The Right Hand Must Know What the Left Hand is Doing: A False-Positive Hotspot on the Sestamibi Scan.

Objective: Imaging studies in the setting of primary hyperparathyroidism are performed to rule out an ectopic parathyroid adenoma. Although rare, false-positive scans can cause confusion and possibly more extensive procedures. Method: A 68-year-old woman with parathyroid hormone-dependent hypercalcemia was found to have uptake in the left midclavicular area on the parathyroid scan with sestamibi. Retention of the isotope was considered a possibility, and the sestamibi scan was repeated after injecting the isotope in the right hand and this did not show uptake in the left midclavicular area. Results: Sestamibi is taken up by the mitochondrial-rich adenoma cells and can help identify an ectopic location of the adenoma. Sestamibi scans are commonly performed before neck exploration to rule out an ectopic adenoma and to localize the parathyroid adenoma. Thyroid adenoma and thyroid cancer can also cause retention of isotopes. Retention of the isotope in the vein can also give an illusion of an ectopic parathyroid adenoma. Injecting the isotope in the contralateral hand can overcome this retention issue. Conclusion: Uptake on parathyroid scan outside of normal embryologic decent of the parathyroid gland should raise the possibility of a false-positive uptake.

Pseudo Primary Aldosteronism as Initial Presentation of Ectopic ACTH Syndrome in Metastatic Small Cell Lung Cancer.

Ectopic adrenocorticotropic hormone (ACTH)-secreting syndrome (EAS) is a rare but often aggressive paraneoplastic syndrome. Patients with EAS typically present with high ACTH levels and rapid clinical progression in the setting of acute cortisol elevation, which can delay diagnosis due to a lack of typical Cushingoid features. High levels of ACTH have also been shown to stimulate the adrenal zona glomerulosa to oversecrete aldosterone. We present the case of a 58-year-old male individual presenting with new-onset hypertension and severe metabolic alkalosis with spontaneous hypokalemia, in the setting of elevated aldosterone and low renin levels, suggestive of primary aldosteronism. Subsequent biochemical testing, imaging, and pathology, however, revealed suppression of aldosterone with evidence of hypercortisolism in the setting of metastatic small cell lung cancer. This was, therefore, suggestive of pseudo primary aldosteronism in the setting of a paraneoplastic ectopic ACTH-producing syndrome. This case highlights that hypercortisolism, in the setting of EAS, can initially present with a clinical picture suggestive of hyperaldosteronism. The use of a dexamethasone suppression test can allow the clinician to differentiate between idiopathic bilateral adrenal hyperplasia and ectopic ACTH syndrome.

Fabrication of amine-functionalized and multi-layered PAN-(TiO2)-gelatin nanofibrous wound dressing: In-vitro evaluation.

The development of advanced multifunctional wound dressings remains a major challenge. Herein, a novel multilayer (ML) electrospun nanofibers (NFs) wound dressing based on diethylenetriamine (DETA) functionalized polyacrylonitrile (PAN), TiO2 nanoparticles (NPs) coating (Ct), and bioderived gelatin (Gel) was developed for potential applications in wound healing. The ML PAN-DETA-Ct-Gel membrane was developed by combining electrospinning, chemical functionalization, synthesis, and electrospray techniques, using a layer-by-layer method. The ML PAN-DETA-Ct-Gel membrane is comprised of an outer layer of PAN-DETA as a barrier to external microorganisms and structural support, an interlayer TiO2 NPs (Ct) as antibacterial function, and a contact layer (Gel) to improve biocompatibility and cell viability. The NFs membranes were characterized by scanning electron microscopy (SEM), surface profilometry, BET analysis, and water contact angle techniques to investigate their morphology, surface roughness, porosity, and wettability. The ML PAN-DETA-Ct-Gel wound dressing exhibited good surface roughness, porosity, and better wettability. Cell morphology, proliferation, and viability were determined using fibroblasts (3T3), and antibacterial assays were performed against six pathogens. The ML PAN-DETA-Ct-Gel NFs membrane showed good cell morphology, proliferation, viability, and antibacterial activity compared with other membranes. This new class of ML NFs membranes offers a multifunctional architecture with adequate biocompatibility, cell viability, and antibacterial activity.

Fish collagen peptides' modulating effect on human skin microbiota against pathogenic Staphylococcus aureus.

