case of a patient taking both of these medications, a dangerous combination that led to the development of SIADH. CASE REPORT An 88-year-old woman with a history of asymptomatic chronic hyponatremia presented to our facility with symptomatic acute-on-chronic hyponatremia after she started using naproxen in addition to her daily citalopram. Her hyponatremia symptoms resolved after discontinuing these 2 offending agents, along with administration of fluid restriction and oral sodium supplements. CONCLUSIONS Naproxen is commonly prescribed and is often taken by elderly patients to control long-term or short-term pain. SSRIs, on the other hand, are a first-line treatment for depression and are usually prescribe by a psychiatrist. Hyponatremia is a rare medication adverse effect that should be kept in mind when treating these patients with either of these medications, and should especially be considered when combining them. Medication reconciliation should be done carefully by the provider to avoid adverse effects and drug interactions. When hyponatremia is encountered, options for future medication prescriptions include rechallenging with the same medication, switching to a different medication with the same mechanism of action, or using a medication from another class altogether. Monitoring of serum sodium level is warranted when titrating the offending agent.

Lateral Arm Flap: Its Usage as Pedicle and Free Flap.

Introduction The lateral arm flap is an excellent flap for both local and microvascular reconstruction. For local reconstruction on the upper extremity or as a distant microvascular flap, its advantages include short operation time, thin pliable tissue, non-dominant vessel, and minimal donor site morbidity. Moreover, it fulfills the goal of optimal reconstruction of form, function, and aesthetics. The objective is to share our experience of using the lateral arm flap, both as a free flap and as a pedicled flap. Methods After taking exemption from the ethical review committee (ERC) of Aga Khan University Hospital, a retrospective data analysis of patients who had undergone lateral arm flap at the Plastic and Reconstructive Surgery department of the Aga Khan University Hospital was carried out from January 2012 to December 2019. The data examined included the patient's age, gender, diagnosis, location of the defect, size of the flap, and outcome of the flap at three weeks post-operation. For free flaps, data of the recipient artery used for anastomosis and the number of veins anastomosed were also included. Results Over a period of eight years, 33 lateral arm flaps were performed, including 23 free flaps and 10 pedicled flaps. The average size of the free flap was 12x6 cm and that of the pedicled flap was 8x5 cm. In the free-flap group, there was a failure in three flaps, two of which were due to arterial anastomosis in the zone of injury. There were no failures in the pedicled flap group. Conclusion The lateral arm flap is a reliable flap, with consistent anatomy, which can be used for coverage in different parts of the body.

Adolescents' mental health and well-being in developing countries: a cross-sectional survey from Pakistan.

Background: Despite global recognition of the significance of adolescents' mental health it remains a neglected area in research and health policy in Pakistan. Aim: To examine the rates of depression and anxiety and to assess the level of well-being among Pakistani adolescents. Methods: A cross-sectional sample of 1124 adolescents (age 11-18 years) was recruited from schools in Rawalpindi, Pakistan. Results: 17.2% and 21.4% participants were identified to be probable cases of depression and anxiety, respectively. The mean well-being score of the participants was 65.79 (S.D = 12.84). Girls were more anxious than boys. Depressive symptoms and well-being were significantly associated with age. Poor economic status, lower level of education and more negative life events were significantly associated with higher levels of depression and anxiety symptoms and poor well-being. Conclusion: To our knowledge, this is the first school-based observational research exploring the rates of symptoms of depression and anxiety as well as well-being among 11-18 years old in Pakistan. This study concludes that mental health of Pakistani adolescents is an important area of public health concern and provides information for making policy level decisions regarding evaluation, prevention and intervention of mental health problems among adolescents in Pakistan.