Gastrointestinal bleeding in recipients of left ventricular assist devices-a systematic review.

The twenty-first century has revolutionized the management of congestive heart failure with the widespread use of left ventricular assist devices and other treatment modalities that improve morbidity and mortality after the failure of medical management. These novel devices come with significant side effects. One of the most common side effects of left ventricular assist devices is the increased frequency of lower gastrointestinal bleeding compared to heart failure patients without left ventricular assist devices. Multiple etiologies of recurrent gastrointestinal bleeding in such patients have been studied. The decreased amount of von Willebrand factor polymers is now recognized as one of the most common causes of increased incidence of gastrointestinal bleeding in patients with left ventricular assist devices alongside increased arteriovenous malformations. Multiple treatment modalities have been identified to prevent and treat gastrointestinal bleeding in these patients. Since the use of left ventricular assist devices is becoming more prevalent in patients with advanced heart failure, we decided to conduct this systematic review. The article summarizes the incidence, pathophysiology, and management of lower gastrointestinal bleeding in patients with left ventricular assist devices.

Facile Pressure-Sensitive Capacitive Touch Keypad for a Green Intelligent Human-Machine Interface.

There is a great demand for human-machine interfaces (HMIs) in emerging electronics applications. However, commercially available plastic-based HMIs are primarily rigid, application-specific, and hard to recycle and dispose of due to their non-biodegradability. This results in electronic and plastic waste, potentially damaging the environment by ending up in landfills and water resources. This work presents a green, capacitive pressure-sensitive (CPS), touch sensor-based keypad as a disposable, wireless, and intelligent HMI to mitigate these problems. The CPS touch keypads were fabricated through a facile green fabrication process by direct writing of graphite-on-paper, using readily available materials such as paper and pencils, etc. The interdigitated capacitive (IDC) touch sensors were optimized by analyzing the number of electrode fingers, dimensions, and spacing between the electrode fingers. The CPS touch keypad was customized to wirelessly control a robotic arm's movements based on the touch input. A low-pressure touch allows slow-speed robotic arm movement for precision movements, and a high-pressure touch allows high-speed robotic arm movement to cover the large movements quickly. The green CPS touch keypad, as a disposable wireless HMI, has the potential to enforce a circular economy by mitigating electronic and plastic waste, which supports the vision of a sustainable and green world.

Garage-Fabricated, Ultrasensitive Capacitive Humidity Sensor Based on Tissue Paper.

The role of humidity sensors in different industries and field applications, such as agriculture, food monitoring, biomedical equipment, heating, and ventilation, is well known. However, most commercially available humidity sensors are based on polymers or electronic materials that are not degradable and thus contribute to electronic waste. Here, we report a low-cost, flexible, easy-to-fabricate, and eco-friendly parallel-plate capacitive humidity sensor for field applications. The sensor is fabricated from copper tape and tissue paper, where copper tape is used to create the plates of the capacitor, and tissue paper is used as a dielectric sensing layer. Along with the low cost, the high sensitivity, better response and recovery times, stability, and repeatability make this sensor unique. The sensor was tested for relative humidity (RH), ranging from 40% to 99%, and the capacitance varied linearly with RH from 240 pF to 720 pF, as measured by an Arduino. The response time of the sensor is ~1.5 s, and the recovery time is ~2.2 s. The experiment was performed 4-5 times on the same sensor, and repeatable results were achieved with an accuracy of ±0.1%. Furthermore, the sensor exhibits a stable response when tested at different temperatures. Due to the above advantages, the presented sensor can find ready applications in different areas.

High-performance ambipolar MoS2transistor enabled by indium edge contacts.

