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Objectives: To determine the one-year and five-year occurrence and prognosticators of major adverse cardiac events (MACE: composition of all-cause death, myocardial infarction, target vessel revascularization, and vessel thrombosis), mortality, and target lesion revascularization (TLR) in patients with in-stent restenosis (ISR) treated with drug-eluting balloons (DEBs).Background: DEBs have become an emerging therapeutic option for ISR. We report the results of a single-center retrospective study on the treatment of ISR with DEB.Methods: 94 consecutive patients with ISR treated with the paclitaxel-eluting balloon were retrospectively studied between August 2011 and December 2019.Results: The one-year MACE rate was 11.8%, and the five-year MACE rate was 39.8%. The one-year mortality was 5.3%, and the five-year mortality rate was 21.5%. The one-year TLR rate was 4.3%, and the five-year rate was 18.7%. The univariable-Cox proportional hazard models for TLR showed lesion length, and the number of DEBs per vessel is associated with adverse outcomes with H.R. of 1.038 (1.007-1.069) and 4.7 (1.6-13.8), respectively.Conclusion: Our data indicate that at one year, DEBs provide an effective alternative to stenting for in-stent restenosis. Our five-year data, representing one of the longest-term follow-ups of DEB use, demonstrate high rates of MACE. The high five-year MACE reflects all-cause mortality in a high-risk population. This is offset by a reasonable five-year rate of TLR, indicating that DEB provides both short-term and long-term benefits in ISR. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) increases the risk of adverse outcomes in acute coronary syndrome (ACS). The optimal regimen of dual antiplatelet therapy (DAPT) post-percutaneous coronary intervention (PCI) in CKD poses a challenge due to the increased bleeding and clotting tendencies, particularly since patients with CKD were underrepresented in randomized controlled trials. We examined the practice patterns of DAPT prescription stratified by the presence of CKD. The multicentre prospective Canadian Observational Antiplatelet Study (COAPT) enrolled patients with ACS between December 2011 and May 2013. The present study is a subgroup analysis comparing type and duration of DAPT and associated outcomes among patients with and without CKD (eGFR < 60 ml/min/1.73 m2, calculated by CKD-EPI). Patients with CKD (275/1921, 14.3%) were prescribed prasugrel/ticagrelor less (18.5% vs 25.8%, p = 0.01) and had a shorter duration of DAPT therapy versus patients without CKD (median 382 vs 402 days, p = 0.003). CKD was associated with major adverse cardiovascular events (MACE) at 12 months (p < 0.001) but not bleeding when compared to patients without CKD. CKD was associated with MACE in both patients on prasugrel/ticagrelor (p = 0.017) and those on clopidogrel (p < 0.001) (p for heterogeneity = 0.70). CKD was associated with increased bleeding only among patients receiving prasugrel/ticagrelor (p = 0.007), but not among those receiving clopidogrel (p = 0.64) (p for heterogeneity = 0.036). Patients with CKD had a shorter DAPT duration and were less frequently prescribed potent P2Y12 inhibitors than patients without CKD. Overall, compared with patients without CKD, patients with CKD had higher rates of MACE and similar bleeding rates. However, among those prescribed more potent P2Y12 inhibitors, CKD was associated with more bleeding than those without CKD. Further studies are needed to better define the benefit/risk evaluation, and establish a more tailored and evidence-based DAPT regimen for this high-risk patient group. [ABSTRACT FROM AUTHOR]

• Fe 2 N/rGO composites are obtained by altering the nitriding time. • The optimal Fe 2 N/rGO-2h composite exhibit capacity of 603 mAh g 1 after 500 cycles. • A fading rate of only 0.014% is retained at a current density of 0.1 A g 1. • The superior cyclability is due to flexible rGO framework and firm synergy with Fe 2 N. • This work can offer new insight to expand metal nitride as high efficacy electrode. [Display omitted] Fe 2 N decorated on reduced graphene oxide (rGO) was prepared by a hydrothermal reaction and the effect of nitridation time was studied concerning the lithium-ion battery (LIB) performance of Fe 2 N/rGO composites. The reversible capacity of as-prepared electrodes was evaluated at currents starting from 0.05 A g 1 and up to 2 A g 1 with the highest capacity demonstrated by the Fe 2 N/rGO sample subjected to a nitriding time of 2 h. Moreover, at 0.1 A g 1 the specific capacity fading was observed to be merely 0.014% per cycle from 120 to 500 cycles. The CV studies demonstrated that good electrochemical performance was due to a smaller peak to peak separation and higher peak currents which agreed well with the lower mass and charge transfer resistance obtained from the EIS results. The conductive graphene network facilitated in Li+-ion diffusion process and fast charge transfer reactions while mesoporous Fe 2 N helped in proper penetration of electrolyte and providing abundant sites for intercalation/deintercalation. The Fe 2 N/rGO-2h electrode prepared in this work overcame the stability issues and large polarization of usual metal nitride electrodes making it a potential candidate for LIB anode. [ABSTRACT FROM AUTHOR]

BACKGROUND & OBJECTIVE: Treatments for ureteral calculi evolve, over the past decades from open ureterolithotomy to minimally invasive procedures. Objective of this study is to compare the efficacy of pneumatic versus laser lithotripsy in ureteric stones. METHODOLGY: A RCT study was conducted in Department of Urology Sir Ganga Ram Hospital, Lahore from 1st March 2018 to 31st August 2018. Patients were divided into two groups. In group A, 2 Fr pneumatic probe was used for pneumatic lithotripsy, while in group B, 550 μm fiber probe was used for laser lithotripsy. RESULTS: Efficacy of Group A (pneumatic lithotripsy) was seen in 57 (77.63%) patients while in Group B (laser lithotripsy) was seen in 71 (93.42%) patients with p-value of 0.006 CONCLUSION: Laser lithotripsy in ureteric stones is better as compared to pneumatic lithotripsy.

