Complete heart block associated with hepatitis A infection in a female child with fatal outcome.

Hepatitis A virus (HAV) infection can cause extra-hepatic manifestations like myocarditis. An 8-year-old female with HAV infection presented with fever, abdominal pain, vomiting, and icterus. She developed viral myocarditis with complete AV dissociation on ECG and was treated with a temporary pacemaker, but her condition worsened, and she died. Hepatitis A viral infection can be associated with viral myocarditis and complete heart block that can lead to cardiogenic shock and death eventually.

Thermal and hydraulic performance of ZnO/EG based nanofluids in mini tubes of different diameters: An experimental investigation.

The present experimental study investigates the thermal and hydraulic performance of Ethylene Glycol (EG)-based ZnO nanofluids (NFs) in circular minichannel test sections, each of 330 mm in length and 1.0-2.0 mm inner diameters. The experiments were conducted under steady-state constant heat flux and laminar flow conditions. The stable ZnO/EG-based NFs were synthesized using a standard two-step method in varying nanoparticles (NPs) loadings (0.012-0.048 wt%). The morphological characteristics, crystal structure, and specific surface area (SSA) showed that the NPs were sized in nm, possessing excellent crystal structure and enhanced surface area. Thermal conductivity (TC) and viscosity (VC) of the NFs were examined in the 20-60 °C temperature range. Both TC and VC possessed an increasing trend with the rise in concentration of the NPs. However, with the temperature rise, TC increased while the VC decreased and vice versa. The highest enhancements in TC and VC were 14.38 % and 15.22 %, respectively, at 40 °C and 0.048 wt% of NPs loading. The highest enrichment recorded in the local and average heat transfer coefficient (HTC) were 14.80 % and 13.48% in a minichannel with 1.0 mm inner diameter, respectively. It was directly proportional to the NPs loading and volume flow rate of the NFs. The friction factor was also directly proportional to the test section's inner cross-sectional area, while the pressure gradient showed an inverse behavior. An inverse relationship was recorded for the volume flow rate of the NFs and vice versa. Maximum friction factor and the pressure drop for all three minichannel test sections were recorded as 34.58 % and 32.16 %, respectively. The well-known Shah correlation predicted the local and average HTC within ±15.0 %, while the friction factor and the pressure gradient were well predicted by the Darcy correlation within the ±10.0 % range.

Trichotillomania, Trichophagia and Trichobezoar in a Male Paediatric Patient: A Case Report and Literature Review.

INTRODUCTION AND IMPORTANCE: Trichotillomania and tricophagia, characterized by compulsive hair-pulling and subsequent ingestion which results in a compact mass of hair called trichobezoar. It represents an uncommon psychiatric disorder, especially in young children. CASE PRESENTATION: This case report describes a distinctive and rare occurrence of trichotillomania, tricophagia and trichobezoar in a 11-year-old male child. Concerns raised by the parents regarding noticeable hair loss, who initially presented to medical outdoor patient with complaints of abdominal pain on and off from the last one year. He had a history of pica and weight-loss. He was then diagnosed with a gastric trichobezoar for which he was operated upon and a giant trichobezoar was retrieved from his stomach. Post-operatively patient remained admitted in ward and was discharged home on fifth post-operative day and sent for psychiatry evaluation. CLINICAL DISCUSSION: Trichotillomania and tricophagia often have roots in psychosocial stressors, anxiety, and depression. Children may engage in hair-pulling as a coping mechanism, especially in response to familial or environmental stressors. The literature emphasizes the importance of understanding the psychosocial context to tailor interventions effectively. CONCLUSION: Trichotillomania and tricophagia is very rare in paediatric population and if presents a multidisciplinary team comprising of a paediatrition, paediatric surgeon and paediatric psychiatrist should be involved and if diagnosed with a gastric trichobezoar should be removed surgically in order to prevent complications.

A uretheral stone causing urinary obstruction in a paediatric patient.

Urinary retention in pediatric patients is an uncommon presentation, particularly when attributed to urethral stones. We present the case of an 8 year old child who experienced acute urinary retention due to a urethral stone, an infrequent occurrence in this age group. Initial assessment revealed signs of obstructive voiding, prompting further investigation. Imaging studies confirmed the presence of a urethral stone causing complete obstruction. Management involved a multidisciplinary approach, incorporating surgical intervention. This case report underlines the need for awareness about the rare occurrence of urethral stones in pediatric age group which must be kept in mind while treating children.

