Unveiling the enigma: A challenging case of protein C deficiency concealed by fever and epistaxis.

Protein C deficiency is a rare genetic disorder caused by mutations in the protein C, inactivator of coagulation factors Va and VIIA gene, affecting approximately 1 in 200-500 individuals. It leads to a hypercoagulable state, increasing the risk of blood clots. Symptoms vary with age, ranging from life-threatening purpura fulminans in neonates to venous thromboembolism, particularly deep vein thrombosis, in adults. A recent case involved a 21-year-old South Asian male presenting with persistent fever, weight loss, epistaxis, abdominal tenderness, and acute pain in the right thigh and leg, raising suspicion of deep vein thrombosis. Tests confirmed deep vein thrombosis in multiple leg veins and a pulmonary embolism. The patient was diagnosed with protein C deficiency and received anticoagulant therapy, thrombolysis, and an inferior vena cava filter. Complications of protein C deficiency include deep vein thrombosis, pulmonary embolism, stroke, and ischemic colitis. Diagnosis involves immunoassays and genetic analysis. Treatment includes heparin followed by anticoagulation therapy with warfarin. In severe cases, an inferior vena cava filter may be implanted. The described case required extensive treatment due to multiple deep vein thrombosis and a pulmonary embolism, with lifelong anticoagulant therapy. Early diagnosis and appropriate management are crucial in young patients with a history of venous thromboembolism to prevent and manage complications associated with protein C deficiency.

Comparison of polymeric clip and endoloop in laparoscopic appendectomy: A systematic review and meta-analysis.

BACKGROUND: Appendicitis is a common surgical emergency with diverse clinical presentations, making its diagnosis challenging. Laparoscopic appendectomy has become the standard treatment, with various methods for appendiceal stump closure, including polymeric clips and endoloops. This study aims to compare the efficacy and safety of polymeric clips compared with endoloops in laparoscopic appendectomy. METHODS: A systematic review and meta-analysis were conducted followingPreferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Medline, Scopus, and Embase were searched for studies up to March 25, 2024. RESULTS: In total, 13 studies, including 6 randomized controlled trials, were analyzed. Polymeric clipping demonstrated significantly shorter surgical time compared with the endoloop (standardized mean difference 0.37, 95% confidence interval 0.22-0.53, P < .00001), with no difference in hospital stay or overall complications. However, the endoloop was associated with a greater incidence of intra-abdominal abscess (risk ratio 3.53, 95% confidence interval 1.56-8.00, P = .003). Other outcomes, including time from instrument application to appendiceal cutting, ileus, and surgical-site infection, showed no significant differences between the 2 techniques. CONCLUSION: Polymeric clipping appears to be superior to endoloop in terms of shorter surgical time and lower risk of intra-abdominal abscess formation in laparoscopic appendectomy for uncomplicated appendicitis. However, both techniques have similar outcomes regarding hospital stay and overall complications. Further research addressing study limitations and exploring patient-centered outcomes is warranted to guide clinical practice.

Chitosan-carrageenan microbeads containing nano-encapsulated curcumin: Nano-in-micro hydrogels as alternative-therapeutics for resistant pathogens associated with chronic wounds.

Antimicrobial resistance is an issue of global relevance for the treatment of chronic wound infections. In this study, nano-in-micro hydrogels (microbeads) of chitosan and κ-carrageenan (CCMBs) containing curcumin-loaded rhamnosomes (Cur-R) were developed. The potential of Cur-R-CCMBs for improving the antibacterial activity and sustained release of curcumin was evaluated. Curcumin-loaded rhamnosomes (rhamnolipids functionalized liposomes) had a mean particle size of 116 ± 7 nm and a surface-charge of -24.5 ± 9.4 mV. The encapsulation efficiency of curcumin increased from 42.83 % ± 0.69 % in Cur-R to 95.24 % ± 3.61 % respectively after their embedding in CCMBs. SEM revealed smooth surface morphology of Cur-R-CCMBs. FTIR spectroscopy confirmed the presence of weak electrostatic and hydrophobic interactions among curcumin, rhamnosomes, and microbeads. Cur-R-CCMBs had demonstrated significant antibacterial activity against multi-drug resistant chronic wound pathogens including Staphylococcus aureus and Pseudomonas aeruginosa. Cur-R-CCMBs also exhibited significantly higher anti-oxidant (76.85 % ± 2.12 %) and anti-inflammatory activity (91.94 % ± 0.41 %) as well as hemocompatibility (4.024 % ± 0.59 %) as compared to pristine microbeads. In vivo infection model of mice revealed significant reduction in the viable bacterial count of S. aureus (∼2.5 log CFU/mL) and P. aeruginosa (∼2 log CFU/mL) for Cur-R-CCMBs after 5 days. Therefore, nano-in-micro hydrogels can improve the overall efficacy of hydrophobic antimicrobials to develop effective alternative-therapeutics against resistant-pathogens associated with chronic wound infections.