The integration of electrical contact into 2D heterostructure is an essential approach to high-quality electronic nano-devices, especially field-effect transistors. However, high contact resistance with transition metal dichalcogenides such as molybdenum disulphide (MoS2)-based devices has been a significant fabrication impediment to their potential applications. Here, we have demonstrated the advantage of 1D indium metal contact with fully encapsulated MoS2within hexagonal boron nitride. The electrical measurements of the device exhibit ambipolar transport with an on/off ratio of102for holes and107for electrons. The device exhibits high field-effect mobility of40.7cm2V-1s-1at liquid nitrogen temperature. Furthermore, we have also analysed the charge-transport mechanism at the interface and have calculated the Schottky barrier height from the temperature-dependent measurement. These results are highly promising for the use of air-sensitive material heterostructure and large-scale design of trending flexible, transparent electronic wearable devices.

High performance self-gating graphene/MoS2 diode enabled by asymmetric contacts.

A graphene-MoS2 (GM) heterostructure based diode is fabricated using asymmetric contacts to MoS2, as well as an asymmetric top gate (ATG). The GM diode exhibits a rectification ratio of 5 from asymmetric contacts, which is improved to 105 after the incorporation of an ATG. This improvement is attributed to the asymmetric modulation of carrier concentration and effective Schottky barrier height (SBH) by the ATG during forward and reverse bias. This is further confirmed from the temperature dependent measurement, where a difference of 0.22 eV is observed between the effective SBH for forward and reverse bias. Moreover, the rectification ratio also depends on carrier concentration in MoS2 and can be varied with the change in temperature as well as back gate voltage. Under laser light illumination, the device demonstrates strong opto-electric response with 100 times improvement in the relative photo current, as well as a responsivity of 1.9 A W-1 and a specific detectivity of 2.4 × 1010 Jones. These devices can also be implemented using other two dimensional (2D) materials and suggest a promising approach to incorporate diverse 2D materials for future nano-electronics and optoelectronics applications.

Comparison of trapped charges and hysteresis behavior in hBN encapsulated single MoS2 flake based field effect transistors on SiO2 and hBN substrates.

Molybdenum disulfide (MoS2) based field effect transistors (FETs) are of considerable interest in electronic and opto-electronic applications but often have large hysteresis and threshold voltage instabilities. In this study, by using advanced transfer techniques, hexagonal boron nitride (hBN) encapsulated FETs based on a single, homogeneous and atomic-thin MoS2 flake are fabricated on hBN and SiO2 substrates. This allows for a better and a precise comparison between the charge traps at the semiconductor-dielectric interfaces at MoS2-SiO2 and hBN interfaces. The impact of ambient environment and entities on hysteresis is minimized by encapsulating the active MoS2 layer with a single hBN on both the devices. The device to device variations induced by different MoS2 layer is also eliminated by employing a single MoS2 layer for fabricating both devices. After eliminating these additional factors which induce variation in the device characteristics, it is found from the measurements that the trapped charge density is reduced to 1.9 × 1011 cm-2 on hBN substrate as compared to 1.1 × 1012 cm-2 on SiO2 substrate. Further, reduced hysteresis and stable threshold voltage are observed on hBN substrate and their dependence on gate sweep rate, sweep range, and gate stress is also studied. This precise comparison between encapsulated devices on SiO2 and hBN substrates further demonstrate the requirement of hBN substrate and encapsulation for improved and stable performance of MoS2 FETs.

Photodetector Based on Multilayer SnSe2 Field Effect Transistor.

We demonstrate a high-performance photodetector with multilayer tin diselenide (SnSe2) exfoliated from a high-quality crystal which was synthesized by the temperature gradient growth method. This SnSe2 photodetector exhibits high photoresponsivity of 5.11 × 105 A W-1 and high specific detectivity of 2.79 × 1013 Jones under laser irradiation (λ = 450 nm). We also observed a reproducible and stable time-resolved photoresponse to the incident laser beam from this SnSe2 photodetector, which can be used as a promising material for future optoelectronic applications.

Prevalence, antibiotic sensitivity and phenotypic screening of ESBL/MBL producer E. coli strains isolated from urine; District Swabi, KP, Pakistan.