Aim: The current research aims to design effective strategies to enhance the body's immune system against pathogenic bacteria. Methods: Skin commensals were isolated, identified and cultured in fish collagen peptides (FCPs). Results: After culturing in FCP, the skin commensals were used in a dose-dependent manner for Staphylococcus aureus in a dual-culture test, which showed significant growth inhibition of the pathogenic bacteria, which concluded that FCP induced the immune defense system of skin microbiota against pathogenic strains. Conclusion: Results have validated that fish collagen peptide plays a vital role in the growth of selected human skin flora and induces more defensive immunity against pathogenic S. aureus bacteria in dual-culture experimentation.

Optimized photodegradation of palm oil agroindustry waste effluent using multivalent manganese-modified black titanium dioxide.

This article presents a methodological approach to use manganese (Mn3+Mn7+)-modified black titanium dioxide (Mn/BTiO2) as a photocatalyst to optimize and improve visible-light-driven photodegradation of treated agro-industrial effluent (TPOME). A modified wet chemical process was used to prepare BTiO2. The BTiO2 was then wet impregnated with Mn and calcined at 300 °C for 1 h to produce Mn/BTiO2. The activity of Mn/BTiO2 was investigated in terms of photo-assisted elimination of chemical oxygen demand (COD), phenolic compounds (PCs), color, and total organic carbon (TOC). Using the design of experiments (DOE), the conditions of the photocatalytic process, including photocatalyst loading, Mn concentration, hydrogen peroxide (H2O2) dose, and irradiation time, were optimized. Under the optimum conditions (0.85 g/L photocatalyst loading, 0.048 mol/L H2O2 dose, 0.301 wt.% Mn concentration, and 204 min irradiation time) COD, PCs, color, and TOC removal efficiencies of 88.87%, 86.04%, 62.8%, and 84.66%, respectively, were obtained. Statistical analysis showed that the response variable's removal from TPOME estimation had high R2 and low RMSE, MSE, MAD, MAE, and MAPE values, indicating high reliability. This study demonstrated the significant potential of the developed photocatalytic system for the treatment of waste effluent generated by the palm oil industry and other agro-industries, with the ability to simultaneously reduce a number of organic pollution indicators (OPIs).

Association of Epileptiform Activity With Outcomes in Toxic-Metabolic Encephalopathy.

The clinical significance of epileptiform abnormalities (EAs) specific to toxic-metabolic encephalopathy (TME) is unknown. OBJECTIVES: To quantify EA burden in patients with TME and its association with neurologic outcomes. DESIGN SETTING AND PARTICIPANT: This is a retrospective study. A cohort of patients with TME and EA (positive) were age, Sequential Organ Failure Assessment Score, Acute Physiology and Chronic Health Evaluation II (APACHE-II) score matched to a cohort of TME patients without EA (control). Univariate analysis compared EA-positive patients against controls. Multivariable logistical regression adjusting for underlying disease etiology was performed to examine the relationship between EA burden and probability of poor neurologic outcome (modified Rankin Score [mRS] 4-6) at discharge. Consecutive admissions to inpatient floors or ICUs that underwent continuous electroencephalography (cEEG) monitoring at a single center between 2012 and 2019. Inclusion criteria were 1) patients with TME diagnosis, 2) age greater than 18 years, and 3) greater than or equal to 16 hours of cEEG. Patients with acute brain injury and cardiac arrest were excluded. MAIN OUTCOMES AND MEASURES: Poor neurologic outcome defined by mRS (mRS 4-6). RESULTS: One hundred sixteen patients were included, 58 with EA and 58 controls without EA, where matching was performed on age and APACHE-II score. The median age was 66 (Q1-Q3, 57-75) and median APACHE II score was 18 (Q1-Q3, 13-22). Overall cohort discharge mortality was 22% and 70% had a poor neurologic outcome. Peak EA burden was defined as the 12-hour window of recording with the highest prevalence of EAs. In multivariable analysis adjusted for Charlson Comorbidity Index and primary diagnosis, presence of EAs was associated with poor outcome (odds ratio 3.89; CI [1.05-14.2], p = 0.041). Increase in peak EA burden from 0% to 100% increased probability of poor discharge neurologic outcome by 30%. CONCLUSIONS AND RELEVANCE: Increasing burden of EA is associated with worse discharge outcomes in patients with TME. Future studies are needed to determine whether short-term treatment with anti-seizure medications while medically treating the underlying metabolic derangement improves outcomes.

