Endovascular thrombectomy for acute ischemic stroke with a large infarct area: An updated systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Since the efficacy and safety of endovascular thrombectomy (EVT) in patients with acute ischemic stroke with a large infarct area is still inconclusive, we sought to compare functional and neurological outcomes with the use of endovascular thrombectomy versus medical care alone. METHODS: We searched MEDLINE (via PubMed), Embase, Cochrane Library, ClinicalTrials.gov, and the International Clinical Trials Registry Platform (ICTRP) to retrieve all the relevant randomized controlled trials (RCTs) on this topic. Review manager (RevMan) was used to perform meta-analyses using a random-effect model. Dichotomous outcomes were pooled using risk ratios (RR) with 95% confidence intervals (CIs). RESULTS: Our meta-analysis included 6 RCTs with a total of 1665 patients. Most studies included patients with an ASPECTS score of 3-5. Our results demonstrate that endovascular thrombectomy significantly increased the rates of functional independence (mRS ≤ 2) (RR, 2.49; 95% CI, 1.89-3.29) and moderate neurological outcome (mRS ≤ 3) (RR, 1.90; 95% CI, 1.50-2.40) at 90 days. The benefit of EVT for these outcomes remained the same at 1-year follow-up. Endovascular thrombectomy was associated with increased rates of early neurological improvement (RR, 2.22; 95% CI, 1.53-3.22), excellent neurological recovery (mRS ≤ 1) (RR, 1.75; 95% CI, 1.02-3.03), and decreased rate of poor neurological recovery (mRS 4-6) (RR, 0.81; 95% CI, 0.76-0.86). No significant difference was found between the two groups regarding all-cause mortality (RR, 0.86; 95% CI, 0.72-1.02), decompressive craniectomy (RR, 1.32; 95% CI, 0.89-1.94), and the incidence of serious adverse effects (RR, 1.39; 95% CI, 0.83-2.32) between the two groups. Endovascular thrombectomy significantly increased the rates of any intracranial hemorrhage (RR, 1.94; 95% CI, 1.48-2.53) and symptomatic intracranial hemorrhage (RR, 1.73; 95% CI, 1.11-2.69). CONCLUSION: Endovascular thrombectomy (EVT) significantly improves neurological and functional outcomes in patients who present within 6 hours of stroke onset with ICA and proximal M1 occlusions, and ASPECTS scores ranging from 3 to 5, compared to medical therapy alone, with an increased risk of symptomatic intracranial hemorrhage.

STATUS OF ETHICAL REVIEW BOARDS IN MEDICAL COLLEGES OF KHYBER PAKHTUNKHWA.

BACKGROUND: Ethics means custom, character, habit or disposition and as a discipline is frequently called Moral Philosophy. Ethics cannot be regulated until it is incorporated in Law. With the advent of research in life sciences, the need of ethical review boards was felt to protect individual and public interests. The objective of this study was to know the status of ethical review boards at all medical colleges of Khyber Pakhtunkhwa in terms of its existence, membership and activities. METHODS: This province wise cross-sectional survey was conducted over a period of three months. All the sixteen medical colleges of the province registered with Pakistan Medical and Dental Council Islamabad were included. A structured questionnaire was used as data collection tool. Single respondent from each medical college was identified by the respective chief executive officer or principal. Data was analysed through SPSS V-20 and MS Excel 2007. Descriptive statistics were calculated for quantitative data. RESULTS: Out of sixteen medical colleges, one had no ethical review board and another neither refused nor returned filled questionnaire. Eleven medical colleges reported combined boards with their teaching hospitals, while 3 had separate boards. Highest number of members noted was 14 and lowest being 4. Mode was 8. None of the boards had a medical doctor with degree or diploma in bioethics, as its member. Six medical colleges had medical doctors who had attended workshops on bioethics. Majority of medical colleges had no track of record about its review boards. CONCLUSION: Overall situation of ethical review boards at the medical colleges of Khyber Pakhtunkhwa is not satisfactory and needs proper regulatory measures.

Pancreatic adenocarcinoma of the tail-Unveiling a rare presentation with venous thrombosis: A case report and literature review.

Pancreatic cancer is a silent and lethal adversary that often conceals its presence until advanced stages. This report elucidates a distinctive case of a 46-year-old patient with pancreatic tail adenocarcinoma presenting with venous thrombosis, a rare manifestation. The patient's symptoms included severe left leg pain, swelling, and redness, accompanied by weight loss and decreased appetite. Laboratory findings indicated a prothrombotic state, whereas imaging revealed a substantial mass on the tail of the pancreas with hepatic metastasis. Elevated cancer antigen 19-9 and carcinoembryonic antigen supported the diagnosis which was confirmed by a liver biopsy. This case underscores the diagnostic challenges posed by pancreatic cancer, particularly in the tail, emphasizing the need for early detection. The intricate interplay between metastasis and thrombosis complicates the clinical landscape, requiring a comprehensive approach to management.