The study aimed to record the prevalence of Urinary Tract Infection caused by E. coli, its antibiotic sensitivity and phenotypic detection of ESBL and MBL producer E. coli. Total of 240 urine samples were collected from Bacha Khan medical complex, Swabi. Antibiotic sensitivity and production of ESBL and MBL according to CLSI guidelines 2017 were performed. Out of 75 E. coli strains, only 25 (33.3%) isolates were positive for ESBL. Similarly, 25 were resistant to Imipenem, in which 12 (16%) isolates were positive for MBL production. E. coli isolates were found more sensitive to Amikacin 57 (76%) followed by Imipenem 50 (66.67%), Ofloxacin 48 (64%), Ciprofloxacin 44 (58.67%), Norfloxacin 42 (56%) and were 100% resistant to Penicillin, Ceftriaxone, Ceftazidime and Cefotaxime. The current study recorded the prevalence rate of UTI caused by E. coli was 75( 66.96%) and ccurrence rate of ESBL and MBL producers in the total (n=75) E. coli isolates was 25( 33.3%) and 12(48%) respectively.

High performance MoS2-based field-effect transistor enabled by hydrazine doping.

We investigated the n-type doping effect of hydrazine on the electrical characteristics of a molybdenum disulphide (MoS2)-based field-effect transistor (FET). The threshold voltage of the MoS2 FET shifted towards more negative values (from -20 to -70 V) on treating with 100% hydrazine solution with the channel current increasing from 0.5 to 25 µA at zero gate bias. The inverse subthreshold slope decreased sharply on doping, while the ON/OFF ratio increased by a factor of 100. Gate-channel coupling improved with doping, which facilitates the reduction of channel length between the source and drain electrodes without compromising on the transistor performance, making the MoS2-based FET easily scalable.

Non-degenerate n-type doping by hydrazine treatment in metal work function engineered WSe2 field-effect transistor.

We report a facile and highly effective n-doping method using hydrazine solution to realize enhanced electron conduction in a WSe2 field-effect transistor (FET) with three different metal contacts of varying work functions-namely, Ti, Co, and Pt. Before hydrazine treatment, the Ti- and Co-contacted WSe2 FETs show weak ambipolar behaviour with electron dominant transport, whereas in the Pt-contacted WSe2 FETs, the p-type unipolar behaviour was observed with the transport dominated by holes. In the hydrazine treatment, a p-type WSe2 FET (Pt contacted) was converted to n-type with enhanced electron conduction, whereas highly n-doped properties were achieved for both Ti- and Co-contacted WSe2 FETs with on-current increasing by three orders of magnitude for Ti. All n-doped WSe2 FETs exhibited enhanced hysteresis in their transfer characteristics, which opens up the possibility of developing memories using transition metal dichalcogenides.

Simultaneous quantitation of Ofloxacin, Fexofenadine HCl and Diclofenac Potassium in affixed dose combinative formulation by HPLC-UV method.

A high-pressure liquid chromatography (HPLC-UV) based simple and specific method for simultaneous quantitative determination of Ofloxacin, Fexofenadine HCl and Diclofenac Potassium has been developed and validated according to ICH guidelines. Chromatographic separation of the three drugs was carried out on 4.6 x 250 mm x 5 µ Licrospher RP Select B Column, using mobile phase constituted of methanol and phosphate buffer pH 3.5 (650: 350), pH adjusted to 3.5 ± 0.05 with dilute ortho-phosphoric acid and delivered at a flow rate of 1 ml/min. The eluents were detected at UV wavelength of 220 nm and the retention times for Ofloxacin, Fexofenadine HCl and Diclofenac Potassium were 2.5 minutes, 4 minutes and 11.5 minutes, respectively. This method is suitable and specific for the three drugs and was found to be linear (R² > 0.996), accurate, specific, reproducible and robust over a concentration range of 0.05 to 0.15 mg/ml for Ofloxacin, 0.015 to 0.045 mg/ml for Fexofenadine HCl and 0.0125 to 0.0375 mg/ml for Diclofenac Potassium. The proposed method is simple and convenient, hence easily utilized for the characterization and quantitation of the three drugs in a single formulation for combination therapy of rheumatoid arthritis, sepsis, infection with fever and flu.