Pellagra Post-Roux-en-Y Gastric Bypass Surgery.

Background/Objective: Micronutrient deficiencies such as pellagra are rarely seen after bariatric surgery and can be challenging to diagnose and manage. Alcohol use can precipitate nutritional deficiencies. Case Report: A 51-year-old woman with a history of Roux-en-Y gastric bypass surgery who later developed an alcohol-use disorder after her diagnosis of breast cancer. She experienced a subacute decline in her physical and cognitive function along with a rash after radiation treatment for breast cancer, lower extremity pain and weakness, anemia, and diarrhea with severe hypokalemia. Workup showed undetectable niacin levels. She initially did not respond to an oral niacin replacement, necessitating intramuscular injections. Alcohol cessation and parenteral B complex replacement led to the resolution of her symptoms and biochemical derangements. Discussion: Bariatric surgery with concomitant alcohol use can precipitate niacin deficiency-induced liver dysfunction. In the correct clinical setting, screening for alcohol use and checking niacin levels may help avoid extensive testing and can help make the correct diagnosis. Parenteral replacement may be necessary in this setting. Conclusion: Niacin deficiency needs to be considered in patients with bariatric surgery with a history of alcoholism in the correct clinical setting.

An Overview on Rumex dentatus L.: Its Functions as a Source of Nutrient and Health-Promoting Plant.

Rumex dentatus L. (Polygonaceae), also known as toothed dock or Aegean dock, is a medicinal plant with a high culinary value in addition to being used as an ethnomedicinal plant. This review focuses on the botanical, nutritional, phytochemical, and pharmacological activities of R. dentatus, as well as the future prospects for systematic investigations into these areas. R. dentatus has been subjected to scientific evaluation, which has confirmed its traditional uses and demonstrated a wide range of biological and pharmacological potentials, including antioxidant, anticancer, antifungal, antibacterial, anti-inflammatory, and other biological properties. Phytochemical analyses showed the presence of anthraquinones, chromones, flavonoids, and essential oils. As a result of this current review, the medicinal significance of R. dentatus has been confirmed, and future research on its unexplored aspects, such as the identification of pharmacologically active chemical constituents and related mechanisms and safety, may be stimulated, with the goal of developing it into a drug.

Human Blastocyst Components Detection Using Multiscale Aggregation Semantic Segmentation Network for Embryonic Analysis.

Infertility is one of the most important health concerns worldwide. It is characterized by not being successful of pregnancy after some periods of periodic unprotected sexual intercourse. In vitro fertilization (IVF) is an assisted reproduction technique that efficiently addresses infertility. IVF replaces the actual mode of reproduction through a manual procedure wherein embryos are cultivated in a controlled laboratory environment until they reach the blastocyst stage. The standard IVF procedure includes the transfer of one or two blastocysts from several blastocysts that are grown in a controlled environment. The morphometric properties of blastocysts with their compartments such as trophectoderm (TE), zona pellucida (ZP), inner cell mass (ICM), and blastocoel (BL), are analyzed through manual microscopic analysis to predict viability. Deep learning has been extensively used for medical diagnosis and analysis and can be a powerful tool to automate the morphological analysis of human blastocysts. However, the existing approaches are inaccurate and require extensive preprocessing and expensive architectures. Thus, to cope with the automatic detection of blastocyst components, this study proposed a novel multiscale aggregation semantic segmentation network (MASS-Net) that combined four different scales via depth-wise concatenation. The extensive use of depthwise separable convolutions resulted in a decrease in the number of trainable parameters. Further, the innovative multiscale design provided rich spatial information of different resolutions, thereby achieving good segmentation performance without a very deep architecture. MASS-Net utilized 2.06 million trainable parameters and accurately detects TE, ZP, ICM, and BL without using preprocessing stages. Moreover, it can provide a separate binary mask for each blastocyst component simultaneously, and these masks provide the structure of each component for embryonic analysis. Further, the proposed MASS-Net was evaluated using publicly available human blastocyst (microscopic) imaging data. The experimental results revealed that it can effectively detect TE, ZP, ICM, and BL with mean Jaccard indices of 79.08, 84.69, 85.88%, and 89.28%, respectively, for embryological analysis, which was higher than those of the state-of-the-art methods.

Therapeutic significance of nano- and biosensor technology in combating SARS-CoV-2: a review.