We propose to perform wearable sensors-based human physical activity recognition. This is further extended to an Internet-of-Things (IoT) platform which is based on a web-based application that integrates wearable sensors, smartphones, and activity recognition. To this end, a smartphone collects the data from wearable sensors and sends it to the server for processing and recognition of the physical activity. We collect a novel data set of 13 physical activities performed both indoor and outdoor. The participants are from both the genders where their number per activity varies. During these activities, the wearable sensors measure various body parameters via accelerometers, gyroscope, magnetometers, pressure, and temperature. These measurements and their statistical are then represented in features vectors that used to train and test supervised machine learning algorithms (classifiers) for activity recognition. On the given data set, we evaluate a number of widely known classifiers such random forests, support vector machine, and many others using the WEKA machine learning suite. Using the default settings of these classifiers in WEKA, we attain the highest overall classification accuracy of 90%. Consequently, such a recognition rate is encouraging, reliable, and effective to be used in the proposed platform.

The gut microbiota is important in regulating host metabolism, maintaining physiology, and protecting immune homeostasis. Gut microbiota dysbiosis affects the development of the gut microenvironment, as well as the onset of various external systemic diseases and metabolic syndromes. Cyclophosphamide (CTX) is a commonly used chemotherapeutic drug that suppresses the host immune system, intestinal mucosa inflammation, and dysbiosis of the intestinal flora. Immunomodulators are necessary to enhance the immune system and prevent homeostasis disbalance and cytotoxicity caused by CTX. In this study, shrimp peptide hydrolysate (SPH) was evaluated for immunomodulation, intestinal integration, and microbiota in CTX-induced immunosuppressed mice. It was observed that SPH would significantly restore goblet cells and intestinal mucosa integrity, modulate the immune system, and increase relative expression of mRNA and tight-junction associated proteins (Occludin, Zo-1, Claudin-1, and Mucin-2). It also improved gut flora and restored the intestinal microbiota ecological balance by removing harmful microbes of various taxonomic groups. This would also increase the immune organs index, serum levels of cytokines (IFN-ϒ, IL1β, TNF-α, IL-6), and immunoglobin levels (IgA, IgM). The Firmicutes/Bacteroidetes proportion was decreased in CTX-induced mice. Finally, SPH would be recommended as a functional food source with a modulatory effect not only on intestinal microbiota, but also as a potential health-promoting immune function regulator.

Canola (Brassica napus L.) meal is a by-product after oil extraction from canola seed and is of relatively low value. This meal may have additional value in the biotechnology, food, and pharmaceutical industries if health-promoting useful bioactive compounds can be identified. Hence, seven canola meal extracts (CMEs) were generated using different organic solvents for two genotypes. HPLC and LCMS analyses were employed for the determination of the phenolic and antioxidant activity of meal extracts, including recovery of major biological compounds. When comparing genotype-1 with genotype-2, the latter had higher antioxidant activity in acetone extract (AE). This study also indicated seven major glucosinolates in CMEs in which water (WE) appeared to be the best solvent for the recovery of glucosinolates. Higher quantities of phenolic, glucosinolate, and antioxidant were present in genotype-2 compared with genotype-1. Using HPLC-DAD and LC-MS analysis 47 compounds were detected. We could identify 32 compounds in canola meal extracts: nine glucosinolates and twenty-three phenolic derivatives. Phenolic compounds in canola meal were conjugates and derivatives of hydroxycinnamic acid (sinapic, ferulic, and caffeic acids). Among phenolics, kaempherol as conjugate with sinapic acid was found; sinapine and trans-sinapic acid were the most abundant, as well as major contributors to the antioxidant and free radical scavenging activities of canola meal extracts. Some samples exhibited mild to moderate in-vitro antidiabetic activity in a Dipeptidyl Peptidase-IV inhibition assay.