Seroprevalence of SARS-CoV-2 antibodies in pediatric hospital surgical unit: a lower-middle-income country perspective.

BACKGROUND: The objective of our study was to measure and give insight into the seropositivity of anti-SARS-CoV-2 antibodies in the patients in our pediatric hospital surgical unit in Pakistan. METHODS: A prospective cohort study was conducted at a tertiary care pediatric hospital surgical unit in Pakistan between 1 January 2021 and 1 June 2021 on the enrolled neonates and children aged 1 day to 13 years. All patients from three different pediatric strata [neonates (<1 month), infants (1 to 12 months) and children (>1 year)] were enrolled in the study. RESULTS: Six-hundred patients were enrolled, and 426 patients were included in the study. Among 426 patients, 234 (54.9%) were male, and 192 (45.1%) were female. Overall only 118 (27.7%) patients developed symptoms. The other 308 (72.3%) were asymptomatic of which 28 (9.1%) had fever, 28 (9.1%) had cough, 38 (12.33%) had body aches, 292 (94.8%) had vomiting/diarrhea, and only 28 (9.1%) developed loss of smell and taste. Our results showed seropositivity of 27.7% (n = 118), while 72.3% (n = 308) had negative antibody titers. CONCLUSION: A much higher pediatric SARS-CoV-2 burden of 27.7% was found in our pediatric surgical unit than has previously been reported in the literature of 6.8% for children in pediatric hospitals or pediatric surgical units. Contrary to reporting early in the COVID-19 pandemic, this study determined that children experience a significant burden of COVID-19 infection. Thus, children appear very important in SARS-CoV-2 pandemic, from harboring the virus and further studies need to be done to find if they are transmitting the disease silently.

Enhancing Data Protection in Dynamic Consent Management Systems: Formalizing Privacy and Security Definitions with Differential Privacy, Decentralization, and Zero-Knowledge Proofs.

Dynamic consent management allows a data subject to dynamically govern her consent to access her data. Clearly, security and privacy guarantees are vital for the adoption of dynamic consent management systems. In particular, specific data protection guarantees can be required to comply with rules and laws (e.g., the General Data Protection Regulation (GDPR)). Since the primary instantiation of the dynamic consent management systems in the existing literature is towards developing sustainable e-healthcare services, in this paper, we study data protection issues in dynamic consent management systems, identifying crucial security and privacy properties and discussing severe limitations of systems described in the state of the art. We have presented the precise definitions of security and privacy properties that are essential to confirm the robustness of the dynamic consent management systems against diverse adversaries. Finally, under those precise formal definitions of security and privacy, we have proposed the implications of state-of-the-art tools and technologies such as differential privacy, blockchain technologies, zero-knowledge proofs, and cryptographic procedures that can be used to build dynamic consent management systems that are secure and private by design.

Ultrasound-Guided Versus Conventional Fluoroscopy-Guided Epidural Injection for Radiculopathy. A Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Radiculopathy, a painful condition due to the irritation of a spinal nerve root, is a common neurosurgical presentation. Apart from its conventional treatment with pain killers and surgical management, it can also be managed with epidural steroid injections (ESIs). The objective of this study is to compare ultrasonography (USG) guidance with conventional fluoroscopy (FL) guidance for ESIs to treat radiculopathy. METHODS: PubMed, Embase, Clinicaltrials.gov, and Cochrane were systematically searched and randomized controlled trials comparing USG with conventional FL for ESIs in the case of radiculopathy were included. Web Revman was used for data analysis. RESULTS: The Literature search resulted in 640 studies, of which 7 studies were included in this meta-analysis after extensive screening. There was no statistically significant difference in pain reduction between USG and FL groups especially in the case of lumbosacral spinal level at 1 month [mean difference -0.12 (-0.47-0.23)] and at 3 months [mean difference 0.73 (-1.49, 2.96)]. Similarly, functional improvement after ESIs was comparable between the 2 groups. The Risk of inadvertent vascular puncture in USG-guided ESIs was lower as compared to conventional FL-guided ESIs [odds ratio 0.21 (0.07, 0.64)]. Furthermore, the procedure time in the USG group was also significantly lower as compared to FL group. CONCLUSION: USG-guided ESIs are not only comparable to conventional FL-guided ESIs in terms of pain control and functional improvement, particularly evident at the lumbosacral spinal level, but also have a lower risk of inadvertent vascular puncture.

