Euglycemic Diabetic Ketoacidosis With Acute Renal Failure: A Challenging Case for Clinicians.

Diabetic ketoacidosis (DKA) is a severe complication of diabetes mellitus characterized by hyperglycemia, metabolic acidosis, and ketosis. We present a challenging case of euglycemic DKA secondary to fasting and urinary tract infection with acute renal failure in a 50-year-old woman. Despite normal random blood sugar levels, the patient exhibited clinical signs of DKA, leading to further investigation. High anion gap metabolic acidosis with hyperkalemia and abnormal renal function tests were identified. After hemodialysis, serum ketones were found to be highly positive, confirming the diagnosis. Prompt management led to a complete clinical and laboratory resolution. This case underscores the importance of considering DKA in patients with suggestive symptoms, even with normal blood sugar levels.

Effects of an Intervention to Improve Evidence-Based Care for People With Diabetes and Cardiovascular Disease Across Sex, Race, and Ethnicity Subgroups: Insights From the COORDINATE-Diabetes Trial.

BACKGROUND: Results from the COORDINATE-Diabetes trial demonstrated that a multifaceted, clinic-based intervention increased prescription of evidence-based medical therapies to participants with type 2 diabetes and atherosclerotic cardiovascular disease. This secondary analysis assessed whether intervention success was consistent across sex, race, and ethnicity. METHODS: COORDINATE-Diabetes, a cluster randomized trial, recruited participants from 43 US cardiology clinics (20 randomized to intervention and 23 randomized to usual care). The primary outcome was the proportion of participants prescribed all 3 groups of evidence-based therapy (high-intensity statin, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, and sodium-glucose cotransporter-2 inhibitor or glucagon-like peptide 1 receptor agonist) at last trial assessment (6 to 12 months). In this prespecified analysis, mixed-effects logistic regression models were used to assess the outcome by self-reported sex, race, and ethnicity in the intervention and usual care groups, with adjustment for baseline characteristics, medications, comorbidities, and site location. RESULTS: Among 1045 participants with type 2 diabetes and atherosclerotic cardiovascular disease, the median age was 70 years, 32% were female, 16% were Black, and 9% were Hispanic. At the last trial assessment, there was an absolute increase in the proportion of participants prescribed all 3 groups of evidence-based therapy in women (36% versus 15%), Black participants (41% versus 18%), and Hispanic participants (46% versus 18%) with the intervention compared with usual care, with consistent benefit across sex (male versus female; Pinteraction=0.44), race (Black versus White; Pinteraction=0.59), and ethnicity (Hispanic versus Non-Hispanic; Pinteraction= 0.78). CONCLUSIONS: The COORDINATE-Diabetes intervention successfully improved delivery of evidence-based care, regardless of sex, race, or ethnicity. Widespread dissemination of this intervention could improve equitable health care quality, particularly among women and minority communities who are frequently underrepresented in clinical trials. REGISTRATION: URL: https://clinicaltrials.gov. Unique identifier: NCT03936660.

Lack of awareness of secondary rheumatic prevention in preoperative candidates for mitral valve surgery - alarming situation.

BACKGROUND: We conducted this study to assess the compliance with secondary rheumatic prophylaxis among preoperative patients with rheumatic mitral valve disease undergoing valvular heart surgery at a tertiary care cardiac hospital in a developing country. METHODS: This is a descriptive cross-sectional study conducted at a tertiary care cardiac hospital in Karachi, Pakistan. The inclusion criteria encompassed patients of any sex, aged between 18 and 80 years, who had been diagnosed with rheumatic mitral valve disease through transthoracic echocardiography and had undergone valvular heart surgery. The level of compliance with secondary rheumatic prophylaxis and barriers toward noncompliance was assessed during routine preoperative interview session. This preventive measure plays a crucial role in reducing the progression of the disease and improving patient outcomes. RESULTS: Out of the 239 patients included in the study, 125 (52.3%) were females, with a mean age of 38.8 ± 11.8 years. The majority of patients (88.7%) came from rural areas. Among the patients, 79 (33.1%) received rheumatic prophylaxis, while 160 (66.9%) did not adhere to it regularly. The common barriers for receiving rheumatic prophylaxis were non availability (41.0%) and nonaffordability (40.6%). Additionally, 28.0% of patients had lacked awareness of the importance of rheumatic prophylaxis, and 2.5% expressed fear of injection site pain and subsequent symptoms. CONCLUSIONS: A concerning level of noncompliance with secondary rheumatic prophylaxis was observed. The barriers identified in patients who did not receive rheumatic prophylaxis were primarily related to affordability, availability, lack of awareness, and fear of injection site pain and subsequent symptoms.