Litchi (Litchi chinensis Sonn.) is a sub-tropical fruit having sweet, juicy and soft pulp with an attractive bright red peel. Garnered litchi fruit is highly perishable and bright red colour of the peel turns dull brown within 24 to 48 hours of harvesting at room temperature. Current study was conducted at Food Technology Section, Ayub Agricultural Research Institute, Faisalabad during 2019. The present study was intended to check whether different organic acids could potentially be applied for slowing down the pericarp browning in litchi fruit as acidic pH could be beneficial in retarding the polyphenol oxidase and peroxidase activities and maintaining the quality during storage. Lowest PPO and POD activity at the start and end of storage time was recorded in fruit samples treated with 10% oxalic acid (0.5 & 0.25 unit/mg protein and 3 and 1 unit/mg protein). Oxalic acid in 10% concentration proved best for maintaining quality parameters (acidity, firmness, ascorbic acid, total and reducing sugars, total soluble solids) during storage among all the tested organic acids and their concentrations. The information generated could be further explored for the metabolic process underlying the slowing of browning of the pericarp. [ABSTRACT FROM AUTHOR]

Valorization of vegetable oil waste residues is gaining importance due to their high protein and polyphenol contents. Protease inhibitors (PIs), proteins from these abundantly available waste residues, have recently gained importance in treating chronic diseases. This research aimed to use canola meal of genetically diverse Brassica napus genotypes, BLN-3347 and Rivette, to identify PIs with diverse functionalities in therapeutic and pharmacological applications. The canola meal PI purification steps involved: native PAGE and trypsin inhibition activity, followed by ammonium sulfate fractionation, anion exchange, gel filtration, and reverse-phase chromatography. The purified PI preparations were characterized using SDS-PAGE, isoelectric focusing (IEF), and N terminal sequencing. SDS-PAGE analysis of PI preparations under native reducing and nonreducing conditions revealed three polymorphic PIs in each genotype. The corresponding IEF of the genotype BLN-3347, exhibited three acidic isoforms with isoelectric points (pI) of 4.6, 4.0, and 3.9, while Rivette possessed three isoforms, exhibiting two basic forms of pI 8.65 and 9.9, and one acidic of pI 6.55. Purified PI preparations from both the genotypes displayed dipeptidyl peptidase-IV (DPP-IV) and angiotensin-converting enzyme (ACE) inhibition activities; the BLN-3347 PI preparation exhibited a strong inhibitory effect with lower IC50 values (DPP-IV 37.42 µg/mL; ACE 129 µg/mL) than that from Rivette (DPP-IV 67.97 µg/mL; ACE 376.2 µg/mL). In addition to potential human therapy, these highly polymorphic PIs, which can inhibit damaging serine proteases secreted by canola plant pathogens, have the potential to be used by canola plant breeders to seek qualitative trait locus (QTLs) linked to genes conferring resistance to canola diseases.

Background: Dengue fever (DF) has become a major public health concern globally. It is an infection caused by a virus of the family Flaviviridae, with five serotypes (DENV 1–5). Recent years have seen an increase in the preva­lence of the disease in Pakistan. The current study was carried out to evaluate the clinical features, laboratory find­ings and demographic information of the patients reported during the dengue outbreak in Multan of Pakistan in 2015. Methods: The hospital documentation-based data of confirmed DF cases were collected for the 6 months period from a Tertiary Care Hospital in Multan, Pakistan. The patients were labeled as confirmed on the basis of NS1 and IgM positivity by ELISA. The data collected were analyzed using SPSS. Results: Overall, 361 patients were investigated (78.67% males and 21.33% females), with maximum infection rate in the age group of 18–35yr (50.41%). Mean hospital stay was 2.64d (SD 1.2), while mean fever duration was 5.27 (SD 1.57). Outbreak occurred during the months from Jul–Dec, while maximum patients were reported in Oct (287). No mortality was reported, and all patients recovered. Conclusion: Better management practices and timely reporting can reduce the risk factors associated with the dis­ease.

We assume Bistatic Phase Multiple Input Multiple Output radar having passive Centrosymmetric Cross Shape Sensor Array (CSCA) on its receiver. Let the transmitter of this Bistatic radar send coherent signals using a subarray that gives a fairly wide beam with a large solid angle so as to cover up any potential relevant target in the near field. We developed Heuristic Computational Intelligence (HCI) based techniques to jointly estimate the range, amplitude, and elevation and azimuth angles of these multiple targets impinging on the CSCA. In this connection, first the global search optimizers, that is,are developed separately Particle Swarm Optimization (PSO) and Differential Evolution (DE) are developed separately, and, to enhance the performances further, both of them are hybridized with a local search optimizer called Active Set Algorithm (ASA). Initially, the performance of PSO, DE, PSO hybridized with ASA, and DE hybridized with ASA are compared with each other and then with some traditional techniques available in literature using root mean square error (RMSE) as figure of merit.

Canola oil and vitamin A were evaluated for their effects on egg characteristics, egg cholesterol and egg triglycerides (TG) in laying hens prone to heat-stress during summer months. Four levels of canola oil (0, 2, 3 and 4% of diet) in combination with two levels of vitamin A (3,000 or 10,000 IU/kg of diet) were fed to laying hens for a period of 12 weeks. Various egg-quality parameters were measured on weekly basis while, serum TG, egg cholesterol and TG contents were analyzed during the last week of the trial. The results of the study showed that the egg weight, egg mass, yolk weight, Haugh unit score, shell thickness, shell weight and egg breaking- strength were similar (P>0.05) for all canola oil levels supplemented to the laying hens. Higher egg weight and egg mass (P<0.05) were noted for the hens at the diet with 10,000 IU vitamin A /kg of diet whereas, all other egg characteristics were not influenced by increasing the supplemental level of vitamin A. Serum TG, egg cholesterol and TG contents were not changed (P>0.05) by increasing canola oil or vitamin A levels in the diet of laying hens. It might be concluded from the results of the present study that canola oil as a source of omega-3 fatty acids can be included in the diet of laying hens without compromising the quality characteristics of the eggs. [ABSTRACT FROM AUTHOR]