Surgical strategies in acute subdural hematoma: a meta-analysis of decompressive craniectomy vs. craniotomy.

OBJECTIVE: Acute subdural hematoma (ASDH) stands as a significant contributor to morbidity after severe traumatic brain injuries (TBI). The primary treatment approach for patients experiencing progressive neurological deficits or notable mass effects is the surgical removal of the hematoma, which can be achieved through craniotomy (CO) or decompressive craniectomy (DC). Nevertheless, the choice between these two procedures remains a subject of ongoing debate and controversy. MATERIALS AND METHODS: We conducted a comprehensive literature review, utilizing prominent online databases and manually searching references related to craniotomy and craniectomy for subdural hematoma evacuation up to November 2023. Our analysis focused on outcome variables such as the presence of residual subdural hematoma, the need for revision procedures, and overall clinical outcomes. RESULTS: We included a total of 11 comparative studies in our analysis, encompassing 4269 patients, with 2979 undergoing craniotomy and 1290 undergoing craniectomy, meeting the inclusion criteria. Patients who underwent craniectomy displayed significantly lower scores on the Glasgow Coma Scale (GCS) during their initial presentation. Following surgery, the DC group exhibited a significantly reduced rate of residual subdural (P = 0.009). Additionally, the likelihood of a poor outcome during follow-up was lower in the CO group. Likewise, the mortality rate was lower in the CO group compared to the craniectomy group (OR 0.63, 95% CI 0.41-0.98, I2 = 84%, P = 0.04). CONCLUSION: Our study found that CO was associated with more favorable outcomes in terms of mortality, reoperation rate, and functional outcome while DC was associated with less likelihood of residual subdural hematoma. Upon further investigation of patient characteristics who underwent into either of these interventions, it was very clear that patients in DC cohort have more serious and low pre-op characteristics than the CO group. Nonetheless, brain herniation and advanced age act as independent factor for predicting the outcome irrespective of the intervention.

The impact of ketogenic diet on drug-resistant epilepsy in children: A comprehensive review and meta-analysis.

The ketogenic diet (KD), characterized by high-fat and low-carbohydrate intake, is currently gaining widespread popularity as a treatment for drug-resistant epilepsy (DRE). In addition to the traditional ketogenic diet, several variants have been introduced to enhance compliance and flexibility, such as the modified Atkins diet (MAD) and the low glycemic index diet (LGID). These adaptations aim to provide patients with more manageable and sustainable options while harnessing the potential therapeutic benefits of DRE. The objective of this study is to evaluate the efficacy and safety of the KD in pediatric patients who exhibit DRE. In this study, we conducted a thorough review of existing literature by searching Cochrane, Embase, Medline, and PubMed. Our approach involved predefined criteria for data extraction and the assessment of study quality. Eleven RCTs with 788 participants were included in this study. The pooled effect estimates revealed a significant association between dietary interventions and seizure frequency reduction of > 50% (OR 6.68, 96% CI 3.52, 12.67) and > 90% (OR 4.37, 95% CI 2.04, 9.37). Dietary interventions also increased the odds of achieving seizure freedom (OR 4.13, 95% CI 1.61, 10.60). The common adverse effects included constipation (39.07%) and vomiting (10%). In conclusion, dietary interventions, notably the KD, hold promise for pediatric DRE, reducing seizures and achieving freedom. These non-pharmacological options improve the quality of life of non-responsive and non-surgical patients. The KD has emerged as a potential therapeutic approach. Further research is needed to address the limitations and investigate their long-term effects.

Effectiveness of Propranolol in Preventing Severe Retinopathy of Prematurity: A Comprehensive Systematic Review and Meta-Analysis.