Computing edge version of metric dimension of certain chemical networks.

In the modern digital sphere, graph theory is a significant field of research that has a great deal of significance. It finds widespread application in computer science, robotic directions, and chemistry. Additionally, graph theory is used in robot network localization, computer network problems and the formation of various chemical structures for networks. Moreover, it finds uses in exploring diffusion mechanisms and scheduling aircraft as well. The present research project examines and concentrates on the edge version of metric dimension of the Concealed Non-Kekuléan Benzenoid Hydrocarbon, Polythiophene, Backbone DNA network and Bakelite networks. All the mentioned networks have constant edge metric dimension except Bakelite network, as demonstrated by the results. If we talk about the applications of these networks, Polythiophene are used to treat prion disorders. It is also capable of detecting metal ions. The concept of Bakelite, which finds applications in the jewelry, electrical, cookware, sports, and clock industries, had an impact on the invention of modern polymers. The functions of DNA include information encoding, replication, mutation, and recombination gene expression.

Nanoseeded Desupersaturation and Dissolution Tests for Elucidating Supersaturation Maintenance in Amorphous Solid Dispersions.

The impact of residual drug crystals that are formed during the production and storage of amorphous solid dispersions (ASDs) has been studied using micron-sized seed crystals in solvent-shift (desupersaturation) and dissolution tests. This study examines the impacts of the seed size loading on the solution-mediated precipitation from griseofulvin ASDs. Nanoparticle crystals (nanoseeds) were used as a more realistic surrogate for residual crystals compared with conventional micron-sized seeds. ASDs of griseofulvin with Soluplus (Sol), Kollidon VA64 (VA64), and hydroxypropyl methyl cellulose (HPMC) were prepared by spray-drying. Nanoseeds produced by wet media milling were used in the dissolution and desupersaturation experiments. DLS, SEM, XRPD, and DSC were used for characterization. The results from the solvent-shift tests suggest that the drug nanoseeds led to a faster and higher extent of desupersaturation than the as-received micron-sized crystals and that the higher seed loading facilitated desupersaturation. Sol was the only effective nucleation inhibitor; the overall precipitation inhibition capability was ranked: Sol > HPMC > VA64. In the dissolution tests, only the Sol-based ASDs generated significant supersaturation, which decreased upon an increase in the nanoseed loading. This study has demonstrated the importance of using drug nanocrystals in lieu of conventional coarse crystals in desupersaturation and dissolution tests in ASD development.

New optimum solutions of nonlinear fractional acoustic wave equations via optimal homotopy asymptotic method-2 (OHAM-2).

The second iteration of the optimal homotopy asymptotic technique (OHAM-2) has been protracted to fractional order partial differential equations in this work for the first time (FPDEs). Without any transformation, the suggested approach can be used to solve fractional-order nonlinear Zakharov-Kuznetsov equations. The Caputo notion of the fractional-order derivative, whose values fall within the closed interval [0, 1], has been taken into consideration. The method's appeal is that it provides an approximate solution after just one iteration. The suggested method's numerical findings have been contrasted with those of the variational iteration method, residual power series method, and perturbation iteration method. Through tables and graphs, the proposed method's effectiveness and dependability are demonstrated.

Improvement of the aerodynamic behaviour of the passenger car by using a combine of ditch and base bleed.

The current study investigates different methods to minimize the drag coefficient (CD) without ignoring the safety factor related to the stability of a vehicle, i.e., the lift coefficient (CL). The study was carried out by employing an SUV car analyzed numerically using one of the CFD software, Ansys. Four different models such as realizable k-ε, standard k-ω, shear stress transport k-ω, and Reynolds stress model (RSM). The considered models have been validated with experimental data and found in good agreement. The considered inlet velocity varies from 28 to 40 m/s, the results showed that the drag coefficient and the stability are both improved by applying a modification on the roof of the considered car.

Chest pain with raised troponin, ECG changes but normal coronary arteries.

A 65-year-old woman presented to A&E department, with acute onset central chest pain and dyspnoea. ECG showed dynamic T wave changes while 12 h troponin was elevated. A diagnosis of acute coronary syndrome was made and she underwent an inpatient coronary angiogram. Although her coronary arteries were normal, symptoms persisted and D-dimers were found to be elevated. This led to a CT pulmonary angiogram, which ruled out pulmonary embolism, but uncovered a large ascending aortic aneurysm with a contained leak. She was immediately transferred to regional cardiothoracic unit for urgent surgical intervention. This case report illustrates the importance of a good clinical history, physical examination and timely investigations. It also emphasises that not all chest pain events with elevated troponin level are due to acute coronary syndrome and that alternative diagnoses should still be considered.