Comprehensive Analysis of Salmonella Species Antibiogram and Evolving Patterns in Empirical Therapy: Insights From Tertiary Care Hospitals in Peshawar, Pakistan.

Background Typhoid fever presents a significant challenge in developing nations, exacerbated by the emergence of antibiotic-resistant strains due to widespread prevalence and overuse of antibiotics. This study seeks to assess the antibiogram profiles of Salmonella species isolated from blood cultures of patients hospitalized at two prominent tertiary care hospitals in Peshawar, Pakistan: Khyber Teaching Hospital (KTH) and Hayatabad Medical Complex (HMC). By examining these profiles, the research aims to provide valuable insights into the evolving landscape of antibiotic resistance in the context of typhoid fever management. Materials and Methods This retrospective cross-sectional study utilized data gathered from two hospitals in Peshawar, KTH and HMC. Cases of enteric fever were identified based on positive blood cultures for Salmonella species. The study encompasses demographic information, seasonal prevalence, and antibiogram profiles of 3,137 cases that were presented between 2017 and 2023. Results Among the total 3,137 cases, males accounted for the majority, comprising 63% (2,044 cases). Particularly notable was the clustering of cases among children and adolescents aged one to 24 years. The incidence peaked during the months of summer and spring, from April to September. In terms of Salmonella Typhi isolates, considerable resistance was noted against first-line antibiotics such as amoxicillin/clavulanate (80.1%), co-trimoxazole/trimethoprim-sulfamethoxazole (66.6%), and chloramphenicol (86.9%), as well as against ceftriaxone (79.7%) and ciprofloxacin (51.6%). Conversely, certain antibiotics displayed higher sensitivity patterns, including meropenem (97.8%), doripenem (99.5%), imipenem (97.7%), ertapenem (96.5%), polymyxin B (99.4%), colistin (98.1%), and tigecycline (97.3%). Despite a limited sample size of 214 specimens, fosfomycin demonstrated a remarkable sensitivity of 93.4%. Sensitivities of amikacin and gentamicin were 90.7% and 81.5%, respectively. However, the sensitivity of azithromycin was concerning, standing at 66.5%. The antibiogram pattern for Salmonella exhibited significant and drastic changes. Conclusion In conclusion, this study sheds light on a higher prevalence of typhoid fever among males, with a notable seasonal peak observed during the summer and spring months. The age group most affected spans from one to 24 years. Salmonella isolates displayed significant resistance to conventional first-line antibiotics, alongside ciprofloxacin and third-generation cephalosporins. Azithromycin exhibited lower sensitivity compared to amikacin, gentamicin, and fosfomycin. The research advocates for the empirical use of amikacin, gentamicin, fosfomycin, and meropenem in the treatment of typhoid fever in Pakistan. Urgent measures, including regular Salmonella antibiogram surveillance, antibiotic stewardship, public health education, and Salmonella vaccination programs, are deemed crucial for primary disease prevention.

Experimental and numerical techniques to evaluate coal/biomass fly ash blend characteristics and potentials.