The diagnosis of novel coronavirus (COVID-19) has gained the spotlight of the world's scientific community since December 2019 and it remains an important issue due to the emergence of novel variants around the globe. Early diagnosis of coronavirus is captious to prevent and hard to control. This pandemic can be eradicated by implementing suppressing strategies which can lead to better outcomes and more lives being saved. Therefore, the analysis showed that COVID-19 can only be managed by adopting public health measures, such as testing, isolation and social distancing. Much work has been done to diagnose coronavirus. Various testing technologies have been developed, opted and modified for rapid and accurate detection. The advanced molecular diagnosis relies on the detection of SARS-CoV-2 as it has been considered the main causative agent of this pandemic. Studies have shown that several molecular tests are considered essential for the confirmation of coronavirus infection. Various serology-based tests are also used in the detection and diagnosis of coronavirus including point-of-care assays and high-throughput enzyme immunoassays that aid in the diagnosis of COVID-19. Both these assays are time-consuming and have less diagnostic accuracy. Nanotechnology has the potential to develop new strategies to combat COVID-19 by developing diagnostics and therapeutics. In this review, we have focused on the nanotechnology-based detection techniques including nanoparticles and biosensors to obstruct the spread of SARS-CoV-2.

Preparation and Characterization of Hydrophilic Polymer Based Sustained-Release Matrix Tablets of a High Dose Hydrophobic Drug.

The objective of this study was the preparation and characterization of a sustained-release matrix tablet containing a high-dose hydrophobic drug and its comparison with marketed products. In the present study, HPMC was applied as the matrix-forming polymer for the sustained release of clarithromycin (500 mg). The compatibility of clarithromycin and excipients was studied using a binary mixture approach and compatible excipients were selected. Matrix tablets were prepared using the high-shear wet granulation technique. Tablets were compressed using oblong (19 mm), shallow concave punches, under a compression weight of 900 mg/tablet. The flow of granules was evaluated by determining their bulk density, tapped density, angle of repose, Hausner ratio, and Car's index. Compressed tablets were tested for their physical parameters, mechanical characteristics, drug content, and in vitro drug release, as per United States Pharmacopeia (USP). Clarithromycin is a drug having poor water solubility and showed compatibility with all the excipients used in the formulation of polymeric matrix tablets. FTIR spectra of clarithromycin, before and after being subjected to the stress conditions, confirmed the compatibility of clarithromycin and other ingredients of the matrix tablets. All the formulations exhibited good rheological characteristics and all the parameters related to flow showed results in the acceptable range. Physically, matrix tablets were smooth and shiny, without any surface defects. Weight variation (±5%) and drug content of the tablets (95-102%) were within the pharmacopeial limits. HPMC successfully sustained the drug release for 24 h. It is concluded from the study that dissolution rate of clarithromycin can be sustained using hydrophilic polymer (HPMC) as a release-controlling agent.

Deep Features Aggregation-Based Joint Segmentation of Cytoplasm and Nuclei in White Blood Cells.

White blood cells (WBCs), also known as leukocytes, are one of the valuable parts of the blood and immune system. Typically, pathologists use microscope for the manual inspection of blood smears which is a time-consuming, error-prone, and labor-intensive procedure. To address these issues, we present two novel shallow networks: a leukocyte deep segmentation network (LDS-Net) and leukocyte deep aggregation segmentation network (LDAS-Net) for the joint segmentation of cytoplasm and nuclei in WBC images. LDS-Net is a shallow architecture with three downsampling stages and seven convolution layers. LDAS-Net is an extended version of LDS-Net that utilizes a novel pool-less low-level information transfer bridge to transfer low-level information to the deep layers of the network. This information is aggregated with deep features in a dense feature concatenation block to achieve accurate cytoplasm and nuclei joint segmentation. We evaluated our developed architectures on four WBC publicly available datasets. For cytoplasmic segmentation in WBCs, the proposed method achieved the dice coefficients of 98.97%, 99.0%, 96.05%, and 98.79% on Datasets 1, 2, 3, and 4, respectively. For nuclei segmentation, the dice coefficients of 96.35% and 98.09% are achieved for Datasets 1 and 2, respectively. Proposed method outperforms state-of-the-art methods with superior computational efficiency and requires only 6.5 million trainable parameters.

Effectiveness of Mild to Moderate Hypothermic Cardiopulmonary Bypass on Early Clinical Outcomes.