• Cobalt doped anatase photoanode for DSSC. • Optimized conversion efficiency. • Enhancement in charge transfer properties. • Synergetic role of rGO and transition metal. In dye-sensitized solar cells (DSSCs), TiO 2 has long been a popular electron transport material for carrying photo-generated electrons from the dye to the outer circuit. However, increasing the electrical conductivity of TiO 2 while preserving its properties is one of the most significant challenges for increasing DSSC efficiency. Here, cobalt-reduced graphene oxide co-doped TiO 2 nanoparticles were synthesized by a modified sol-gel procfess that together controlled the particle size as well as narrowed bandgap of nanoparticles as determined by XRD and UV-Vis absorption measurements. The SEM and TEM were used to perform in-depth morphological characterization of the newly synthesized nanocomposites while J-V (current-voltage) curves, EIS Nyquist curves, and incident photon to current conversion efficiency (IPCE) spectra were used to examine the photovoltaic parameters. Enhanced short circuit current density (J sc 12.83 mA cm−2), open-circuit voltage (V oc 0.618 V) and overall power conversion efficiency (PCE, η = 5.24%) of DSSC was obtained with Co/rGO co-doped TiO 2 based photoanode in comparison to bare TiO 2 (η = 3.71%), cobalt doped TiO 2 (η = 4.09%) and rGO doped TiO 2 (η = 4.43%) based DSSCs. Huge improvement in efficiency, 41% higher PEC in Co/rGO co-doped TiO 2 , was attributed to better utilization of visible radiations, greater dye adsorption and enhancement in charge transfer properties by suppressing the electron transport resistances. The incorporation of rGO improved electron transfer, which compensated for recombination losses, thereby increasing the DSSC's J sc. The synergetic role of rGO and transition metal helped in keeping the structure intact in the nano-assembly that enhance the photo-generated carriers. [ABSTRACT FROM AUTHOR]

Introduction: The objectives of this study were to evaluate the prognostic impact of pre-referral surgical resection of Wilms tumor (WT) performed at non-oncology centers, and to strategize an improved care plan for this very curable pediatric tumor., Methods: In this study conducted in a large pediatric cancer center in Pakistan, we retrospectively reviewed the electronic medical records (EMR) of 149 patients with unilateral WT from September 2008 to August 2017. Based on treatment approach, patients were categorized into two groups: (i) pre-referral tumor resection (PTR: n = 75), and (ii) post-neoadjuvant chemo nephrectomy (PCN: n = 74)., Results: The proportion of metastatic disease in PTR and PCN groups was 33.3% and 35.1%, respectively. In the PTR subset, median time to admission after PTR was 5 weeks (mean 11, SEM 2.8, range: 2-202) weeks, with 53.3% (n = 40) presenting more than 4 weeks after PTR. Twenty patients had no cross-sectional imaging prior to PTR and underwent surgery after abdominal ultrasound only. On baseline imaging at our center, 58.7% (n = 44) of the PTR group had radiologically evaluable disease (four metastases only, 19 local residual tumor only, 21 both localized tumor and visible metastases). Disease staging was uncertain in 23 patients because of no or inadequate histology specimens and/or lymph node sampling in patients with no evaluable disease. Statistically significant differences were recorded for the two subsets regarding tumor volume, extent and nodularity, renal vein and renal sinus involvement, lymph node status, tumor rupture and histopathologic features, and tumor stage, with a 10-year event-free survival (EFS) for PCN and PTR of 74.3% and 50.7%, respectively (p < .001). In the PTR group, EFS for those presenting within 4 weeks and later was 91.4% versus 15.0%, respectively (p < .0001)., Conclusion: Suboptimal pre-referral surgical intervention results in poor survival outcomes in unilateral WT. Our findings highlight the need for a comprehensive action plan for educating healthcare professionals engaged in WT diagnosis and referral process. PCN in a multidisciplinary team approach can reduce surgical morbidity and seems to be a better strategy to improve the survival rates in low-resource settings., (© 2023 Wiley Periodicals LLC.)