Fossil and renewable fuels are used by industrial units that produce energy-intensive products. Competitive fuel pricing encourages these fuel sources' usage globally, particularly in developing nations, which leads to large volumes of byproducts like fly ash among thermal power plant operators. The elements and compounds found in coal fly ash (CFA) and biomass fly ash (BFA) can be utilized through several engineering applications. This study aims to assess typical CFA and BFA samples quantitatively and qualitatively via techniques such as ultimate analysis (CH-S), Fourier transform infrared spectroscopy (FTIR), thermogravimetric analysis (TGA), X-ray diffraction (XRD), X-ray fluorescence (XRF) elemental analysis, and ash fusion temperature (AFT), to anticipate the ideal ratios of coal to biomass blends for combustion applications while adhering to environmental regulations. The optimal blend, consisting of 75 % CFA and 25 % BFA, exhibited improved carbon (C%) and hydrogen (H%) percentages, increasing from 2.5 % to 4.67 % and from 0 % to 0.12 %, respectively. These improvements were further confirmed by the observed functional groups in FTIR, indicating a rising trend in both carbon and hydroxyl groups from BFA to CFA. XRF and XRD also confirmed it and TGA also showed optimum mass loss (ML%) behavior of 14.55 % for 75CFA + 25BFA. According to slagging and fouling indices, the values of RB/A, Rs, and Fu indicate a reduction in slagging and fouling issues through the blending of CFA with BFA. Simultaneously, the fusion temperature increased from 1181 °C to 1207 °C. CFA was found to increase the AFT of the BFA from 1197 °C to 1247 °C, mitigating their propensity. This suggests that a blend of 75CFA + 25BFA results in lower to medium range of slagging and fouling. However, AFI and BAI indicate a slightly higher range. AFT analysis further validates the conclusions drawn from the indices. The ternary phase diagram shows that the ash's melting point increases in the optimum blend. This is attributed to a reduced content of K2O (<15 %) and increased proportions of >50 % CaO and SiO2, effectively inhibiting slagging, agglomeration, and deposition. Meanwhile, the blend maintains a medium level of acidity and susceptively to corrosion, as observed in the case of 75CFA + 25BFA. The identification of optimal blend ratios can be anticipated to offer essential solutions for future research, aiming to ensure smooth industrial operations and regulatory compliance in power plants.

Serological and Molecular Detection of Toxoplasma gondii in Domestic Pigs Intended for Human Consumption and Potential Occupational Hazard to Pig Farmers in India.

Toxoplasma gondii, an important food-borne zoonotic parasite, poses a worldwide public health hazard. Domestic pigs are considered one of the main intermediate hosts in the zoonotic transmission of T. gondii. To date, seroepidemiological information on T. gondii in domestic pigs in India is very scarce, and there are no reports of occupational hazards to pig farmers in this country. Here, we aimed at estimating the occurrence of T. gondii (antibodies and parasite DNA) in slaughtered pigs and pig farmers in Central India. Seroprevalence was determined in 410 serum samples from slaughtered pigs and 103 sera from pig farmers using an in-house prepared antigen-based modified agglutination test (MAT), enzyme-linked immunosorbent assay (ELISA), and indirect-fluorescent antibody test (IFAT). Anti-T. gondii IgG antibodies were detected in 200 pigs (up to 48.8%, confidence interval [95% CI]: 40.4-52.2) and 44 pig farmers (up to 42.7%, 95% CI: 35.6-47.3) using MAT, ELISA, and IFAT. Inter-rater agreement showed an excellent agreement (kappa κ = 0.9) among the different serological tests suggesting similar detection potential of these tests. Recently acquired infections in all seropositive subjects were determined using IgG avidity testing and polymerase chain reaction (PCR). IgG avidity showed that 20 (10.3%) of slaughtered pigs and 8 (19.5%) pig farmers had a recently acquired infection. PCR for B1 and 529 repeats was performed in the heart tissues of slaughtered pigs and the blood cells of pig farmers. T. gondii DNA was detected in 14 (7.2%) slaughtered pigs and 5 (12.2%) pig farmers. Univariate analysis revealed that adult animals (>1 year), cats and rodents on the farm, and outdoor access are common factors (p ≤ 0.05) associated with T. gondii infection in pigs. Our results indicate that T. gondii is widely distributed in slaughtered pigs and pig farmers at risk of infection, highlighting a potential zoonotic transmission and health risk to consumers.

