Search

Background: Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) is quickly becoming a routine and effective means by which to treat degenerated bioprosthetic valves. A known complication of ViV-TAVI is patient-prosthesis mismatch, which substantially affects survival. Bioprosthetic valve fracture is a method by which to reduce the risk of patient-prosthesis mismatch and post–ViV-TAVI transvalvular gradients. This study sought to determine the safety and efficacy of post–ViV-TAVI bioprosthetic valve fracture. Methods: Patients with a history of surgical aortic valve replacement undergoing ViV-TAVI bioprosthetic valve fracture (N = 25) at the corresponding institution from 2015 to 2022 were cataloged for a retrospective analysis. The implanted transcatheter valves were Medtronic Evolut R, Evolut PRO, and Evolut PRO+. Gradients were assessed before and after implantation and after fracturing using transthoracic echocardiogram. Results: The mean left ventricular ejection fraction of patients who underwent fracturing was 55.04%. The average (SD) peak and mean (SD) transvalvular gradients before the intervention were 68.17 (19.09) mm Hg and 38.98 (14.37) mm Hg, respectively. After ViV-TAVI, the same gradients were reduced to 27.25 (12.27) mm Hg and 15.63 (6.47) mm Hg, respectively. After bioprosthetic valve fracture, the gradients further decreased to 17.59 (7.93) mm Hg and 8.860 (3.334) mm Hg, respectively. The average reduction in peak gradient associated with fracturing was 12.07 mm Hg (95% CI, 5.73-18.41 mm Hg; P = .001). The average reduction in mean gradient associated with valve fracturing was 6.97 mm Hg (95% CI, 3.99-9.74 mm Hg; P < .001). Conclusion: Bioprosthetic valve fracture is a viable option for reducing residual transvalvular gradients after ViV-TAVI and should be considered in patients with elevated gradients (>20 mm Hg) or with concern for patient-prosthesis mismatch in patients who have an unacceptable risk for a redo sternotomy and surgical aortic valve replacement.

Abstract Background Eosinophilic gastroenteritis is a rare disease characterized by eosinophilic infiltration into one or more layers of the gastrointestinal tract. It commonly affects children more than adults. The clinical features depend on the site of gut involvement, but the most common symptoms include abdominal pain and diarrhea. The most common cause reported in the literature is hypersensitivity, as many patients have a history of seasonal allergies, atopy, asthma, food allergies, and so on. However, drugs can be a rare triggering factor. In the literature review, we found multiple case reports of eosinophilic gastroenteritis; however, only one other case of carbimazole-induced eosinophilic gastritis has been reported. Case presentation We report herein the case of a 36-year-old female from the Philippines who developed eosinophilic gastroenteritis localized to the esophagus and ileum 12 months following treatment with carbimazole for hyperthyroidism. In our facility, she was extensively investigated for malignancy, autoimmune pathologies and infectious etiologies. As the symptoms coincided with carbimazole exposure and other causes were ruled out, we labeled her as carbimazole-induced eosinophilic gastroenteritis. On subsequent follow-up after discharge, her symptoms and eosinophilia resolved when carbimazole was discontinued, suggesting a causative role. This is the first case of eosinophilic gastroenteritis secondary to carbimazole encountered in our region. Conclusion Diagnosis of eosinophilic gastroenteritis requires three criteria, namely (1) presence of gastrointestinal symptoms, (2) histologic evidence of eosinophilic infiltration in one or more areas of the gastrointestinal tract, and (3) exclusion of other causes of tissue eosinophilia. Our patient fulfilled all the criteria; additionally, she had a positive history of atopic tendencies and drug exposure. The diagnosis of hyperthyroidism was established a year ago and in another facility, so we were not sure of the underlying etiology of hyperthyroidism. Upon subsequent follow-up, her thyroid function remained stable. The case highlights the need for a collaborative multidisciplinary approach toward managing rare conditions.

The adaptive versions of charting tools are well-established statistical monitoring techniques for detecting unknown changes in the process over a range of shifts. A re-weighted adaptive CUSUM mean (RACUSUM) charting scheme has been proposed in this study for monitoring the range of shifts. The proposed RACUSUM statistic estimates the unknown changes in the ongoing process using an EWMA statistic by plugging in an unbiased shift estimator and choosing a suitable smoothing constant according to the estimated shift to update the slack value of the CUSUM statistic. By employing Monte Carlo simulation using the zero- and steady-state processes, the proposal’s run-length (RL) profiles have been calculated. The proposed RACUSUM chart shows more sensitive behavior under the shift delay process than in the case of zero-state. A comparative analysis between the proposal and competitors has been presented using average RL, extra quadratic loss (EQL), and the relative mean index (RMI) as metrics for 1-sided and 2-sided charting schemes. The robustness of the proposed 2-sided RACUSUM chart against non-normality has also been reported. The proposal’s applicability has been demonstrated using two cases, one from the artificial and the other from a dataset of piston ring manufacturing industrial process.

