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Background: Congenital Insensitivity to Pain (CIPA), otherwise known as Hereditary Sensory and Autonomic Neuropathy Type IV (HSAN IV), is a rarely occurring autosomal recessive disorder encompassed by a group of hereditary and sensory autonomic neuropathies, which was initially described as pure analgesia present congenitally. Its clinical manifestation includes recurrent episodes of infections with unexplained behavior, anhidrosis, mental retardation, and damage to oral structures. Case Presentation: In this case report, we have demonstrated the signs and symptoms of a 7-year-old boy presented to the pediatric out-patient department of Memon Medical Institute Hospital with complaints of multiple fluid-filled blisters since the age of 1 year. He had a history of multiple hospital admissions due to infections, where he was diagnosed with a case of CIPA. Management & Results: Since the diagnosis of this medical condition, the child has undergone multiple debridements of his wound and amputations. The treatment plan was aimed to manage the blisters, prevent self-injuries, and treat orthopedic problems by regular dermal and orthopedic follow-ups. Conclusion: There is no cure for CIPA patients, the families that have CIPA patients must undergo prenatal testing and screening to prevent the birth of another affected child.

High cholesterol could be dangerous, along with the deposits of other substances, such as fat, on the walls of the arteries. These plaques can reduce blood flow through the arteries, which in turn can cause complications such as chest pain, blood clots, and heart attack. Hence, there is a need for an efficient way to measure the concentration of cholesterol in blood vessels with great accuracy to predict its risk on health. The present study aims to measure the concentration of cholesterol and track it accurately in the blood vessels using an ultrasound pressure sensor, which detects the concentration of cholesterol and produces a pressure field around its surface that is directly proportional to the concentration. This field can be tracked by ultrasound. In this study, the experiments conducted involved the insertion of aluminum nanoparticles, which represent a pressure sensor coated with a massless piezoelectric aluminum nitride nanoplate, into simulated blood vessels containing different concentrations that mimic human blood. The sensitivity of the blood vessels was monitored at different time periods. Moreover, an experimental setup was constructed to validate the possibility of using existing ultrasound medical imaging technologies in tracking the proposed nano biosensors. The setup involves prototyping a medical phantom with a specific acoustic characteristic for simulating human tissues. Various clinical scenarios have been imitated and the possibility of tracking these novel micro electromechanical pressure biosensors has been discussed.

Most current modern devices have micro dimensions. For engineers and manufacturers, it is now possible to manufacture completely remote devices in a modern way. To determine the critical points in measuring the dimensions for the manufacturing of devices, which is achieved in practice and at an appropriate cost, numerous studies have been conducted around the world. Researchers have attempted to develop a pragmatic approach to interface various nanoscale devices together and to study their focal points and disadvantages. The objective of this study is to focus on modern trends in the manufacturing of nanoscale devices. These trends are divided into the following five sections: development of tribotronic devices, nanodevice fabrication using two-dimensional materials, fabrication using carbon nanotubes (CNTs), on-chip nanodevice fabrication, and nanodevices based on photonics. In this study, the views on these trends and how to effectively apply them in the future are presented. To enhance the structure and features of nanowires inside a scanning tunneling microscope (STM) scanner, a novel view about the structure of nanowire is presented. These nanowires demonstrate unique metal properties that enable them to operate in multiple environments with high efficiency. Using these nanowires inside an STM scanner can improve their ability to withstand high pressure because their metal properties minimize the chances of breakage.

The present study was undertaken with the objectives to study the information seeking behaviour of post graduate students of Punjab Agricultural University, Ludhiana. A total of 120 students (40 students from Ph.D. and 80 students from M.Sc.) were selected from all colleges using probability proportional to number method. Data were collected from the respondent by using distributed questionnaire approach. The findings of the study revealed that majority of the respondents (76%) from Masters’ respondents were in the age group of 20-25 years and majority of respondents (72%) from Ph.D. respondents were in the age group of 23-27 years. All the Masters as well as Ph.D. students (100%) had used text books and internet browsing as a source/method of information. Majority of the respondents (95%) sought information for course work and research purpose. Majority from Masters’ respondents (67%) and Ph.D. respondents (75%) occasionally delegate work of information collection to others, and expressed lack of time (49% and 48% respectively) main reason behind this. Majority of Masters’ respondents (68%) Ph. D respondents (70%) preferred the both print and electronic sources and spending 1 to 4 hours per day for information seeking.