PURPOSE: To learn more about the effectiveness of oral propranolol as a therapeutic alternative for preterm newborns with pre-existing retinopathy of prematurity (ROP) as well as an early prevention method for ROP, one of the most common but avoidable causes of juvenile blindness. STUDY DESIGN: Meta-analysis of relevant literature. METHODS: A total of 3464 papers were identified, with 2873 from PubMed, 39 from Scopus, 67 from Medline, and 16 from Embase. After screening, finally, a total of 8 studies were deemed suitable for review. Following the PRISMA guidelines, published literature was systematically assessed up to May 10, 2023. Trials and observational studies were included in which beta blockage was used to prevent severe ROP (defined as stage ≥3 or requiring treatment). A total of 3646 papers were identified, with 2873 from PubMed, 39 from Scopus, 67 from Medline, and 16 from Embase. After screening, a total of 8 studies were deemed suitable for review. RESULTS: The use of propranolol is linked to a lower risk of disease development in ROP compared to other therapies or control groups, according to the overall risk ratio of 0.59 (95% CI = 0.42, 0.82; P = .002, I2 = 41%). Additionally, the overall risk ratio for plus disease is 0.42 (95% CI = 0.23, 0.78; P = .006, I2 = 0%), for laser photocoagulation is 0.48 (95% CI = 0.31, 0.74; P = .001; I2 = 2%), and for intravitreal injection of VEGF is 0.43 (95% CI = 0.24, 0.74; P = 0.003, I2 = 0%), suggesting that use of propranolol may reduce the likelihood of developing a disease such as plus disease, requiring laser photocoagulation or necessitating intravitreal injection of vascular endothelial growth factor for ROP, respectively. No statistically significant heterogeneity was found in this study (P > .10, I2 = 50%). It can be concluded from this that the results of the chosen studies were sufficiently comparable and consistent. CONCLUSION: This study showed that oral propranolol given as a preventive treatment in premature newborns successfully prevented severe ROP. Propranolol dosage and timing must now be carefully considered in the context of the study population, as these factors may have a major impact on the observed outcomes and treatment success.

Meta-analysis of direct endovascular thrombectomy vs bridging therapy in the management of acute ischemic stroke with large vessel occlusion.

BACKGROUND: Debates persist when using intravenous thrombolysis (IVT) before mechanical thrombectomy (MT) for acute ischemic stroke (AIS) due to large-vessel occlusion (LVO). This systematic review and meta-analysis synthesized evidence on outcomes in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO), comparing bridging therapy (BT) with MT alone. METHOD: We conducted searches of PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials from inception to July 2023 to identify pertinent clinical trials and observational studies. RESULT: 76 studies, involving 37,658 patients, revealed no significant difference in 90-day functional independence between DEVT and BT. However, a trend favoring BT for achieving functional independence with a modified Rankin Scale (mRS) of 0-1 was observed, having Odds ratio (OR) of 0.75 (95% CI 0.66-0.86; p < 0.001). DEVT was associated with higher postprocedural mortality (OR 1.44;95% CI 1.25-1.65; p < 0.001), but a lower risk of symptomatic intracranial hemorrhage compared to BT (OR 0.855; 95% CI 0.621-1.177; p = 0.327). Successful recanalization rates favored BT, emphasizing the importance of individualized treatment decisions (OR 0.759; 95% CI 0.594-0.969; p = 0.027). Sensitivity analyses were conducted to identify key contributors to heterogeneity. CONCLUSION: Our meta-analysis underscores the intricate equilibrium between functional efficacy and safety in the evaluation of DEVT and BT for ACS-LVO. Fundamentally, while BT appears more efficacious, concerns about safety arise due to the superior safety profile demonstrated by DEVT. Individualized treatment decisions are imperative, and further trials are warranted to enhance precision in clinical guidance.

Pre and post characterization of ODTs with emphasis on compression force and quality of super-disintegrants: In vivo analysis in healthy volunteers.