Melting heat transfer analysis in magnetized bioconvection flow of sutterby nanoliquid conveying gyrotactic microorganisms.

In biotechnology and biosensors bioconvection along with microorganisms play a important role. This article communicates a theoretic numerical analysis concerning the bioconvective Sutterby nanofluid flow over a stretchable wedge surface. Bioconvection is a remarkable occurrence of undercurrents fluid that is produced owing to the turning of microbes. It is considered for hydrodynamics unsteadiness and forms classified in interruption of inclined swimming microbes. Bioconvection is perceived practically in many uses for example pharmaceutical products, bio sensing applications, biomedical, bio-micro systems, biotechnology advancements and refining of mathematical models. Additionally, unsteady parameter influences are taken into account. Furthermore, no mass flux as well as heat sink/source consequences are measured in existing analysis. The similarity transformation are established for the non-linear PDEs of microorganism's field, nanofluid concentration, energy, momentum and mass for bioconvection flow of Sutterby nanofluid. Then, altered non-linear ODEs are resolved by utilizing the bvp4c technique. Moreover, nanofluids are declining in thermal and concentration fields and the greater number of Peclet number declines the field of microorganisms. Acquired numerical data displays that temperature field of nanofluid increases for more thermophoretic and unsteady parameters.

Serological and molecular detection of Toxoplasma gondii and Neospora caninum in free-ranging rats from Nagpur, India.

Toxoplasma gondii and Neospora caninum are cyst-forming coccidian parasites that infect both wild and domestic non-felids as intermediate hosts, with rodents serving as important reservoir hosts during their life cycles. This study was aimed at investigating T. gondii and N. caninum infections and identifying factors favouring T. gondii infection in free-ranging rats from India. A total of 181 rodents were trap-captured, and blood and brain samples were subsequently collected for serological and molecular examination of T. gondii and N. caninum. Antibodies against T. gondii and N. caninum were detected by MAT/NAT and IFAT in 13.8% (25/181) and 1.65% (3/181) of rodents, respectively. All three N. caninum samples positive by NAT/IFAT were also positive for ELISA, while for T. gondii, 19 of 25 MAT/IFAT positive samples were also positive for ELISA. The antibody titers (MAT/NAT/IFAT) of rodents seropositive for T. gondii ranged from 25 to 400, while those of rats seropositive for N. caninum ranged from 25 to 100. Also, using PCR, DNA from T. gondii (B1 gene) and N. caninum (NC5 gene) was found in 2.76% (5/181) of brain samples and 0.55% (1/181) of brain samples. All PCR positive samples were also seropositive. No mixed infections were observed in the serological and molecular detections. A Chi-square analysis revealed that older rats and rats living in urban areas are significantly associated with T. gondii infection; however, rodent species, gender, location, habitat types, and seasonality were statistically nonsignificant. Overall, this study demonstrated that T. gondii was widely distributed while N. caninum was less prevalent among free-ranging rats in the studied area.

Microsatellite-based diversity analysis and the development of core-set germplasm in Pakistani barley lines.