Arrhythmia is a dangerous disease in which the heart rhythm varies and it may be very fast or very slow. Rapid heartbeats can lead to shortness of breath, chest pain, and sudden weakness, whereas slow heartbeats can lead to dizziness, problems with concentration, and constant stress. Finding an effective treatment for arrhythmia has become a very important endeavor for researchers and clinicians. In this article, we review the latest methodologies used in arrhythmia diagnosis and treatment. They include the application of five different types of artificial neural networks trained by machine learning and powered by artificial intelligence: convolutional, recurrent, feedforward, radial basis function, and modular neural network. Some of these methodologies are merged to enhance accuracy and efficacy. This review suggests that more research needs to be carried out in merging neural network types for their application in electrocardiogram (ECG).

Methods for testing the presence of a virus in the blood are of interest to researchers and doctors because they determine how rapidly a virus is detected. In general, virus detection is a major scientific problem due to the serious effects of viruses on the human body. At present, only one virus can be detected in a single test. This potentially costs the medical establishment more time and money that could be saved if blood testing was more efficient. This study presents a qualitative method to enable doctors and researchers to detect more than one virus simultaneously. This was performed using quartz nanoparticles. Using polymer thin films of polydimethylsiloxane (PDMS), each chip emits a different frequency for each specific type of virus on the chip. The multiplicity of these chips allows for the detection of a number of viruses with the same number of nanoscale chips simultaneously. Blood flow around quartz nanoparticles was modelled. In this model, several conventional Quartz Crystal Microbalance (QCM) with nanostructures (Nano-QCM) particles are inserted into the three main types of blood vessels. The results showed that the best location for the Nano-QCM is the large artery and that it is possible to test for a number of viruses in all types of blood vessels.

In this paper, we propose an indoor visible light communication (VLC) system which makes use of Walsh precoding and multiple light-emitting diodes (LEDs) at the transmitter for multiplexing the data. The proposed VLC system is based on intensity modulation and uses the notion of spatial modulation for communicating the positive and negative values of the synthesized transmit signal using signal processing technique at the transmitter. We also illustrate the flexibility, ability, and easiness of the system to configure well in a multiuser environment. We have also developed a near-maximum likelihood (ML) detection technique for efficiently decoding the data bits at the receiver. The proposed near-ML reduces the search space involved in ML technique by using the initial ZF solution. The results of the simulation studies illustrate that the proposed technique offers a higher data rate and good bit error rate (BER) performance in indoor VLC environments.

Key Teaching Points • Late-onset asystole is a rare but significant complication in patients with a vagal nerve stimulator of which the clinician needs to be aware. A good clinical suspicion, thorough history, and physical examination are key to help discern cardiac vs neurogenic causes of syncope. • Autonomic neural input to the heart exhibits some “sidedness,” with the left vagal nerve having more influence on the atrioventricular node and right vagal nerve having more influence on the sinus node, which is why the stimulator is placed on the left side of the chest. This is thought to be secondary to the embryonic rotation of the body during development. However, it is important to know that there is some degree of overlap between the left and right vagal nerve innervation. • Very few cases of late-onset syncopal events associated with vagal nerve stimulation therapy have been reported that were treated with removal or deactivation of the device. Another approach could be to implant a permanent pacemaker in a patient who would not tolerate removal of the stimulator owing to intractable epilepsy.

Cardiovascular diseases (CVD) are among the leading causes of mortality globally, especially in the developed countries. While 17.3 million mortalities occurred from CVDs in 2008...

Compound nanoparticle drug delivery system plays an important role in the interaction with lymph nodes. There are three primary types of lymphocytes: B cells, T cells, and natural killer cells. When the cells of the immune system turn carcinogenic, they assault body cells. The lymph fluid plays an important role in attacking healthy cells of the body; hence, this paper aimed to design a drug delivery system, which can efficiently direct nanoparticles to target the infected cells, helping in high-speed elimination of such cells. The proposed design depends on the interaction between these molecules, and the intelligent nano-controller has the ability to guide the nanoparticles by anaerobic contact. The proposed design proved that the smaller the nanoparticle size and density, the less dynamic viscosity of the liquid would be, which would reflect its resistance to flow. In addition, it was concluded that hydrogen molecules play a significant role in reducing lymphatic fluid resistance due to their low density.

Cardiac contractility modulation (CCM) is an investigational device-based therapy to enhance ventricular contractility in systolic heart failure patients who are not candidates for cardiac resynchronization therapy (CRT) owing to the absence of wide QRS complexes or who have failed to respond on CRT. The principal mechanism is based on the stimulation of cardiac muscles by nonexcitatory electrical signals to augment the influx of calcium ions into the cardiomyocytes. The majority of patients receiving CCM therapy have concurrent implantable cardioverter defibrillators, and the manufacturer declares both devices can be used in parallel without any interactions. Nevertheless, proper lead positioning of both devices are crucial, and it is mandatory to check device-device interactions during each and every cardiac electronic implantable device-related procedure to prevent adverse outcomes.