Oral dispersible tablets (ODTs) are patient compliant dosage forms which rapidly disintegrate in the mouth following active absorption with rapid onset of action. The current study was designed to resolve compression problems used for ODTs, as high compression force exhibited hardness and drug release problems. Formulations, F1-F9 were compressed at three different forces 44, 54 and 64 kN using cross-carmellose sodium (CCS) and sodium starch glycolate (SSG) and evaluated for pre and post compression. Formulations F1, F4 and F7 which were compressed at 44 kN showed hardness ranges between 5.09-6.15 with lowest DT (less than 15 s) and better LTZ release. While F2, F5 and F8 (compressed at 54 kN) demonstrated hardness in between 6.90-7.02. Similarly, F3, F6 and F9 compressed at 64 kN showed hardness values between 8.70-8.98 with increased DT and slow LTZ release. Friability results for all the formulations were within United States Pharmacopeial (USP) specifications (<1%). All formulations depicted t-test value <0.5, hence it found that all formulations showed significant statistical value within limits, however best compression force 44 kN showed low p value. It was concluded that optimized compression force for ODTs was 44 kN among all employed forces that exhibited desirable drug release.

Optimization of ranitidine hydrochloride based on stability performance in directly compressible immediate and sustained release formulations.

Ranitidine hydrochloride (RTD), a moisture-sensitive drug, has issues of stability during shelf life especially when formulated through wet granulation method. In current study, RTD was blended with non-hygroscopic excipient like ethyl cellulose and compressed using direct compression method. The physical and physicochemical characteristics were evaluated including hardness, thickness, diameter, friability, weight variation, disintegration, dissolution and accelerated stability study to optimize findings. Subsequently, the optimized formulation was characterized for Fourier Transform Infrared (FTIR) analysis and in vitro drug release kinetics. The physical characterization was unaffected by polymer variation while the friability and weight variation were within the USP limits. In vitro drug release depicted that the release rate was sustained by increasing the amount of ethyl cellulose, with a 10% increase of ethyl cellulose 99.09% drug was released. FTIR analysis exhibited no interaction among the ingredients of the optimized formulation (E2). The optimized formulation followed Hixson-Crowell release kinetics. Formulation A5 displayed immediate release characters as plain uncoated formulation. Accelerated studies showed no significant change in the drug content. The RTD was successfully sustained to be released up to 6 h and accelerated stability showed that the optimized formulation (E2) containing 4% starch 1500 and 10% of ethyl cellulose, respectively, was stable up to 6 months.

Incorporating Heterogeneous Features into the Random Subspace Method for Bearing Fault Diagnosis.

In bearing fault diagnosis, machine learning methods have been proven effective on the basis of the heterogeneous features extracted from multiple domains, including deep representation features. However, comparatively little research has been performed on fusing these multi-domain heterogeneous features while dealing with the interrelation and redundant problems to precisely discover the bearing faults. Thus, in the current study, a novel diagnostic method, namely the method of incorporating heterogeneous representative features into the random subspace, or IHF-RS, is proposed for accurate bearing fault diagnosis. Primarily, via signal processing methods, statistical features are extracted, and via the deep stack autoencoder (DSAE), deep representation features are acquired. Next, considering the different levels of predictive power of features, a modified lasso method incorporating the random subspace method is introduced to measure the features and produce better base classifiers. Finally, the majority voting strategy is applied to aggregate the outputs of these various base classifiers to enhance the diagnostic performance of the bearing fault. For the proposed method's validity, two bearing datasets provided by the Case Western Reserve University Bearing Data Center and Paderborn University were utilized for the experiments. The results of the experiment revealed that in bearing fault diagnosis, the proposed method of IHF-RS can be successfully utilized.

Non-linear finite element modeling of damages in bridge piers subjected to lateral monotonic loading.

Bridges are among the most vulnerable structures to earthquake damage. Most bridges are seismically inadequate due to outdated bridge design codes and poor construction methods in developing countries. Although expensive, experimental studies are useful in evaluating bridge piers. As an alternative, numerical tools are used to evaluate bridge piers, and many numerical techniques can be applied in this context. This study employs Abaqus/Explicit, a finite element program, to model bridge piers nonlinearly and validate the proposed computational method using experimental data. In the finite element program, a single bridge pier having a circular geometry that is being subjected to a monotonic lateral load is simulated. In order to depict damages, Concrete Damage Plasticity (CDP), a damage model based on plasticity, is adopted. Concrete crushing and tensile cracking are the primary failure mechanisms as per CDP. The CDP parameters are determined by employing modified Kent and Park model for concrete compressive behavior and an exponential relation for tension stiffening. The performance of the bridge pier is investigated using an existing evaluation criterion. The influence of the stress-strain relation, the compressive strength of concrete, and geometric configuration are taken into consideration during the parametric analysis. It has been observed that the stress-strain relation, concrete strength, and configuration all have a significant impact on the column response.