68 Ga-DOTATATE PET/CT is widely used for the evaluation of neuroendocrine tumors. Some reports exist on its use in the management of neuroblastoma. Building on the prior reports as well as our previous experience in using this technique for initial staging, we propose to describe its practical benefits in restaging and response to therapy. We describe different aspects including supply logistics, preparation, spatial resolution, and other practical applications. Methods: We reviewed the medical records for 8 patients who were evaluated with 68 Ga-DOTATATE PET/CT at our institution over 2 y. A note was made of the patient and disease characteristics and the indication for PET imaging, and the results were retrospectively analyzed for feasibility, logistics, radiation exposure, and utility in answering the clinical question. Results: Eight children (5 girls and 3 boys; age range, 4-60 mo; median age, 30 mo) diagnosed with neuroblastoma were imaged with 68 Ga-DOTATATE PET/CT and 5 with 123 I-metaiodobenzylguanidine ( 123 I-MIBG) SPECT/CT over 2 y. Three 68 Ga-DOTATATE PET scans were done for staging, 10 for response evaluation, and 2 for restaging. 68 Ga-DOTATATE PET accurately identified neuroblastoma lesions suspected or seen on anatomic imaging. It has been shown to be more specific and more sensitive than 123 I-MIBG and at times also MRI. It had better spatial and contrast resolution than 123 I-MIBG. 68 Ga-DOTATATE PET was better than 123 I-MIBG SPECT/CT, CT, and MRI in the detection of early progression and viable tumor delineation for response assessment, as well as in target volume definition for external-beam radiotherapy and proton-beam radiotherapy. 68 Ga-DOTATATE PET was also better at assessing bony and bone marrow disease changes with time. Conclusion: 68 Ga-DOTATATE PET/CT offers added value and a superior edge to other imaging modalities in restaging and response assessment in neuroblastoma patients. Further multicenter evaluations in larger cohorts are needed., (© 2023 by the Society of Nuclear Medicine and Molecular Imaging.)

Background: Wilms Tumor (WT) is one of the most curable childhood cancers. High cure rates seen in the developed countries are not reproduced in developing countries. Lack of access to cancer treatment facilities, financial constraints, late presentation, and abandonment have previously been described. We reviewed our data over the last 20 years to highlight some of these challenges., Methods: This is a retrospective chart review of children with WT at our center up to the age of 18 years between 1 November 1997 and 30 November 2017. Demographic details, presentation characteristics and treatment details were recorded. Factors associated with poor outcome were analyzed., Results: Two hundred eleven children were registered; 117(55.5%) were males. Median age at presentation was 3 (range 0 to 18) years. Presentation data were available for 184/211 patients, staging details for 159/211 and metastatic status for 178/211. Of the available dataset, 60% presented without prior treatment, whereas 40% presented atleast after primary surgical excision. High-stage (stage III or above) disease was present in 79 (49.7%) patients; 61 (34.3%) was presented with metastases or recurrence; 63 (29.8%) abandoned or refused treatment; 99/172 (57.6%) patients finished treatment, 23 (13.4%) died during treatment, and 6 died before treatment. Of the 99 patients who finished treatment 83 (83.8%) are well off therapy; 15(15.2%) relapsed; 6 (40%) are alive after salvage therapy, while 9 (60%) died., Conclusions: Our data highlights the challenges of managing WT in resource poor environments. Prior surgery, incomplete staging work-up and abandonment are some of the most frequently encountered barriers. A multipronged approach is required to overcome these challenges., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Low- and middle-income countries sustain the majority of pediatric cancer burden, with significantly poorer survival rates compared to high-income countries. Collaboration between institutions in low- and middle-income countries and high-income countries is one of the ways to improve cancer outcomes., Methods: Patient characteristics and effects of a pediatric neuro-oncology twinning program between the Hospital for Sick Children in Toronto, Canada and several hospitals in Karachi, Pakistan over 7 years are described in this article., Results: A total of 460 patients were included in the study. The most common primary central nervous system tumors were low-grade gliomas (26.7%), followed by medulloblastomas (18%), high-grade gliomas (15%), ependymomas (11%), and craniopharyngiomas (11.7%). Changes to the proposed management plans were made in consultation with expert physicians from the Hospital for Sick Children in Toronto, Canada. On average, 24% of the discussed cases required a change in the original management plan over the course of the twinning program. However, a decreasing trend in change in management plans was observed, from 36% during the first 3.5 years to 16% in the last 3 years. This program also led to the launch of a national pediatric neuro-oncology telemedicine program in Pakistan., Conclusions: Multidisciplinary and collaborative efforts by experts from across the world have aided in the correct diagnosis and treatment of children with brain tumors and helped establish local treatment protocols. This experience may be a model for other low- and middle-income countries that are planning on creating similar programs., (© 2022 Wiley Periodicals LLC.)

Although MRI is the workhorse of brain tumor initial evaluation and follow-up, there is a growing amount of data recommending the incorporation of amino-acid PET imaging at different stages of the management of these patients. Recent nuclear medicine and neuro-oncology clinical practice recommendations support the use of amino-acid imaging in brain tumor imaging. Considering 18 F-DOPA is FDA approved for the evaluation of parkinsonian syndromes, it could be used clinically for other valuable clinical indications such as brain tumor evaluations. This value seems to be well established in adults and has growing evidence for its use in pediatrics as well. We offer to present four pediatric brain tumor cases imaged with 18 F-DOPA and review the literature., (Copyright © 2022 by the Society of Nuclear Medicine and Molecular Imaging, Inc.)