BACKGROUND: Intraoperative hypothermia is an integral part of cardiopulmonary bypass (CPB), and a precise degree of hypothermia may improve the early clinical outcomes of cardiac surgery. Presently, there is no agreement on an accurate, advantageous temperature range for routine use in CPB. To address this issue, we conducted a retrospective observational study to compare the effects of different hypothermic temperature ranges on primary (inotropic support, blood loss, and platelet count) and secondary (ventilation support and in-hospital stay) outcomes in patients undergoing elective cardiac surgery. METHODS: Data were retrieved from the medical database of the Cardiovascular Surgery Department, King Edward Medical University, Lahore-Pakistan (a tertiary care hospital), dating from February 2015 to December 2017. Patients were divided into mild (34 °C to 36 °C), intermediate (31 °C to 33 °C), or moderate (28 °C to 30 °C) hypothermic groups. RESULTS: Out of 275 patients, 245 (89.09%) fit the inclusion criteria. The cohort with mild hypothermic CPB temperatures presented better clinical outcomes in terms of requiring less inotropic support, less blood loss, fewer blood transfusions, improved platelet counts, shorter in-hospital stays, and required less ventilation support, when compared with other hypothermic groups. CONCLUSIONS: Mild hypothermic CPB (34 °C to 36 °C) may produce better clinical outcomes for cardiac surgery and improve the quality of health of cardiac patients.

Detecting Blastocyst Components by Artificial Intelligence for Human Embryological Analysis to Improve Success Rate of In Vitro Fertilization.

Morphological attributes of human blastocyst components and their characteristics are highly correlated with the success rate of in vitro fertilization (IVF). Blastocyst component analysis aims to choose the most viable embryos to improve the success rate of IVF. The embryologist evaluates blastocyst viability by manual microscopic assessment of its components, such as zona pellucida (ZP), trophectoderm (TE), blastocoel (BL), and inner cell mass (ICM). With the success of deep learning in the medical diagnosis domain, semantic segmentation has the potential to detect crucial components of human blastocysts for computerized analysis. In this study, a sprint semantic segmentation network (SSS-Net) is proposed to accurately detect blastocyst components for embryological analysis. The proposed method is based on a fully convolutional semantic segmentation scheme that provides the pixel-wise classification of important blastocyst components that help to automatically check the morphologies of these elements. The proposed SSS-Net uses the sprint convolutional block (SCB), which uses asymmetric kernel convolutions in combination with depth-wise separable convolutions to reduce the overall cost of the network. SSS-Net is a shallow architecture with dense feature aggregation, which helps in better segmentation. The proposed SSS-Net consumes a smaller number of trainable parameters (4.04 million) compared to state-of-the-art methods. The SSS-Net was evaluated using a publicly available human blastocyst image dataset for component segmentation. The experimental results confirm that our proposal provides promising segmentation performance with a Jaccard Index of 82.88%, 77.40%, 88.39%, 84.94%, and 96.03% for ZP, TE, BL, ICM, and background, with residual connectivity, respectively. It is also provides a Jaccard Index of 84.51%, 78.15%, 88.68%, 84.50%, and 95.82% for ZP, TE, BL, ICM, and background, with dense connectivity, respectively. The proposed SSS-Net is providing a mean Jaccard Index (Mean JI) of 85.93% and 86.34% with residual and dense connectivity, respectively; this shows effective segmentation of blastocyst components for embryological analysis.

Artificial Intelligence-Based Solution in Personalized Computer-Aided Arthroscopy of Shoulder Prostheses.

BACKGROUND: Early recognition of prostheses before reoperation can reduce perioperative morbidity and mortality. Because of the intricacy of the shoulder biomechanics, accurate classification of implant models before surgery is fundamental for planning the correct medical procedure and setting apparatus for personalized medicine. Expert surgeons usually use X-ray images of prostheses to set the patient-specific apparatus. However, this subjective method is time-consuming and prone to errors. METHOD: As an alternative, artificial intelligence has played a vital role in orthopedic surgery and clinical decision-making for accurate prosthesis placement. In this study, three different deep learning-based frameworks are proposed to identify different types of shoulder implants in X-ray scans. We mainly propose an efficient ensemble network called the Inception Mobile Fully-Connected Convolutional Network (IMFC-Net), which is comprised of our two designed convolutional neural networks and a classifier. To evaluate the performance of the IMFC-Net and state-of-the-art models, experiments were performed with a public data set of 597 de-identified patients (597 shoulder implants). Moreover, to demonstrate the generalizability of IMFC-Net, experiments were performed with two augmentation techniques and without augmentation, in which our model ranked first, with a considerable difference from the comparison models. A gradient-weighted class activation map technique was also used to find distinct implant characteristics needed for IMFC-Net classification decisions. RESULTS: The results confirmed that the proposed IMFC-Net model yielded an average accuracy of 89.09%, a precision rate of 89.54%, a recall rate of 86.57%, and an F1.score of 87.94%, which were higher than those of the comparison models. CONCLUSION: The proposed model is efficient and can minimize the revision complexities of implants.