Surface engineering of chitosan nanosystems and the impact of functionalized groups on the permeability of model drug across intestinal tissue.

Surface attributes of nanocarriers are crucial to determine their fate in the gastrointestinal (GI) tract. Herein, we have functionalized chitosan with biochemical moieties including rhamnolipid (RL), curcumin (Cur) and mannose (M). FTIR spectra of functionalized chitosan nanocarriers (FCNCs) demonstrated successful conjugation of M, Cur and RL. The functional moieties influenced the entrapment of model drug i.e., coumarin-6 (C6) in FCNCs with payload-hosting and non-leaching behavior i.e., >91 ± 2.5 % with negligible cumulative release of <2 % for 5 h in KREB, which was further verified in the simulated gastric and intestinal fluids. Consequently, substantial difference in the size and zeta potential was observed for FCNCs with different biochemical moieties. Scanning electron microscopy and atomic force microscopy of FCNCs displayed well-dispersed and spherical morphology. In addition, in vitro cytotoxicity results of FCNCs confirmed their hemocompatibility. In the ex-vivo rat intestinal models, FCNCs displayed a time-dependent-phenomenon in cellular-uptake and adherence. However, apparent-permeability-coefficient and flux values were in the order of C6-RL-FCNCs > C6-M-FCNCs > C6-Cur-FCNCs = C6-CNCs > Free-C6. Furthermore, the transepithelial electrical resistance revealed the FCNCs mediated recovery of membrane-integrity with reversible tight junctions opening. Thus, FCNCs have the potential to overcome the poor solubility and/or permeability issues of active pharmaceutical ingredients and transform the impact of functionalized-nanomedicines in the biomedical industry.

A triangulation model for assessment of change in classroom behavior of medical teachers participating in faculty development program on lecturing skills.

BACKGROUND & AIMS: We utilized a triangulation method of a faculty development program's (FDP) evaluation comprising short-course workshops on classroom behaviors and lecturing skills of basic sciences faculty in a medical school. METHODS & RESULTS: This study utilized data from the pre and post evaluation of classroom lectures by an expert observer. Course participants were observed before the inception of a 4-month FDP and after 6-months of program completion. Findings at 6-month post-FDP interval were supplemented with students' and participant's self-evaluation. Expert evaluation of 15 participants showed that more participants were summarizing lectures at the end of their class (p = 0.021), utilizing more than one teaching tool (p = 0.008) and showing a well-structured flow of information (p = 0.013). Among the students, majority (95.5%, n = 728) agreed on "teachers were well-prepared for the lecture", however, a low number (66.1%, n = 504) agreed on "teachers were able to make the lecture interesting". On self-evaluation (n = 12), majority of the participants (91.7%, n = 11) thought these FDP workshops had a positive impact on their role as a teacher. CONCLUSIONS: Gathering feedback from multiple sources can provide a more holistic insight into the impact of an FDP and can provide a robust framework for setting up future FDP targets.

Efficacy and safety of steroids for chronic subdural hematoma: A systematic review and meta-analysis.

Background: Chronic subdural hematoma (CSDH) is a condition characterized by the accumulation of fluid, blood, and blood breakdown products between the brain's arachnoid and dura mater coverings. While steroids have been explored as a potential treatment option, their efficacy and safety remain uncertain. This meta-analysis and systematic review aimed to assess the impact of steroids on CSDH management, including mortality, recurrence, complications, and functional outcomes. Methods: We conducted a comprehensive literature search in major electronic databases up to June 2023, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Cochrane Handbook for Systematic Reviews and Interventions. Inclusion criteria encompassed adult patients with CSDH, the use of steroids as monotherapy or adjuvant therapy, and clearly defined outcomes. Randomized controlled trials and cohort studies meeting these criteria were included in the study. Results: The initial search yielded 4315 articles, with 12 studies meeting the inclusion criteria. Our findings indicate a non-significant trend toward reduced mortality with steroids in combination with standard care (Odds ratios [OR] = 0.66, 95% confidence interval [CI] 0.20-2.18). However, substantial heterogeneity was observed (I2 = 70%). Sensitivity analysis, excluding influential studies, suggested a potential increased mortality risk associated with steroids (OR = 1.47, 95% CI 0.87-2.48). Steroids showed a possible benefit in reducing the recurrence of CSDH (OR = 0.58, 95% CI 0.20-1.67), but with significant heterogeneity (I2 = 89%). No clear advantage of steroids was observed in terms of functional outcomes at three months (modified Rankin scale scores). Furthermore, steroids were associated with a significantly higher incidence of adverse effects and complications (OR = 2.17, 95% CI 1.48-3.17). Conclusion: Steroids may have a potential role in reducing CSDH recurrence but do not appear to confer significant advantages in terms of mortality or functional outcomes. However, their use is associated with a higher risk of adverse effects and complications. Given the limitations of existing studies, further research is needed to refine the role of steroids in CSDH management, considering patient-specific factors and treatment protocols.