Illustrating the population structure and genetic diversity in selected germplasm resources (after three year multi locations trials) plays a key role which directly utilize the selection of lines in a population for accumulative trait breeding in crops. In order to further understand, the structure of population and genetic variability, we explored 100 selected lines, cultivated for three consecutive years (2016-2019) in swat, University of Malakand, Khyber Pakhtunkhwa Pakistan and Provinces of China (Chongqing and Beijing) with 33 mapped SSR markers. The integrated population structure analysis in a core of hundred germplasm with Pakistani origin with three approved commercial barley cultivars have strong stratification that allowed their division into four major subpopulations (i.e. PI, PII, PIII and PIV) and an admixture subpopulation, with 52, 9, 15 and 27 germplasm respectively. A total of 133 alleles were identified with mean value of 0.80 Polymorphic information content. The number of alleles detected by the system varied from two alleles amplified to as six with an average of 4.03 per SSR marker pair. The gene diversity ranged from 0.56 to 0.98 with an average of 0.82 in selected germplasm resources. Based on the SSR data, the 100 selected germplasm with three cultivars were classified into four main phylogenetic Linages (LI, LII, LIII and LIV) which corresponded to the phylogenic grouping in genotypes. We assembled a core set of 20 barley genotypes (~1/5 of original population size) to sustain sufficient mapping of SSR marker with Phenotype, in which we proposed four SSR markers, Bmac0040, Bmac0134, Bmag0125 and Bmag0211 for malt gene and marker (Bmac0399) for tolerance to salinity gene, which will be applicable for marker assisted breeding in barley gene resources.

Interaction of gyrotactic moment of microorganisms and nanoparticles for magnetized and chemically reactive shear-thinning fluid with stratification phenomenon.

Nanotechnology has gained substantial attention on account of its vast applications in food manufacturing, heat exchanges, electronic cooling systems, medical treatment, coolant processes, energy production, biotechnology, transportation, biochemistry, nuclear reactors, and metrology. Currently, the phenomenon of bioconvection using nanomaterials has found wide industrial and technical implementations. Contemporary nanofluids are a dynamic source for illuminating heat transport systems related to engineering as well as industrial phenomena. Bioconvection has numerous applications in bio-micro-systems, owing to the augmentation in mass renovation besides collaborating, which are vital complications in diverse micro-systems. This study intended to model and examine an incompressible, unsteady 3D Casson fluid nanofluid with bioconvection on a stretching surface. A model by means of these characteristics is beneficial in applications, such as in nuclear reactors, coolants in automobiles, metallurgical procedures, energy construction, micro-manufacturing, industrial engineering, and geophysical fluid mechanics along with dynamics. The performance of the Brownian motion along with thermophoresis diffusion is assumed through an extraordinary effect of thermal radiation in the temperature equation of the fluid movement. This model was created by using PDE, which was then converted into an ODE system. The somatic behavior of substantial parameters was investigated graphically. Similarly, tables were interpreted to display the effect of the control of physical quantities on the local Nusselt number, local Sherwood number, and motile density. Consequently, it was determined that the temperature of Casson fluid grew exponentially with higher estimates of the magnetic parameter and the thermal Biot number. At the same time, we detected that augmented estimation of the Lewis number decreases the Casson fluid concentration. For growing values of the parameters, Biot number and the stretching parameter, there is a direct reaction for the microorganism profile.

Edifications on Indirect IgM ELISA and Immunofluorescence assay (IFA) of scrub typhus in humans and erudition of Orientia tsutsugamushi in the vector of cohabiting rodents.

Scrub typhus is a vector-borne disease caused by Orientia tsutsugamushi, propagated into humans by the bite of infected mite belonging to genus Leptotrombodium. The present study was conducted in the Nagpur region of central India aiming towards a survey of cohabiting rodents and their potential vectors for the presence of Orientia tsutsugamushi by PCR method. The study also emphasizes serological diagnosis of the disease by employing indirect IgM ELISA and IFA amongst the human cases of pyrexia of unknown origin. Indirect IgM ELISA recorded 39.69% (31/92) seropositive patients, further processing of ELISA positive samples for IFA revealed 67.74 % (21/31) positivity for Boryong, Gilliam, Karp, and Kato serotypes. A total of 50 rodents were trapped from the cohabit areas of the patients. Three different types of rodents were identified; among which, Rattus bandicoot was highest. From these rodents, 164 vectors viz mites, lice, and fleas were collected. The highest chiggar index was recorded for Ornithonyssus biscotti mites (3.4). This study prompts a detailed analysis of different species of rodents and vectors in the said endemic region.