National Cancer Institute Collaborative Workshop on Shaping the Landscape of Brain Metastases Research: challenges and recommended priorities.

Brain metastases are an increasing global public health concern, even as survival rates improve for patients with metastatic disease. Both metastases and the sequelae of their treatment are key determinants of the inter-related priorities of patient survival, function, and quality of life, mandating a multidimensional approach to clinical care and research. At a virtual National Cancer Institute Workshop in September, 2022, key stakeholders convened to define research priorities to address the crucial areas of unmet need for patients with brain metastases to achieve meaningful advances in patient outcomes. This Policy Review outlines existing knowledge gaps, collaborative opportunities, and specific recommendations regarding consensus priorities and future directions in brain metastases research. Achieving major advances in research will require enhanced coordination between the ongoing efforts of individual organisations and consortia. Importantly, the continual and active engagement of patients and patient advocates will be necessary to ensure that the directionality of all efforts reflects what is most meaningful in the context of patient care.

Pathologic Complete Response Achieved in Early-Stage HER2-Positive Breast Cancer After Neoadjuvant Therapy With Trastuzumab and Chemotherapy vs. Trastuzumab, Chemotherapy, and Pertuzumab: A Systematic Review and Meta-Analysis of Clinical Trials.

Patients diagnosed with human epidermal growth factor receptor 2 (HER2)-positive breast cancer require treatment upfront because of the aggressive nature of this type of cancer. Patients with early-stage HER2-positive breast cancer are usually treated with neoadjuvant therapy. This neoadjuvant therapy comprises targeted therapy and chemotherapy. Targeted therapy is given with trastuzumab. Pertuzumab is either administered or not with trastuzumab as a targeted therapy. This systematic review and meta-analysis aim to find out and compare the benefit achieved in terms of pathologic complete response (pCR) by adding pertuzumab to the neoadjuvant treatment regimen for early-stage HER2-positive breast cancer patients. Various databases were searched to find out relevant clinical trials. After going through PubMed, Embase, and Cochrane, three clinical trials were shortlisted for this systematic review and meta-analysis. These three clinical trials were double-armed. Pertuzumab was present in one arm while being absent in one arm to assess the benefit of adding pertuzumab in terms of pCR achieved. Data were analyzed using RevMan Web (Cochrane, London, UK). The odds ratio and 95% confidence interval were calculated for the outcome. The Mantel-Haenszel method and random effect model were used for analysis. The risk of bias in studies was evaluated using the Cochrane risk of bias tool for randomized controlled trials (ROB2). The summary statistics showed that the incidence of pCR was more in the experimental group (having pertuzumab) as compared to the control group (without pertuzumab) with an odds ratio of 2.10 (95% CI: 1.56-2.83) with I2 = 0%. In three double-arm trials, there were 840 participants, 445 in the experimental group and 395 in the control group. A total of 203 (45%) patients out of 445 in the experimental group achieved pCR, whereas 127 (32%) patients out of 395 in the control group achieved pCR. Through the results of this study, it can be concluded that the rate of pCR achieved was higher in that arm in which pertuzumab was present compared to the study arm in which only trastuzumab was given as targeted therapy. Thus, it can be suggested that pertuzumab be added to the neoadjuvant regimen for early-stage HER2-positive breast cancer patients. This would result in achieving a better pCR. And by improving pCR rates, the survival outcomes of patients can be significantly improved.

Data Provenance in Healthcare: Approaches, Challenges, and Future Directions.

Data provenance means recording data origins and the history of data generation and processing. In healthcare, data provenance is one of the essential processes that make it possible to track the sources and reasons behind any problem with a user's data. With the emergence of the General Data Protection Regulation (GDPR), data provenance in healthcare systems should be implemented to give users more control over data. This SLR studies the impacts of data provenance in healthcare and GDPR-compliance-based data provenance through a systematic review of peer-reviewed articles. The SLR discusses the technologies used to achieve data provenance and various methodologies to achieve data provenance. We then explore different technologies that are applied in the healthcare domain and how they achieve data provenance. In the end, we have identified key research gaps followed by future research directions.