Simultaneous quantitation of aspirin, amlodipine and simvastatin in a fixed dose combination of encapsulated tablet formulation by HPLC-UV method.

A high-pressure liquid chromatography (HPLC-UV) based simple and specific method for simultaneous quantitative determination of aspirin, amlodipine besylate and simvastatin in a capsule formulation has been developed and validated according to ICH guidelines. Chromatographic separation of the three drugs was carried out by aSpherisorbODS2 reverse phase column (4.6 x 250 mm; 5 µm) using amobile phase, which consisted of 70: 30 (v/v) mixture of acetonitrile and triethylamine phosphate buffer (pH 3; 0.015 M) with final pH adjusted to 2.5 using dilute ortho-phosphoric acid, at a flow rate of 1mL/min. The eluents were detected at UV wavelength of 237 nm and the retention times for aspirin, amlodipine besylate and simvastatin were ~2.7 mins, ~6.1 mins and ~10.5mins, respectively. This method is suitable and specific for the three drugs and was found to be linear (R2>0.995), accurate, specific, reproducible and robust in the concentration range of 375 to 1125mcg/ml for aspirin, 25 to 75mcg/ml for amlodipine besylate and 50 to 150mcg/ml for simvastatin. This simple and convenient method could be easily utilized for the characterization and quantitation of the three drugs in a single formulation for combination therapy of cardiovascular diseases.

Economic policy uncertainty and financial system efficiency.

Economic policy uncertainty (EPU) adversely affects financial system functioning with potentially critical repercussions for economies and corporations worldwide. Financial system efficiency (FSE) has a vital influence on fostering optimal economic growth and development; however, the impact of EPU on FSE remains under-explored. This study investigates the effect of EPU on FSE along with its components financial institution efficiency (FIE) and financial market efficiency (FME). Using data from 22 countries over a 20-year period (2002-2021), our analysis reveals a significant negative effect of EPU on FSE, FIE and FME. Notably, our split-sample analysis highlights the accentuated adverse effects of EPU in high-EPU regimes, emphasising the importance of vigilance during periods of elevated policy uncertainty. We conduct a series of sensitivity tests, including alternative measures of EPU, FSE, FIE and FME, and apply two-stage least squares and two-step dynamic system generalised method of moments estimators and introduce additional control variables. These tests consistently reaffirm the core conclusions of our study. Finally, we discuss the implications of our findings for policymakers.

Democracy's limited impact on innovation: Panel data evidence from developing countries.

This study investigates the relationship between democracy and innovation across 61 developing countries from 2013 to 2020, utilizing data from Global Innovation Index. Employing the Freedom House Index and Polity2 indicators as proxies for democracy, research employs Ordinary Least Squares (OLS), Fixed Effects and SystemGMM techniques to analyze their impact on innovation. The findings of the study reveal no statistically significant relationships between democracy and innovation in developing nations within specified timeframe. Through empirical analysis, including various econometric approaches, it is observed that the level of democracy as measured by these indicators, does not appear to exert a discernable impact on the innovation landscape of these countries. These results carry important implications for public policy. While the promotion of democracy remains a crucial goal, especially for societal development and political stability, this study suggests that solely focusing on enhancing democratic institutions might not necessarily yield immediate direct improvements in the innovation capacities of developing nations. Policymakers and stakeholders involved in fostering innovation ecosystems in these regions may need to consider a more nuanced approach, encompassing factors beyond the scope of democratic governance to effectively spur innovation. Understanding the nuanced relationship between democracy and innovation in developing countries has significant implications for designing targeted policies aimed at enhancing innovation capacities, economic growth and overall societal development in these regions.