Clinical Characteristics and Etiological Spectrum of Pancytopenia in Pediatric Age Group: A Cross-Sectional Outlook From a Developing Country.

Background The etiologies of pancytopenia in the pediatric age group remain exceedingly ubiquitous and warrant extensive hematological and interventional investigations like bone marrow biopsy. It varies widely from benign nutritional disorders to fatal malignancies. The present study aims to delineate the prevalence of various causes of pancytopenia in the pediatric population. Methods The present cross-sectional study included 96 patients between the age of one month till 15 years with pancytopenia. Study participants were evaluated for various parameters including their demographical details, clinical features, immunization history, and nature of the disorder. The prevalence of various etiologies (nutritional, neoplastic, infectious, autoimmune, and others) of pancytopenia was ascertained. Results Of the 96 patients, 42 (43.75%) were males with a mean age of 69.47 ± 7.12 months. Fever was present in 71.87%, arthralgias in 56.25%, weight loss in 35.41%, and failure to thrive in 18.75% of patients. The bone marrow examination revealed aplastic changes in 36 (37.50%), hyperplastic changes in 21 (21.87%), and normal cellularity in 40.62% of patients. Megaloblastic anemia was the most common nutritional cause of pancytopenia present in 21.85% of cases. Acute lymphoblastic leukemia (ALL) was the most prevalent neoplastic etiology present in 19.79% of patients. Aplastic anemia, miliary tuberculosis, parvovirus B19, and hemolytic anemia were other notable etiologies. Conclusion Megaloblastic anemia and infections like tuberculosis were common treatable etiologies of pancytopenia among the pediatric age group. ALL was the most common neoplastic etiology. Bone marrow biopsy remains crucial in elucidating the various neoplastic and nutritional etiologies of pancytopenia in children.

Immunohistochemical Detection and Prognostic Significance of p53, Epidermal Growth Factor Receptor, Murine Double Minute 2, and Isocitrate Dehydrogenase 1 in Glioblastoma Multiforme Patients of Pakistan.

Introduction: Glioblastoma multiforme (GBM) is one of the deadliest cranial tumors occurring in adults. Various biomarkers have been tested for their significance in diagnosis, prognosis, and treatment of GBM. Some well-studied markers in GBM are Isocitrate dehydrogenase 1 (IDH1), Murine double minute 2 (MDM2), Epidermal Growth Factor Receptor (EGFR), and p53. The aim of this study was to investigate the protein expression of these markers in GBM patients of Pakistan. Methods: A total of 102 surgically resected formalin-fixed paraffin-embedded specimens from patients diagnosed and treated at Aga Khan University Hospital were included in this study. Immunohistochemistry (IHC) for IDH1, MDM2, EGFR, and p53 was performed using Dako EnVision System and respective monoclonal antibodies. Survival analysis was performed to check association of markers protein expression with prognosis in GBM patients. Results: There were 73 males and 29 females in this study, with a median age of 49 years at the time diagnosis. Overexpression of molecular markers was as follows: 52% for EGFR, 26% for p53, 72% for IDH1, and 83% for MDM2. We did observe that EGFR was significantly associated with increased age of our patients and with worse survival. Age > 40 years was a predictor for worse prognosis as well. Conclusion: EGFR overexpression and advanced age were worse prognostic indicators.

Determination of Asphaltene Stability in Crude Oils Using a Deposit Level Test Coupled with a Spot Test: A Simple and Qualitative Approach.