Innovation modeling and simulation of thermal convective on cross nanofluid flow over exponentially stretchable surface.

This work reported to investigate convective flow of non-Newtonian fluid effect on an exponentially stretchable surface. Effect of nanoparticle is considered in heat and mass equation. The transformation technique utilized on dimensionless equations is converted to non-dimensionless equations are solved thought numerical approach Bvp4c. Influence of approatiate analysis of velocities, heat and mass transport are scrutinized through figures. Furthermore, the comparative analysis of drag forces, Nusselt number and Sherwood number are evaluated over and done with tabulated values. It is give details that the temperature field strengthens with intensification in thermophoresis and random diffusions. Similarly, rises in thermophoresis effect parameter both temperature and concentration profile increasing.

Heat and mass transport in an electrically conducting nanofluid flow over two-dimensional geometries.

Engineering equipment in medicine, chemical and power engineering, electronics, and other human endeavours use nanofluids. The ability to improve mass and heat transport because of the low concentration of nanoparticles is the primary driver behind the vast array of nanofluid applications. Thus, the famous problems of viscous, incompressible, Newtonian, and 2-D laminar flow are revisited to investigate the mass and heat transmission rates for water-based carbon nanotubes (CNTs) with variable magnetic fields and external pressure gradients. Flow cases considered with varying pressure gradients are the flows upon a flat plate, flow in a planar diverging and converging channel, flow over a wedge, and plane stagnation flows, which are investigated. The impressions of thermophoresis and Brownian motion parameters are examined through the Buongiorno model. Using the Görtler transformation, the leading boundary layer (BL) equations are converted into dimensionless forms of ordinary differential equations (ODEs). Runge-Kutta Fehlberg Method (RKF45) is operated to tackle the ensuing ODEs to find the mass, heat, and skin friction rates. It has been found that the rates of shear stress, mass, and heat transport slow down with an escalating magnetic field. Although mass transport rates are decreased, shear stress and heat transport (HT) rates escalate due to the solid volume portion of carbon nanotubes. Furthermore, the pressure gradient parameter facilitates faster heat and shear stress transmission rates.

A Genome-Wide Identification and Expression Pattern of LMCO Gene Family from Turnip (Brassica rapa L.) under Various Abiotic Stresses.

Laccase-like multi-copper oxidases (LMCOs) are a group of enzymes involved in the oxidation of numerous substrates. Recently, these enzymes have become extremely popular due to their practical applications in various fields of biology. LMCOs generally oxidize various substrates by linking four-electron reduction of the final acceptor, molecular oxygen (O2), to water. Multi-copper oxidases related to laccase are extensively distributed as multi-gene families in the genome sequences of higher plants. The current study thoroughly investigated the LMCO gene family (Br-Lac) and its expression pattern under various abiotic stresses in B. rapa L. A total of 18 Br-Lac gene family members located on five different chromosomes were identified. Phylogenetic analysis classified the documented Br-Lac genes into seven groups: Group-I (four genes), Group-II (nine genes), Group-III (eight genes), Group-IV (four genes), Group-V (six genes), and Group-VI and Group-VII (one gene each). The key features of gene structure and responsive motifs shared the utmost resemblance within the same groups. Additionally, a divergence study also assessed the evolutionary features of Br-Lac genes. The anticipated period of divergence ranged from 12.365 to 39.250 MYA (million years ago). We also identified the pivotal role of the 18 documented members of the LMCO (Br-lac) gene family using quantitative real-time qRT-PCR. Br-Lac-6, Br-Lac-7, Br-Lac-8, Br-Lac-16, Br-Lac-17, and Br-Lac-22 responded positively to abiotic stresses (i.e., drought, heat, and salinity). These findings set the stage for the functional diversity of the LMCO genes in B. rapa.