Background: The disposition of patients presenting with ST-elevation myocardial infarction (STEMI) is commonly the coronary care unit. Recent studies have suggested that low-risk STEMI patients could be managed in a lower-acuity setting immediately after percutaneous coronary intervention (PCI). We sought to determine the frequency of downstream intensive-care therapy used in our "stable" STEMI patients post-PCI., Methods: A single-centre, retrospective review was completed of consecutive patients who underwent primary PCI for STEMI between 2013 and 2016. Post-PCI, patients were defined as being stable if they had not required intensive-care therapy or suffered significant complications. Intensive-care therapies and complications were defined as invasive/noninvasive ventilation, pacing, cardiac arrest, use of vasopressors/inotropes, dialysis, stroke, or major bleeding. This group of stable patients had their course followed to discharge., Results: A total of 731 patients presented with STEMI for primary PCI. Of these, 132 patients (18%) required intensive-care therapies and/or had complications prior to PCI and were excluded. After PCI, 599 STEMI patients (82%) were defined as stable, according to the above definition. Of these, 11 patients (1.8%) required intensive-care therapies during their hospitalization. Zwolle scores were significantly higher in patients with complications (6.3 ± 4.4 vs 2.0 ± 1.5, P < 0.0001). The most frequent intensive-care complications and therapies were cardiac arrest (7 patients, 1%) and vasopressor use (4 patients, 0.7%). These complications most frequently occurred on the first admission day (6 patients, 1%)., Conclusions: Patients who are stable at the completion of their primary PCI rarely develop complications that require intensive care. These patients are easily identified for triage to a lower-acuity setting, alleviating congestion in cardiac care units and reducing hospitalization costs., (© 2022 The Authors.)

Metaiodobenzylguanidine (MIBG) imaging has been the standard for neuroblastoma staging for many decades. Novel agents such as 18 F-DOPA and 68 Ga-DOTATATE are being used nowadays in academic centers. During the coronavirus disease 2019 (COVID-19) pandemic, procurement of 123 I-MIBG has proved particularly challenging, necessitating the use of 68 Ga-DOTATATE PET. 68 Ga-DOTATATE is Food and Drug Administration-approved for imaging of somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumors. Methods: 68 Ga-DOTATATE PET/CT imaging was performed for staging of 3 pediatric patients with neuroblastoma at our institution. A review of the literature was also completed. Results: 68 Ga-DOTATATE PET/CT scans were successfully performed on all patients. All patients showed 68 Ga-DOTATATE-avid disease. PET scans showed an excellent spatial resolution and demonstrated high accuracy in concordance with current European Association of Nuclear Medicine guidelines. Conclusion: We have presented 68 Ga-DOTATATE PET/CT imaging for staging of neuroblastoma and believe it can reliably be used as an alternative to 123 I-MIBG. It has technical, clinical, and practical advantages making it an attractive option. Further multicenter studies are required before it can be recommended for standard clinical use., (© 2021 by the Society of Nuclear Medicine and Molecular Imaging.)

Background: Acute kidney injury (AKI) complicating primary percutaneous coronary intervention (PCI) is an independent predictor of short- and long-term outcomes in patients presenting with ST-elevation myocardial infarction (STEMI). Prior studies suggest a lower incidence of AKI in patients undergoing PCI through radial artery compared to femoral artery access; however, no randomized clinical trials have specifically investigated this question in patients presenting with STEMI., Methods: To determine whether radial access (RA) is associated with a reduced frequency of AKI following primary PCI, we performed a substudy of the SAFARI-STEMI trial. The SAFARI-STEMI trial was an open-label, multicenter trial, which randomized patients presenting with STEMI to RA or femoral access (FA), between July 2011 and December 2018. The primary outcome of this post hoc analysis was the incidence of AKI, defined as an absolute (>0.5 mg/dL) or relative (>25%) increase in serum creatinine from baseline., Results: In total 2,285 (99.3%) of the patients enrolled in SAFARI-STEMI were included in the analysis-1,132 RA and 1,153 FA. AKI occurred in 243 (21.5%) RA patients and 226 (19.6%) FA patients (RR: 0.91, 95% CI: 0.78-1.07, P = .27). An absolute increase in serum creatinine >0.5 mg/dL was seen in 49 (4.3%) radial and 52 (4.5%) femoral patients (RR: 1.04, 95% CI: 0.71-1.53, P = .83). AKI was lower in both groups when the KDIGO definition was applied (RA 11.9% vs FA 10.8%; RR: 0.90, 95% CI: 0.72-1.13, P = .38)., Conclusions: Among STEMI patients enrolled in the SAFARI-STEMI trial, there was no association between catheterization access site and AKI, irrespective of the definition applied. These results challenge the independent association between catheterization access site and AKI noted in prior investigations., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: To determine outcome of first relapse of Hodgkin lymphoma with standard dose chemotherapy, and to identify the prognostic factors predicting survival outcome in paediatric patients., Methods: The retrospective study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised data of Hodgkin lymphoma patients who relapsed at least 3 months after the completion of initial treatment from January 2001 to December 2010. Probabilities of overall survival, event-free survival and cumulative incidence were calculated. Data was analysed using SPSS 21., Results: Of the 43 patients, 31(72%) were males and 12(29%) were females. Mean age at relapse was 11±3.3 years (range: 4-17 years). In 31(72%) patients, early post-operative intraperitoneal chemotherapy was employed. Median follow-up of the cohort was 62 months (interquartile range: 4-187 months). Overall survival and event-free survival at 10 years was 23(54%) and 15(35%) respectively. On univariate analysis, initial disease stage (p=0.021), stage at relapse (p=0.003), treatment protocol (p=0.005), treatment responsiveness at initial two cycles of salvage chemotherapy (p=0.002) and at the end of treatment assessment (p=0.0009) were statistically significant factors. Multivariate cox regression analysis revealed disease stage at relapse (p=0.004), chemotherapy regimen (p=0.025) and end-of-treatment disease evaluation (p=0.005) as the significant variables., Conclusions: Improved outcome with early post-operative intraperitoneal chemotherapy regimen was noted for Hodgkin lymphoma patients who had disease-free interval >2 years.