Parasitological, molecular, and epidemiological investigation of Trypanosoma evansi infection among dromedary camels in Balochistan province.

Surra is a zoonotic disease caused by Trypanosoma evansi (T. evansi), which affects a wide variety of animals worldwide. The disease has a severe impact on the productivity, health, and working capacity of camels and causes mortality and extensive economic losses if not diagnosed early. This is the first comprehensive report on the prevalence of T. evansi infection in dromedaries in Balochistan province. In the present study, 393 blood samples (indigenous, n = 240; imported, n=153) were collected from one-humped camels (Camelus dromedarius) and were tested by molecular methods to estimate the prevalence of T. evansi in three districts (Pishin, Nushki, and Lasbella) of Balochistan province. The overall prevalence of T. evansi among examined camel samples was 28.24% (95% confidence interval (CI): 24.02-32.89%). The risk of T. evansi infection in adult camels (> 10 years) is higher than that in young ones (odd-ration (OR) = 2.7; 95% CI: 1.3357-5.3164%). Moreover, male camels were six times more likely to get an infection than female camels. The detection of T. evansi infection in camels sampled in summer and spring was 3.12- and 5.10-fold higher, respectively, than in camels sampled in winter. In conclusion, our findings showed a high rate of T. evansi infection in camels from the three districts. Our study emphasizes the need for a strict surveillance program and risk assessment studies as prerequisites for control measures.

Patterns and predictors of periodontal disease and tooth loss among users of smokeless tobacco.

BACKGROUND: Smokeless tobacco (SLT) products of several different types are widely used in several South Asian countries including Pakistan. These products are consumed in different forms and with different names. The study aims to determine adverse effects of the SLT consumption on periodontal tissues. METHODS: This cross sectional study was conducted in Karachi, Pakistan. It recruited 377 users of (SLT) with 231 males (61.3%) and 146 females (38.7%) of age 15 to 45 years. After obtaining informed consent, quantitative data were collected via a questionnaire followed by intra oral clinical examination to determine presence of periodontal diseases using community periodontal index (CPI). To determine the association between periodontal diseases and smokeless tobacco consumption habits, Chi Square test was conducted. RESULTS: Gingival recession (Class II-IV) (65.8%) was the most prevalent periodontal disease among SLT users. CPI score was high (CPI score 3 and 4) in 31.3% participants, whereas tooth loss was found in 21%. Among types of SLT products, gutka (28.6%) and betel quid (23.3%) were most commonly used. Using SLT for five or more years was found to be associated with a high CPI score, gingival recession (Class II-IV), moderate to severe tooth mobility, and presence of tooth loss. CONCLUSIONS: The study found statistically significant association between duration in years of using SLT and periodontal disease including gingival recession, tooth mobility and tooth loss. However, no significant results were found between retention during single use and frequency of SLT use per day. However, the link of these factors with the periodontal disease cannot be eliminated.

Fixed versus Adjustable differential pressure valves in case of idiopathic normal pressure hydrocephalus treated with ventriculoperitoneal shunt. A systematic review and meta-analysis of proportion.

INTRODUCTION: Idiopathic normal pressure hydrocephalus is a common cause of communicating hydrocephalus in adult age, presenting with classic Hakim-Adam's triad. Ventriculoperitoneal shunting is the treatment of choice in these cases. The main objective of this study is to compare the complication rate of Adjustable differential pressure valves with fixed differential pressure valves in these cases. LITERATURE SEARCH: We systematically searched PubMed/Medline, Embase, LILACS, and ClinicalTrials.gov from their date of inception to 30th Jan 2023. We included observational studies, Randomized Controlled Trials (RCTs), and comparative and noncomparative studies in the search. The literature search resulted in 1394 studies, and only 22 studies were eligible to be included in the meta-analysis. We performed the meta-analysis of proportion to compare incidence rates by performing a Freeman-turkey double arcsine transformation. RESULTS: The summary of the proportions of the incidence rate of complications was less for Adjustable Differential Pressure Valves (ADPV) as compared to Fixed Differential Pressure Valves (FDVP) but the confidence intervals overlapped. The summary proportion of surgical revision of shunt in the case of ADPV was 0.081 (95% CI (0.047, 0.115)), and in the case of FDPV was 0.173 (95% CI (0.047, 0.299)). Similarly, the summary proportion of subdural fluid collection in the case of ADPV was 0.090 (0.058, 0.122), and in the case of FDPV was 0.204 (0.132, 0.277). The incidence of complication was low in population implanted with DPV along with gravitational or anti-siphon unit (GASU). CONCLUSION: Complication rates in the case of ADPV plus GASU were the lowest. Though the summary proportion of complication rate in the case of ADPV was low as compared to FDPV, the statistical significance of this difference is doubted due to overlapping confidence intervals.