The main goal of this study is to monitor the stability of crude oils in terms of both precipitation and deposition magnitude with respect to time. To achieve this goal, two experimental techniques which include a deposit level test and a spot test were integrated and applied simultaneously. The method was implemented using six crude oils, namely A, B, D, E, F, and G, and tests were performed at different times which split them into short duration tests and long duration tests. All crude oils were found to exhibit potential for asphaltene precipitation and subsequent deposition at different rates. Crude oils B, G, and D were observed to have started asphaltene precipitation and subsequent deposition relatively quicker. Similarly, crude oils B, A, and F exhibit a higher potential for producing asphaltene deposits in terms of deposition level. Crude oil E produces relatively fewer deposits at comparatively slower rates. The overall result indicates that crude oil B was found to be the most risky crude oil as it produces a higher quantity of deposits at higher rates, while crude oil E proved to be the least risky. Sensitivity analysis was also performed via the computing relevancy factor to determine the relative importance of two input parameters, namely the specific gravity of crude oil and the time for two-output precipitation intensity and deposition level. Precipitation intensities were found by the implementation of an image-processing tool on spot test results. The relationship between time and precipitation intensity was found to be negligible; however, the correlation between time and deposition level was found to be strongly positive with a relevancy factor value of approximately 0.521. Similarly, the relationship of the specific gravity of oil with precipitation intensity and deposition level was found to be moderately negative and very close to each other, i.e., -0.228 and -0.247, respectively. The integration of the deposit level test with the spot test allows the continuous and simultaneously reliable monitoring of both asphaltene precipitation and deposition at different times without involving cost, complex instrumentation, or interpretation, irrespective of the type of oil. The method enables the successful determination of stability ranking of different crude oils both in terms of precipitation and deposition.

Hormone receptors AR, ER, PR and growth factor receptor Her-2 expression in oral squamous cell carcinoma: Correlation with overall survival, disease-free survival and 10-year survival in a high-risk population.

Oral squamous cell carcinoma (OSCC) comprises most of head and neck neoplasms and is one of the highest-ranking and lethal cancers in Pakistan due to prevailing mouth habits. Several types of receptors act as prognostic markers and targets for therapy in some cancers, but their application in OSCC is largely unexplored. This study aimed to evaluate the expression of hormonal receptors and Her-2 in OSCC patients and correlate it with 10-year, overall and disease-free survival. To achieve this objective, immunohistochemistry for Her-2, AR, ER and PR was performed on 100 formalin-fixed paraffin-embedded primary OSCC specimens. Receptor expression was correlated with mouth habits and clinicopathological features and patient survival was analyzed using Kaplan-Meier method and Cox regression univariate analysis. We observed that in 100 patients, there were 57 males and 43 females. Immunopositive Her-2 expression was observed in 21% of patients, AR in 13%, ER in 3% and 0% for PR. Patients with betel quid/areca nut mouth habits had significantly absent Her-2 expression (P = 0.035). Also, Her-2 negative patients were also negative for AR expression (P = 0.002). Her-2 positive patients had poor 10-year survival (P = 0.041). A trend of low survival and high recurrence rate was observed in AR positive patients, but this was not significant (P = 0.072). No statistically relevant correlations were seen in the case of ER and PR. In conclusion, Her-2 may be a valuable marker for predicting long-term prognosis of OSCC patients.

Leriche Syndrome with Digital Gangrene: Is Aortic Bypass Grafting Safe in Intravenous Drug Abusers? A Case Report and Literature Review.

A 47-year-old male with Leriche syndrome presented with digital gangrene due to TASC II type-D occlusion of the distal aorta and common iliac arteries. Open revascularization was performed using a Dacron aorto-biiliac bypass graft; however, the postoperative course revealed a nondisclosed history of intravenous opioid abuse as he went into withdrawal psychosis. Our report highlights ways to mitigate infection risk associated with prosthetic aortic grafts in suspected or confirmed intravenous drug abusers. The literature review suggests alternative strategies like aortoiliac endarterectomy, total endovascular approach using non-covered stents, or a hybrid approach. The primary use of autologous venous grafts should be considered as a last resort so that the veins are retained for future use in case of graft infection. Patient factors like comorbidities, fitness to undergo surgery, anatomical extent of occlusion, and availability of facilities/expertise can further guide the management plan owing to a lack of evidence-based guidelines.