Anodes derived from SnO 2 offer a greater specific capacity comparative to graphitic carbon in lithium-ion batteries (LIBs); hence, it is imperative to find a simple but effective approach for the fabrication of SnO 2 . The intelligent surfacing of transition metal oxides is one of the favorite strategies to dramatically boost cycling efficiency, and currently most work is primarily aimed at coating and/or compositing with carbon-based materials. Such coating materials, however, face major challenges, including tedious processing and low capacity. This study successfully reports a new and simple WO 3 coating to produce a core-shell structure on the surface of SnO 2 . The empty space permitted natural expansion for the SnO 2 nanostructures, retaining a higher specific capacity for over 100 cycles that did not appear in the pristine SnO 2 without WO 3 shell. Using WO 3 -protected SnO 2 nanoparticles as anode, a coin half-cell battery was designed with Li-foil as counter-electrode. Furthermore, the anode was paired with commercial LiFePO 4 as cathode for a coin-type full cell and tested for lithium storage performance. The WO 3 shell proved to be an effective and strong enhancer for both current rate and specific capacity of SnO 2 nanoarchitectures; additionally, an enhancement of cyclic stability was achieved. The findings demonstrate that the WO 3 can be used for the improvement of cyclic characteristics of other metal oxide materials as a new coating material., (© 2020 Wiley-VCH GmbH.)

Cancer is an evolving cause of morbidity and mortality in children worldwide. In recent decades, there has been a significant increase in the survival of children with cancer, after applying new methods and treatment protocols in practice. However, the complexity of the disease itself, as well as the intensity and toxicity of treatment is such that many children require admission to the pediatric intensive care unit (PICU) which should be well equipped and led by personnel who have adequate training and expertise to provide optimum care to these complex patients. Most oncology patients who require PICU admission categorized into oncological emergencies, and/or decompensation from treatment and its side effects. In this study, we provide a summary of the essential and most recent evidence-based recommendations from published reviews and articles to aid PICU physicians and to ensure the best treatment and outcome possible for the children with such disease. How to cite this article: Al Haj Moussa A, Maaz AUR, Faqih N, Sundaram M. Critically Ill Pediatric Oncology Patients: What the Intensivist Needs to Know? Pediatric Critical Care Medicine. Indian J Crit Care Med 2020;24(12):1256-1263., Competing Interests: Source of support: Nil Conflict of interest: None, (Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.)

Objective The objective of this study is to find a correlation between internal jugular vein (IJV) and common carotid artery (CCA) diameter ratio and central venous pressure (CVP) measurement and find a cut-off value for the IJV/CCA ratio to predict low CVP i.e. < 10 cm H 2 0, for estimating the volume status in critically ill patients. Methods This prospective cross-sectional study was conducted at the critical care department of Shifa International Hospital, Islamabad, from July to December 2017. A sample of 49 patients ≥ 18 years with intrathoracic central venous catheters (CVCs) who underwent bedside sonographic assessments of IJV and CCA diameter were included in this study using convenient sampling. The IJV/CCA diameter ratio was calculated and correlated with CVP and the predictive value of the IJV/CCA diameter ratio to predict CVP < 10 cm H 2 O was explored by calculating the area under the receiver operating characteristic (ROC) curve, sensitivity, specificity, and positive and negative predictive values. Results A total of 49 patients, 30 males (61.2%) and 19 females (38.8%) with a mean age of 56.00±16.11 years were included in the study. The mean CVP was 8.98±2.37cm H 2 O in ventilated (51%) and 10.7± 6.01 cm H 2 O in non-ventilated (49%) patients. The mean IJV/CCA diameter ratio was 1.60±0.55 at expiration and 1.41±0.56 at inspiration. There was a significant correlation between the IJV/CCA diameter ratio and CVP at expiration (r=0.401, p=0.004). The correlation between IJV/CCA and CVP was significant in non-ventilated patients at expiration (r=0.439, p=0.032). The area under the ROC curve for the IJV/CCA diameter ratio for predicting CVP < 10 cm H 2 O was 0.684 (p=0.028). The predictive value of the IJV/CCA diameter ratio for CVP < 10 cm H 2 0 at the cutoff value of < 2 was insignificant. A new cut-off < 1.75 was taken for the IJV/CCA diameter ratio from the coordinates of the ROC curve. The sensitivity, specificity, PPV, and NPV of an IJV/CCA diameter ratio of < 1.75 for predicting a CVP < 10 cm H 2 0 were 84.62%, 52.17%, 66.67%, and 75.00%, respectively. Conclusion The assessment of volume status by the IJV/CCA diameter ratio with a sonographic device may be a useful noninvasive alternative for a central venous catheterization with a cut-off < 1.75., Competing Interests: The authors have declared that no competing interests exist.