Energetics of Microwaves Probed by Double Quantum Dot Absorption.

We explore the energetics of microwaves interacting with a double quantum dot photodiode and show wave-particle aspects in photon-assisted tunneling. The experiments show that the single-photon energy sets the relevant absorption energy in a weak-drive limit, which contrasts the strong-drive limit where the wave amplitude determines the relevant-energy scale and opens up microwave-induced bias triangles. The threshold condition between these two regimes is set by the fine-structure constant of the system. The energetics are determined here with the detuning conditions of the double dot system and stopping-potential measurements that constitute a microwave version of the photoelectric effect.

The impact of psychiatric comorbidities on emergency general surgical patients' outcomes.

BACKGROUND: Psychiatric disorders are increasingly prevalent. Studies have demonstrated that the presence of comorbid psychiatric conditions (CPC) is associated with a number of worsening outcomes in hospitalised patients in general. The relationship between a wide range of psychiatric comorbidities and acute surgical presentations has not been studied to date. STUDY DESIGN: The Hospital In-Patient Enquiry (HIPE) system and prospectively maintained eHandover were used to identify all surgical emergency admissions to Mayo University Hospital, Ireland. Patient demographics, comorbidities, primary diagnoses, length of stay (LoS), and procedures undergone were recorded over a 12-months period. Subgroup analyses examining LoS variation in surgical presentation types were performed. RESULTS: 1028 admissions occurred over this one year period, amongst 995 patients, the presence of psychiatric comorbidities increased the mean LoS by 1.9 days (p = 0.002). Comorbid depression, dementia, and intellectual disability conferred a significant increase in LoS by 2.4 days, 2.8 days and 6.7 days respectively. Subgroup analysis revealed greater LoS in patients with CPC diagnosed with non-specific abdominal pain (1.4 days, p = 0.019), skin and soft tissue infections (2.5 days, p = 0.040), bowel obstruction (4.3 days, p = 0.047), and medical disorders (18.6 days, p = 0.010). No significant difference was observed in mortality and readmission rates. CONCLUSION: Psychiatric comorbidities significantly impact length of hospital stay and discharge planning in surgical inpatients. Greater awareness of this can facilitate better care delivery for this population to reduce the LoS and subsequent economic burden on the healthcare system.

A Rare Case of a Type IV Dual Left Anterior Descending Artery and Ectopic Left Anterior Descending and Circumflex Arteries Requiring Surgery.

Congenital anomalous coronary arteries (CACAs) comprise an important variant of the coronary vasculature. They are benign in the vast majority of cases, whereas a small minority may be affected by serious consequences such as myocardial infarction, arrhythmia, cardiac arrest, and even death. We herein describe a 62-year-old man with sudden and severe substernal chest pain; Q waves in electrocardiographic leads II, III, and aVF; and positive serum troponin I enzyme. Left heart cardiac catheterization revealed triple coronary vessel disease with a 60% to 70% occlusion in the left main coronary artery (LMCA). The left anterior descending (LAD) and the left circumflex artery arose from the ostium of the right coronary artery. Additionally, a rudimentary type IV dual LAD originated from the LMCA. A coronary artery bypass graft surgery was performed using a left internal mammary artery graft for the LAD and a saphenous vein graft for the diagonal branches (I & II) of the LAD and the posterior descending artery. The patient was discharged after an uneventful 1-week hospital course.

A new species in the grassland leafhopper genus Stirellus Osborn amp; Ball (Hemiptera: Cicadellidae: Deltocephalinae: Stenometopiini) from Pakistan.

A new leafhopper species Stirellus pakistanicus Shah Duan sp. n. is described from Attock region of the Punjab province of Pakistan. Habitus photos and illustrations of male genitalia of the new species are provided. An updated checklist and a distribution map of the known species of Stirellus from Pakistan are also given.

Migratory birds as the vehicle of transmission of multi drug resistant extended spectrum ß lactamase producing Escherichia fergusonii, an emerging zoonotic pathogen.