Background: Trans-cerebellar diameter (TCD) is a crucial fetal biometric parameter used in modern radiology to assess the progress of fetal growth which is vital for prosperous maternal and fetal well-being. Despite advances in ultrasound technology, the accurate measurement of fetal biometers continues to pose considerable challenges. TCD provides a more accurate gestational age, especially in late pregnancy when other parameters may be less reliable due to organic conditions. Aims and Objectives: The aim of this study was to evaluate the significance of TCD as a reliable biometric parameter in estimating gestational age and to measure the TCD in different gestational ages and establish a reference range. Assessing the correlation between TCD and other biometric parameters to that of gestational age. Materials and Methods: A cross-sectional study was conducted at SKIMS MCH Bemina, with 60 pregnant female participants recruited in the study, with consecutive purposive sampling used in the study. Consent was obtained with ethical clearance sought. The correlation between TCD, biparietal diameter (BPD), and crown-rump length (CRL) with gestational age was evaluated using the Statistical Package for the Social Sciences 24.0 to determine the strength of these relationships. Results: The study found strong correlations between fetal biometric measurements and gestational age: TCD (r=0.995), BPD (r=0.993), and CRL (r=0.988). A linear increase in BPD and CRL with increasing gestational age was observed, consistent with previous research the TCD was found particularly as a strong reliable parameter with a higher correlation for assessing fetal growth, especially in cases where other measurements may be less reliable. Conclusion: Findings suggest that TCD could be a valuable addition to standard fetal biometric measurements in clinical practice. The strong correlation between TCD and gestational age has pivotal implications for improving gestational age estimation. More research is needed to emphasize the use of TCD across many population samples and to explore its potential in fetal growth assessment.

Abstract This article presents a comprehensive benchmarking analysis of merit performance factors in the Effluent Treatment Plants (ETP) of the textile industry. The study aims to identify and evaluate key factors that contribute to the efficient operation and performance of ETPs. The performance of ETP was analyzed by valuable data gained from figures of PH, Dissolved oxygen, Dissolved solids, Suspended solids, Density, COD and BOD. The technical trends showed the deviations in the working conditions of Effluent Treatment Plant by variation in temperature. This variation is achieved by varying the settling time of wastewater in the sedimentation tank during the working process. The required dosing, plant efficiency and economic factors were taken into account. The Plant efficiency was determined to be 83.5% at normal conditions of water entering at temperature of 30°C and pressure of 1 atm along with addition of coagulants and flocculants in the wastewater. While the efficiency of the ETP plant was calculated about 88% using a Compact photometer at elevated conditions of temperature such as > 45°C, while at other temperatures the efficiency decreases significantly due to several reasons. The operating time of water treatment was decreased due to the variations in temperature of wastewater while other conditions kept constant like pressure, flow rates of water and chemicals (Polyacrylamide and Polymeric Ferric Sulfate). The usage of coagulants and flocculants at optimum conditions has been discussed in this study.

Ample of knowledge leads to positive attitude. Knowledge is an important tool that promotes attitude changes. Knowledge and Attitude of students towards safety is important because action of a person depends on believe. Unsafe actions of students are caused most of injuries and harms. It is important to minimize such harms by knowledge. Present study was conducted to find out the relationship between safety knowledge and attitude of students towards their safety. Study was quantitative in nature and researchers applied correlational research design. Sample of the study consisted of eighty-nine grade three students enrolled in government schools. Data were collected by self-constructed knowledge test for safety having 50 items and attitude scale for safety having 40 items mode of 5-point Likert type options. Content validity of self-constructed instruments was ensured from experts and Cronbach's Alpha reliability was censured in SPSS. Researchers personally collected data from respondents after ensuring ethical consideration prior to collect data. The data were analyzed by descriptive statistics and Pearson coefficient of correlation. The major findings of the study indicate that body safety, road safety, food safety, Internet safety, sports safety and fire safety knowledge strengthen the attitude towards safety. The results indicated that there was statistically significant relationship between knowledge and attitude about safety. On the basis of results, it is recommended that existing safety knowledge and attitude should be strengthening in school students in addition to their conventional education. Further researches may include research with male and female students at elementary and secondary level.

Diagnostic development must occur in parallel with drug development to ensure the longevity of new treatment compounds. Despite an increasing number of novel and repurposed anti-tuberculosis compounds and regimens, there remains a large number of drugs for which no rapid and accurate molecular diagnostic option exists. The lack of rapid drug susceptibility testing for linezolid, bedaquiline, clofazimine, the nitroimidazoles (i.e pretomanid and delamanid) and pyrazinamide at any level of the healthcare system compromises the effectiveness of current tuberculosis and drug-resistant tuberculosis treatment regimens. In the context of current WHO tuberculosis treatment guidelines as well as promising new regimens, we identify the key diagnostic gaps for initial and follow-on tests to diagnose emerging drug resistance and aid in regimen selection. Additionally, we comment on potential gene targets for inclusion in rapid molecular drug susceptibility assays and sequencing assays for novel and repurposed drug compounds currently prioritized in current regimens, and evaluate the feasibility of mutation detection given the design of existing technologies. Based on current knowledge, we also propose design priorities for next generation molecular assays to support triage of tuberculosis patients to appropriate and effective treatment regimens. We encourage assay developers to prioritize development of these key molecular assays and support the continued evolution, uptake, and utility of sequencing to build knowledge of tuberculosis resistance mechanisms and further inform rapid treatment decisions in order to curb resistance to critical drugs in current regimens and achieve End TB targets.Trial registration: ClinicalTrials.gov identifier: NCT05117788..

The higher dimensional Fokas equation is the integrable expansion of the Davey–Stewartson and Kadomtsev–Petviashvili equations. In wave theory, the Fokas model plays a crucial role in explaining the physical phenomena of waves both inside and outside of water. The (4+1)-dimensional fractional-order Fokas equation is the subject of this article. Two effective approaches are employed to obtain the solutions for the considered equation: the generalized auxiliary equation technique and the G′/(bG′+G+a) technique. Several novel soliton solutions are obtained, including periodic solitary waves, bright solitons, and dark solitons. Various parametric values are employed to produce these new soliton waves at certain fractional order levels α. Furthermore, the bilinear version of the equation helps to develop its two-wave, three-wave, and multi-wave, as well as lump and rogue wave solutions. The properties of the solutions to the underlying problem are most effectively analyzed through the use of graphical representations. These outcomes and techniques can be used to study various fractional-order problems that emerge in wave theory, such as those in physics, hydraulics, optical technology, quantum mechanics, and plasma particles.