Background: Most common malignant tumour of the kidney is Renal Cell Carcinoma (RCC) and is known for its unpredictable clinical behaviour. Aetiology and risk factors are not completely understood. Extensive workup is being done in the understanding of the disease, especially to diagnose early and to treat promptly. The objective of this study was to determine the clinical presentation and pathological pattern of RCC., Methods: After approval from ethical committee a retrospective review of records was conducted extending from January 2012 to January 2014 to identify clinical characteristics of renal cell carcinomas. The study included all renal cancer patients presented to Sheikh Zayed Hospital Lahore with in this specified period. The data was retrieved regarding, history, physical examination and necessary investigations such as ultrasonsgraphy of abdomen and pelvis and CT scan of abdomen and pelvis., Results: There were total of 50 cases. The male to female ratio was 3:2. Mean age of patients were 52.38 (18-93) years old. Most common clinical presentation was gross haematuria (66%).The mean tumour size was 8.34 (3-24) cm. Tumour histology were clear cell (84%), papillary transitional cell carcinoma (12%) and oncosytoma contributed 4%., Conclusion: We observed that large number of the patients with RCC presented with haematuria and most of them were male. Common pathological type was clear cell carcinoma.

Drug coated stents have reduced the incidence of in-stent restenosis with coronary intervention. Whether this effect is long lasting or just delaying the process is not clear. We report here a case of late in-stent restenosis with Rapamycin drug eluting stent.

Objective: To determine the pattern of excretion of total bilirubin IXa and IXb in the first meconium of newborn infants., Methods: First two newborns of varying gestational age were selected every week through random sampling from the neonatal unit. Of the 41 newborn infants selected 8 expired before meconium passage, hence the results are from 33 newborns. Meconium was collected and stored at -20 degrees C, protected by aluminium foil. Samples were defrosted, vortex mixed with equal amount of dimethyl-sulfoxide, centrifuged, and analyzed by HPLC., Results: Unconjugated Bilirubin-IXalpha and -IXbeta were identified and quantitative estimation of Bilirubin-IXa done. Bilirubin-IXb was greater than 50% of the total, in the first meconium of the newborn. Amount of bilirubin excreted in meconium was 29.2 - 90.8 mg [0.051 - 0.155 mmol] per sample of meconium passed. Amount was 9.7 mg/ Kg of body weight in term newborn and 12 mg/kg in preterm., Conclusion: The amount of bilirubin -IXb decreases and bilirubin-IXa increases with increasing gestational age. Newborns with birth asphyxia (BA) had significantly greater quantity of bilirubin in meconium, compared to infants without BA.

A case of spontaneous multi-vessel coronary artery dissection in a young man, with markedly elevated serum homocysteine levels, is reported. The effects of elevated homocysteine levels on arterial endothelial function and possible plaque rupture leading to coronary dissection and acute coronary syndrome and / or sudden cardiac death are also discussed.

Objective: Clinical and echocardiographic features of significant pericardial effusion (PE) have been reported from the west. Currently there is lack of published data from this part of the world, we reviewed all consecutive cases of significant PE requiring echocardiographic assisted pericardiocentesis to analyze the clinical and echocardiographic features of these patients., Methods: Forty four consecutive patients who underwent echocardiography assisted pericardiocentesis at the Aga Khan University Hospital (AKUH) between January 1988 and May 2001" re included in this review., Results: Most common presenting symptoms were dyspnea (89%) and fever (36%). Elevated JVP and pulsus paradoxus were documented in 59% and 41% of patients respectively. Sinus tachycardia (75%) and low voltage (34%) were the most common ECG findings. Malignancy (45-51%) and tuberculosis (27%) were among the most frequent causes of PE. One patient died during echocardiography-assisted pericardiocentesis., Conclusion: The symptoms and physical findings of haemodynamically significant PE are frequently nonspecific. Transthoracic echocardiography is the gold standard for rapid and confirmatory diagnosis of PE and cardiac tamponade. The most common cause of PE was malignancy followed by tuberculosis. Pericardiocentesis under echocardiographic guidance is a safe and effective treatment for significant PE.

Myocardial infarction (MI) is considered to be the disease of the fifth and sixth decade as seen in the West but an earlier age incidence is not infrequently encountered in the South Asian population. However, occurrence of MI in the teen-age still remains a rare happening. We are reporting a case of a teenager, who suffered a myocardial infarction with cardiogenic shock and pulmonary edema on two separate occasions with ECG and biochemical evidence of myocardial infarction. An exercise stress test done in between the two episodes was negative at a workload of 13.5 METs. A coronary angiogram done after the second event revealed normal coronary arteries and a preserved left ventricular systolic and segmental function. Except for low HDL (high density lipoprotein) and mildly raised homocysteine levels, the patient did not have other conventional or novel risk factors for coronary artery disease.