Superporous acrylic acid and HPMC hydrogels of mefenamic acid: Formulation, characterization and optimization by central composite design.

The purpose of the study was to devise the superporous hydrogels (SPHs) of mefenamic acid (MA) to acquire the sustained action of the MA in the body. The superporous hydrogels of mefenamic acid were formulated by employing the gas blowing method. The central composite rotatable design (CCRD) was applied to optimize the effect of independent formulation factors like acrylic acid (AC), HPMC and glycerol (GLY) over dependent variables like porosity, viscosity, drug content and swelling ratio of superporous hydrogels in water, phosphate buffer (pH 6.8) and in 0.1N HCl (pH 1.2). A number of characteristics such as void fraction, surface morphology by Scanning electron microscopy (SEM) and in vitro drug release study were governed along with physico-chemical analysis by Fourier transform infrared spectroscopy (FTIR), Differential scanning calorimetry (DSC) and appraised statistically by employing the ANOVA. The comparative analgesic activity of optimized superporous hydrogel formulation SPH17 was also analyzed by using tail flick method. The Fourier transform infrared spectroscopy and Differential scanning calorimetry studies approved the physical compatibility between the polymers and the drug. The Scanning electron microscopy study specified micrographic insight about the structure of formed formulations comprising presence of pores, fibers and drug-hole aggregates. The superporous hydrogels were detected to be low dense as they expressed density lower than 0.75 g/cc. The decrease in concentration of the polymers and cross linker contributed towards the increase in the void fraction of the superporous hydrogel formulations. The optimized formulation SPH 17 exhibited a highly sustained release of MA for up to 10 h in the both 0.1 N HCl and phosphate buffer (66.6%) media. The non-fickian release of drug revealed the coupling of the diffusion and polymer relaxation mechanism of the drug release from the formulations. The obtained outcomes suggested that analgesic effect of SPH 17 was significantly (p < 0.05) higher than that of simple suspension of mefenamic acid and total analgesic effect duration for superporous hydrogel was also doubled as compared to the duration of analgesic effect produced by drug suspension. The successfully formulated SPH with HPMC K100M as a gelling agent had sustained the action of the mefenamic acid (MF) by improving its poor solubility and permeability. The introduction of inter-penetrating polymeric network (acrylic acid) using glycerol as a cross linker impart increased residence time to superporous hydrogels which ultimately enhanced the feasibility of using superporous hydrogel as oral sustained release devices particularly for gastric retention.

2-Methoxy-6-Acetyl-7-Methyljuglone: A Bioactive Phytochemical with Potential Pharmacological Activities.

Natural products have been the focus of biomedical and pharmaceutical research to develop new therapies in recent years. 2-methoxy-6-acetyl-7-methyljuglone (2-methoxystypandrone, MAM) a natural bioactive juglone derivative, is known to have various levels of pharmacotherapeutic efficacies as an anti-inflammatory, anticancer, antioxidant, antimicrobial, and anti-HIV activities. MAM fights cancer progression by inducing apoptosis, necroptosis and deregulating signaling pathways through H2O2-induced JNK/iNOS/NO and MAPK, ERK1/2 pathways, JNK activation, and the RIP1/RIP3 complex. In this review, we summarize the pharmacological importance of MAM in the field of drug discovery. Furthermore, this review not only emphasizes the medicinal properties of MAM, but also discusses its potential efficacy in future medicinal products.

Maturity-Onset Diabetes of Young Type 5: Diabetes with Extrapancreatic Features.