Investigating global surface temperature from the perspectives of environmental, demographic, and economic indicators: current status and future temperature trend.

Anthropogenic activities have increased atmospheric concentrations of greenhouse gas emissions, which have observably increased global temperature. Recognizing it as one of the most critical issues caused by human activities, this study investigates the effects of environmental, demographic, and economic indicators on global and regional temperature. For this purpose, advanced and powerful machine learning techniques, such as ANN, CNN, SVM, and LSTM, are employed using the data from 1980 to 2018 of the aforementioned regions to predict and forecast global and regional temperatures in Africa, Asia, Europe, North America, and South America. First, the predicted results were found very close to the actual surface temperature, confirming that environmental, economic, and demographic indicators are critical drivers of climate change. Second, this study forecasted global temperature from 2023 to 2050 and regional temperature from 2022 to 2050. The results also predicted a considerable increase in global temperature and regional temperature in the forthcoming years. Particularly, Asia and Africa may experience extreme weather in the future with an increase of more than 1.6 °C. Based on the findings of this study, the major implications have been that maintaining greenhouse gas emissions, balancing economic development, urbanization, and environmental quality while reducing fossil fuel energy consumption will ensure climate mitigation. The findings demand an alteration in human behavior regarding fossil fuel energy consumption to control greenhouse gas emissions, which is the most significant contributor to climate change.

Pharmacokinetics of Midazolam in preterm neonates with an insight in brain Tissue: A PBPK approach.

Physiological maturity is a gradual process taking place throughout infancy and childhood. Though for years anatomical growth has been the basis for dose calculation in pediatric population, physiological immaturity can-not be overlooked especially in neonates. The potential difference in physiology can significantly affect the outcomes of treatment and may result in under dosing or over-dosage. For many ethical and logistic constrains, carrying out pharmacokinetic studies of pharmacological agents in neonatal population remains a challenging task and such data is therefore, insufficient. This work presents Physiologically Based Pharmacokinetic modeling approach to predict the disposition of IV Midazolam in preterm neonates of different gestational ages, validated by the experimental studies. Furthermore, midazolam concentration in brain tissue of these neonates- the major site of its action- has been noted. The predicted and observed plasma pharmacokinetic parameters are comparable. This article demonstrates the usefulness of in-silico approach for finding out the PK parameters in neonates which may aid in deciding the frequency of drug administration in this population.

Comparison of empagliflozin and vildagliptin for efficacy and safety in type 2 diabetes mellitus in the Pakistani population.

Background: Diabetes mellitus (DM) is a chronic disease that needs early management to prevent complications and premature mortality. Therefore, it is essential to select evidence-based drugs available to control diabetes and limit the progression to related complications. This study aimed to compare the efficacy and safety of empagliflozin and vildagliptin in people with type 2 DM. Methods: This was an open-label, parallel randomized controlled trial (NCT05359432) conducted at two tertiary care hospitals in Karachi, Pakistan. After obtaining consent, participants were randomized into two groups. The first group was given empagliflozin (10 mg once or two times daily) with metformin, and the second group got vildagliptin (50 mg once or two times daily) with metformin. HbA1c, high-density lipoprotein (HDL) levels, systolic blood pressure, fasting blood glucose, and body weight were measured at the baseline and 24-week visits. Results: A total of 120 patients fulfilled the selection criteria and then underwent randomization to be placed into empagliflozin and vildagliptin groups. The mean change in HbA1c (-0.97% ± 0.68 for empagliflozin and -0.82% ± 1.57 for vildagliptin) was statistically similar in both groups (p-value = 0.980). No statistically significant difference was observed between the two groups for safety parameters such as eGFR (p = 0.46), serum ALT (p = 0.13), LDL (p = 0.23), total cholesterol (p = 0.49), and triglycerides (p = 0.49). Conclusion: Results of the study highlight that vildagliptin and empagliflozin have a significant beneficial effect in reducing HbA1c, fasting blood glucose, systolic blood pressure, and weight of participants. Both drugs had no differences when compared on safety parameters.