Predictors of cytomegalovirus reactivation after allogeneic hematopoietic cell transplantation: Insights from a real-world experience.

BACKGROUND: We aimed to investigate factors associated with cytomegalovirus (CMV) viremia and CMV disease and its impact on post-transplant outcomes including overall survival (OS) following allogeneic hematopoietic stem cell transplantation (Allo-SCT). METHODS: We conducted a single-center retrospective study including 452 Allo-SCT recipients (matched unrelated donor, MUD 61%; haploidentical, haplo 39%) from 2016 to 2021. Data were analyzed using SPSS v28. Descriptive (chi-square and t-test), Kaplan-Meier and regression analyses were conducted. RESULTS: The median age was 57 years. Sixty-one percent were males and 84.3% were Caucasians. CMV serostatus was positive in 59.1% of recipients. The median follow-up was 24.4 months. CMV viremia and CMV disease were observed in 181 (40%) and 32 (7%) patients, respectively. Among CMV seropositive recipients, 65% developed CMV viremia and 11% were noted to have CMV disease compared to 4% and 1% in seronegative recipients, respectively (p < 0.001). Patients with CMV disease had significantly lower OS than those without CMV disease (median 14.1 months vs. not reached, p = 0.024); however, OS was not associated with CMV viremia (median not reached in both groups, p = 0.640). Letermovir prophylaxis was used in 66% (n = 176/267) of CMV seropositive recipients, but no impact was observed on the incidence of CMV viremia or CMV disease and OS. CONCLUSIONS: CMV disease leads to significantly inferior survival after an allogeneic hematopoietic cell transplantation. Recipient CMV seropositive status was associated with the risk of CMV viremia and CMV disease, and this was not abrogated with the use of Letermovir prophylaxis.

Routine preoperative chest x-ray and its impact on decision making in patients undergoing elective surgical procedures.

BACKGROUND: It is the routine of our hospital that all patients undergoing any kind of surgery in any specialty are subjected to routine pre-op chest x-ray (CXR). However there is increasing evidence that this practice does not have much influence on patient management and thus could be limited to a very small number of patients in whom it is justified. We conducted this study to know the significance of routine pre-op x-rays chest in patients admitted in a surgical unit for elective surgery and to what extent such routine x-ray affected our surgical intervention. METHODS: It is a cross sectional study in which 500 consecutive adult patients admitted in surgical 'C' unit of Lady Reading Hospital Peshawar, for elective surgical procedures were included. The age, gender, co-morbidity, delay in operation if any was recorded and CXR were reported upon by a qualified radiologist. The influence on decision making regarding fitness of patients for general anaesthesia/surgery was also determined. Data were analysed using SPSS-20. RESULTS: Out of total of 500 chest x-rays 109 (21.8%) were reported to have some abnormality in the film. Out of these 109, 58 were male 51 were female patients. The percentages of abnormal CXR according to age were 13.6%, 35.8%, and 50% in the 16-39 years, 40-69 years and > or = 70 year age groups respectively. Amongst the patients with abnormal CXR, 30 had their surgery delayed. However in only one patient out of the 30 the delay was on the basis of significant finding on the CXR. CONCLUSION: Good medical history and clinical examination can save many patients from unnecessary CXR. Preoperative CXR may only be dclone in patients who have a clear indication for this investigation.

Marijuana as a Cause of Diffuse Coronary Vasospasm Leading to Cardiac Arrest.

Marijuana is considered as the most popular illicit drug around the world. It has numerous cardiovascular effects with myocardial infarction (MI) being a lethal one. The negative physiological effects of marijuana are well-studied, including tachycardia, nausea, memory impairment, anxiety, panic, and arrhythmia. We present a case of cardiac arrest following marijuana use in a patient who had a normal electrocardiogram (EKG) on presentation but diffuse coronary vasospasm on left heart catheterization (LHC) with no obstructive lesion. The patient had a transient episode of ST elevation on EKG following the procedure which resolved with an increased dose of nitroglycerine drip. Synthetic cannabinoids are more potent and not detected on a regular urine drug screen (UDS). In patients with low risk for cardiovascular events, particularly young adults, presenting with symptoms of MI/cardiac arrest, marijuana-induced MI should be suspected due to the severe adverse effects of its synthetic component.