OBJECTIVE: This case involves a new-onset diabetes patient diagnosed during pregnancy with the congenital dysplastic right kidney. Case Report. Clinical presentation, biochemical features, imaging in a patient with diabetes diagnosed during pregnancy, and congenital dysplastic right kidney. Discussion. We present a case of a 22-year-old female with the congenital dysplastic right kidney diagnosed with gestational diabetes mellitus after failing a 1-hour oral glucose tolerance test, requiring insulin during pregnancy. Because of the family history of diabetes and morphologic renal abnormalities at young ages on the maternal side of the family, our patient was evaluated for maturity-onset diabetes of adult and was found to have HNF-1ß mutation. CONCLUSION: This case highlights the importance of considering the diagnosis of maturity-onset diabetes of young and particularly MODY-5 in individuals with extrapancreatic features. MODY-5 should also be considered in a patient undergoing renal transplant at young ages with a family history of morphologic renal abnormalities.

Smart and pH-sensitive rGO/Arabinoxylan/chitosan composite for wound dressing: In-vitro drug delivery, antibacterial activity, and biological activities.

Carbohydrate polymers are biological macromolecules that have sparked a lot of interest in wound healing due to their outstanding antibacterial properties and sustained drug release. Arabinoxylan (ARX), Chitosan (CS), and reduced graphene oxide (rGO) sheets were combined and crosslinked using tetraethyl orthosilicate (TEOS) as a crosslinker to fabricate composite hydrogels and assess their potential in wound dressing for skin wound healing. Fourier-transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), atomic force microscopy (AFM), transmission electron microscopy (TEM), and biological assays were used to evaluate the composite hydrogels. FTIR validated the effective fabrication of the composite hydrogels. The rough morphologies of the composite hydrogels were revealed by SEM and AFM (as evident from the Ra values). ATC-4 was discovered to have the roughest surface. TEM revealed strong homogeneous anchoring of the rGO to the polymer matrix. However, with higher amount of rGO agglomeration was detected. The % swelling at various pHs (1-13) revealed that the hydrogels were pH-sensitive. The controlled release profile for the antibacterial drug (Silver sulfadiazine) evaluated at various pH values (4.5, 6.8, and 7.4) in PBS solution and 37 °C using the Franz diffusion method revealed maximal drug release at pH 7.4 and 37 °C. The antibacterial efficacy of the composite hydrogels against pathogens that cause serious skin diseases varied. The MC3T3-E1 cell adhered, proliferated, and differentiated well on the composite hydrogels. MC3T3-E1 cell also illustrated excellent viability (91%) and proper cylindrical morphologies on the composite hydrogels. Hence, the composite hydrogels based on ARX, CS, and rGO are promising biomaterials for treating and caring for skin wounds.

Efficacy of Whole-Blood Del Nido Cardioplegia Compared with Diluted Del Nido Cardioplegia in Coronary Artery Bypass Grafting: A Retrospective Monocentric Analysis of Pakistan.

Background and Objectives: Cardioplegia is one of the most significant components used to protect the myocardium during cardiac surgery. There is a paucity of evidence regarding the utilization of whole-blood Del Nido cardioplegia (WB-DNC) on clinical outcomes in coronary artery bypass grafting (CABG). The purpose of this retrospective cross-sectional study is to compare the effectiveness of diluted (blood to crystalloid; 1:4) Del Nido cardioplegia (DNC) with WB-DNC in patients who underwent elective CABG in a tertiary care hospital in Lahore-Pakistan. Materials and Methods: This was a retrospective descriptive study conducted at the Department of Cardiovascular Surgery, King Edward Medical University, Lahore. The medical database of all consecutive patients admitted from January 2018 to March 2020 and who fulfilled the inclusion criteria were reviewed. Results: Out of 471 patients admitted during the study period, 450 underwent various elective cardiac surgeries. Out of 450, 321 patients (71.33%) were operated on for CABG. Only 234/321 (72.89%) CABG patients fulfilled our inclusion criteria; 120 (51.28%) patients received WB-DNC, while 114 (48.71%) patients were administered with DNC. The former group presented with better clinical outcomes compared with the latter in terms of lesser requirements of inotropic support, low degree of hemodilution, shorter in-hospital stay, improved renal function, and cost-effectiveness. Peak values of serum Troponin-T (Trop-T), creatine kinase-myocardial band (CK-MB) release, and activated clotting time (ACT) were also lower in the WB-DNC group compared with the DNC group. Conclusions: The WB-DNC conferred better myocardial protection, improved early clinical outcomes, and also proved to be economical for patients undergoing elective CABG compared with classical crystalloid cardioplegia solution.