The acquisition of multi-drug resistance (MDR) genes by pathogenic bacterial bugs and their dispersal to different food webs has become a silent pandemic. The multiplied use of different antibacterial therapeutics during COVID-19 pandemic has accelerated the process among emerging pathogens. Wild migratory birds play an important role in the spread of MDR pathogens and MDR gene flow due to the consumption of contaminated food and water. Escherichia fergusonii is an emerging pathogen of family Enterobacteriaceae and commonly causes disease in human and animals. The present study focused on the isolation of E. fergusonii from blood, saliva, and intestine of selected migratory birds of the Hazara Division. The sensitivity of isolated strains was assessed against ten different antibiotics. The isolation frequency of E. fergusonii was 69%. In blood samples, a high rate of resistance was observed against ceftriaxone (80%) followed by ampicillin (76%) whereas, in oral and intestinal samples, ceftriaxone resistant strains were 56% and 57% while ampicillin resistance was 49% and 52% respectively. The overall ceftriaxone and ampicillin-resistant cases in all three sample sources were 71% and 65% respectively. In comparison to oral and intestinal samples, high numbers of ceftriaxone-resistant strains were isolated from the blood of mallard while ampicillin-resistant strains were observed in blood samples of cattle egrets. 16S rRNA-based confirmed strains of E. fergusonii were processed for detection of CTX-M and TEM-1 gene through Polymerase chain reaction (PCR) after DNA extraction. Hundred percent ceftriaxone resistant isolates possessed CTX-M and all ampicillin-resistant strains harbored TEM-1 genes. Amplified products were sequenced by using the Sanger sequencing method and the resulted sequences were checked for similarity in the nucleotide Database through the BLAST program. TEM-1 gene showed 99% and the CTX-M gene showed 98% similar sequences in the Database. The 16S rRNA sequence and nucleotide sequences for TEM-1 and CTX-M genes were submitted to Gene Bank with accession numbers LC521304, LC521306, LC521307 respectively. We posit to combat MDR gene flow among the bacterial pathogens across different geographical locations, regular surveillance of new zoonotic pathogens must be conducted.

COVID-19 Antibodies in Vaccinated Healthcare Workers: The Security Currency.

Background The coronavirus disease 2019 (COVID-19) vaccinations have brought new hope to the world and have a significant psychosocial impact on communities as well as healthcare systems around the globe. This study aimed to assess the antibody titer level among healthcare workers after at least six weeks of the second dose of the COVID-19 vaccine. Methods Participants of the study were healthcare workers of a tertiary care cardiac center including doctors, nursing staff, paramedics, and office staff. All participants were fully vaccinated with recommended double dose of available vaccine at least six weeks before the study. A blood sample of five milliliters was collected from all the participants by a trained phlebotomist at a local laboratory, and COVID-19 antibodies titer level was assessed using Food and Drug Administration (FDA) approved kit with a standard range of 1.0. This qualitative assay detects IgG and IgM as total antibodies targeted against nucleocapsid antigen performed on a fully automated cobas® 6000 analyzer (F. Hoffmann-La Roche Ltd, Basel, Switzerland) using electrochemiluminescence technology. COVID-19 antibodies titer levels were categorized as ≤100, 101-250, and >250. Results A total of 151 healthcare workers were included, of which 70.2% (106) were male. The history of COVID-19 infection before vaccination was found in 41.1% (62). The mean duration since the last dose of the vaccine was 89.6±40.07 days. In total 71.5% (108) had antibodies titer level of >250, which were mostly found in participants of younger age and who had previous COVID-19 infection. However, antibodies titer level of >250 were observed in 84% (21/25) at 61 to 90 days of vaccination, which declined to 80% (20/25) after 91 to 120 days and to 57.1% (32/56) after >120 days of vaccination. Conclusions Good antibodies titer levels were observed in vaccinated healthcare workers, especially in those who were younger and had previous COVID-19 infection.