Emerging Two-Dimensional Materials-Based Electrochemical Sensors for Human Health and Environment Applications.

Two-dimensional materials (2DMs) have been vastly studied for various electrochemical sensors. Among these, the sensors that are directly related to human life and health are extremely important. Owing to their exclusive properties, 2DMs are vastly studied for electrochemical sensing. Here we have provided a selective overview of 2DMs-based electrochemical sensors that directly affect human life and health. We have explored graphene and its derivatives, transition metal dichalcogenide and MXenes-based electrochemical sensors for applications such as glucose detection in human blood, detection of nitrates and nitrites, and sensing of pesticides. We believe that the areas discussed here are extremely important and we have summarized the prominent reports on these significant areas together. We believe that our work will be able to provide guidelines for the evolution of electrochemical sensors in the future.

Invisible touch sensors-based smart and disposable door locking system for security applications.

Nowadays, security is one of the living essentials, and there is a dire need for reliable, secure, and smarter locking systems. The stand-alone smart security systems are of great interest as they do not involve keys, cards, or unsecured communication in order to prevent carrying, loss, duplication, and hacking. Here, we report an invisible touch sensors-based smart door locking system (DLS). The passive transducer-based touch sensors are fabricated through a facile do-it-yourself (DIY) based fabrication process by pasting the hybrid geometry copper electrodes on cellulose paper. The employment of biodegradable, and non-toxic materials like paper and copper tape makes this configuration a good candidate for green electronics. For additional security, the keypad in the DLS is made invisible by covering it with paper and spray paint. One can only open the door by knowing the password as well as the location of each key on the sensor keypad. The system can efficiently recognize the exact pattern of passwords without any false values. Invisible touch sensors-based locking systems can easily contribute to the security applications in homes, banks, automobiles, apartments, lockers, and cabinets.

Role of Anifrolumab in Refractory Cutaneous Manifestations of Lupus Erythematosus: A Case Series and Literature Review.

Lupus erythematosus (LE) is an autoimmune disease that presents either as a systemic (SLE) or an isolated skin disease (CLE). Currently, there is no FDA-approved medication specifically for CLE, and is treated with the same approach as SLE. We present two refractory cases of SLE with severe cutaneous manifestations unresponsive to the first-line therapy treated with anifrolumab. First, a 39-year-old Caucasian female with a known history of SLE with severe subacute CLE presented to the clinic for her refractory cutaneous symptoms. Her current regimen was hydroxychloroquine (HCQ), mycophenolate mofetil (MMF), and s/c belimumab with no improvement. Belimumab was discontinued, and she was started on anifrolumab with significant improvement. Another, a 28-year-old female with no known medical history was referred to a rheumatology clinic for elevated anti-nuclear antibody (ANA) and ribonucleoprotein (RNP) titers. She was diagnosed with SLE, and was treated with HCQ, belimumab, and MMF but failed to produce a reasonably good outcome. Hence belimumab was discontinued and anifrolumab was added instead with significant cutaneous improvement. The treatment spectrum for SLE is wide, which includes antimalarial (HCQ), oral corticosteroids (OCS), and immunosuppressants (Methotrexate-MTX, MMF, azathioprine-AZT). Anifrolumab, a type 1 IFNα receptor subunit 1 (IFNAR1) inhibitor, has been recently approved by the FDA for moderate to severe SLE while on standard therapy in August 2021. Early use of anifrolumab in moderate to severe cutaneous manifestations of SLE or CLE may result in significant improvement in patients.