The State of Preclinical Modeling for Early Phase Cancer Trials Using Molecularly Targeted Agents with Radiation.

Preclinical studies inform and guide the development of novel treatment combination strategies that bridge the laboratory with the clinic. We aimed to evaluate approaches cancer researchers used to justify advancing new combinations of molecularly targeted agents and radiation treatment into early-phase human clinical trials. Unsolicited early phase clinical trial proposals submitted to the National Cancer Institute's Cancer Therapy Evaluation Program between January 2016 and July 2020 were curated to quantify key characteristics and proportion of preclinical data provided by trialists seeking to conduct molecularly targeted agent-radiation combination studies in cancer patients. These data elucidate the current landscape for how the rationale for a molecularly targeted agent-radiation combination therapy is supported by preclinical research and illustrate unique challenges faced in translation at the intersection of precision medicine and radiation oncology.

Irrational Use of Selected Herbal Medicines During Pregnancy: A Pharmacoepidemiological Evidence From Yemen.

Background: Recent research indicates irrational use of herbal medicine (HM) during pregnancy that can be harmful to the mother and development of baby. However, no study has been conducted to explore the use of HM among pregnant women in a conflict region. Methods: This was a cross-sectional research conducted in July and August in the year 2017, at three hospitals in Sana'a, Yemen. Postpartum women were interviewed via the structured instrument to collect data on patterns of HM used during pregnancy. Results: A total of three hundred postpartum women participated in the study, with 59.3% (178) of them using at least one modality of HM in the previous pregnancy. Cinnamon (Cinnamomum verum L), ginger (Zingiber officinale Z), barley (Hordeum vulgare P), and garlic (Allium sativum A) were the most commonly used HM. Statistical analysis showed that consumers of HM had a higher rate of caesarian section and complications during and after the delivery. Conclusion: Consumption of HM during pregnancy was high including contraindicated modalities such as cinnamon (C. verum L) and barley (H. vulgare P). The use of potentially harmful modalities and association with complications pose a threat to the well-being of mothers and newborns. Further studies in this area will be helpful to generate evidence for the rational use of HM during pregnancy.

Monkeypox in 2022: A new threat in developing.

Monkeypox that started spreading from central and western Africa has recently been detected in various countries including Spain, Canada, Australia, and UAE. Though it has a very low incidence rate, it is still a significant threat that must be dealt with as quickly as possible and the probability of it spreading to many other countries is still very high. It is caused the by Monkeypox virus that belongs to the genus Orthopox that also include smallpox virus, which has quite similar clinical presentation as that of Monkeypox. With fading immunity against Smallpox, it is important to counter this threat with newly developed vaccines.

Role of inflammatory and hematological markers in predicting the complicated and perforated acute appendicitis in pediatric population: A cohort study.

Introduction: It is important to promptly assess the severity of appendicitis since late diagnosis can proceed towards perforation, peritonitis and sepsis. The main objective of this study is to decipher the ability of CRP, TLC and neutrophils in acute appendicitis to predict complications and perforation in pediatric age group. Methods: This cohort study was conducted in the Pediatric Surgery Department of Liaquat National Hospital, Karachi. It included all the patients diagnosed and operated on for acute appendicitis within the pediatric age group. Results: The median (IQR) age of study population was 9 (7-11) years, the majority of which fell into 6-12 years of age group with 70% males. Histopathology came out positive in 127 individuals. Out of those 127 patients, 45.9% (n = 62) had simple appendicitis and 48.1% (n = 65) had complicated appendicitis (n = 65), while 37 (27.4%) had shown perforation. The majority of individuals had suppurative appendicitis on histopathology (35.6%). On receiver operating characteristic (ROC) analysis, CRP has the highest specificity for complicated appendicitis and the highest positive likelihood ratio for both complicated and perforated appendicitis. Conclusion: CRP was observed in our study to be an independent marker of severity in acute appendicitis.