Infective endocarditis (IE) can lead to significant morbidity and mortality without appropriate treatment. Modified Duke Criteria are accepted by many professional societies to establish the diagnosis of IE, and cardiac imaging is one of the major diagnostic criteria. Transesophageal echocardiography is an algorithmic escalation to diagnose IE when transthoracic echo does not appreciate a positive finding. In patients with contraindications to transesophageal echocardiography, cardiac magnetic resonance imaging, cardiac computed tomography (CT), cardiac CT angiography, and fluorodeoxyglucose positron emission tomography with CT or CT angiography may be alternative diagnostic tools. However, these imaging modalities have their own limitations such as local unavailability, the presence of non–magnetic resonance imaging compatible implants, or impaired renal function. Intracardiac echocardiography could be a considerable alternative under those circumstances.

Intravenous delivery is the fastest conventional method of delivering drugs to their targets in seconds, whereas intramuscular and subcutaneous injections provide a slower continuous delivery of drugs. In recent years, nanoparticle-based drug-delivery systems have gained considerable attention. During the progression of nanoparticles into the blood, the sound waves generated by the particles create acoustic pressure that affects the movement of nanoparticles. To overcome this issue, the impact of sound pressure levels on the development of nanoparticles was studied herein. In addition, a composite nanostructure was developed using different types of nanoscale substances to overcome the effect of sound pressure levels in the drug-delivery process. The results demonstrate the efficacy of the proposed nanostructure based on a group of different nanoparticles. This study suggests five materials, namely, polyimide, acrylic plastic, Aluminum 3003-H18, Magnesium AZ31B, and polysilicon for the design of the proposed structure. The best results were obtained in the case of the movement of these molecules at lower frequencies. The performance of acrylic plastic is better than other materials, the sound pressure levels reached minimum values at frequencies of 1, 10, 20, and 60 nHz. Furthermore, an experimental setup was designed to validate the proposed idea using advanced biomedical imaging technologies. The experimental results demonstrate the possibilities of detecting, tracking, and evaluating the movement behaviors of nanoparticles. The experimental results also demonstrate that the lowest sound pressure levels were observed at lower frequency levels, thus proving the validity of the proposed computational model assumptions. The outcome of this study will pave the way to understand the interaction behaviors of nanoparticles with the surrounding biological environments, including the sound pressure effect, which could lead to the useof such an effect in facilitating directional and tactic movements of the micro- and nano-motors.

Oral squamous cell carcinoma (OSCC) affects approximately 30,000 people and is associated with tobacco use. Little is known about the mechanistic effects of second-hand smoke in the development of OSSC. The receptor for advanced glycation end-products (RAGE) is a surface receptor that is upregulated by second-hand smoke and inhibited by semi-synthetic glycosaminoglycan ethers (SAGEs). Our objective was to determine the role of RAGE during cigarette smoke extract-induced cellular responses and to use SAGEs as a modulating factor of Ca9-22 OSCC cell invasion. Ca9-22 cells were cultured in the presence or absence of cigarette smoke extract and SAGEs. Cell invasion was determined and cells were lysed for western blot analysis. Ras and nuclear factor of kappa light polypeptide gene enhancer in B-cells (NF-κB) activation were determined. Treatment of cells with cigarette smoke extract resulted in: (i) increased invasion of OSCC; (ii) increased RAGE expression; (iii) inhibition of cigarette smoke extract-induced OSCC cell invasion by SAGEs; (iv) increased Ras, increased AKT and NF-κB activation, and downregulation by SAGEs; and (v) increased expression of matrix metalloproteinases (MMPs) 2, 9, and 14, and downregulation by SAGEs. We conclude that cigarette smoke extract increases invasion of OSCC cells in a RAGE-dependent manner. Inhibition of RAGE decreases the levels of its signaling molecules, which results in blocking the cigarette smoke extract-induced invasion.

Strangulated hernia in quite common in surgical practice and always present with its typical symptoms. In this hardly found unique case, a 76-year's old female with no co morbid presented to us with abdominal pain, vomiting and diarrhoea initially and later developed left groin abscess after 4 days of swelling. It was assumed to be inguinal lymphadenitis leading to abscess formation but after complete evaluation on digital examination, diagnosis of Strangulated Femoral hernia of Richter type was made. This distinguishing presentation among the list of all hernias has to be discussed for the differential diagnosis.

Bidirectional ventricular tachycardia (BVT) is a rare variety of tachycardia with morphologically distinct presentation: The QRS axis and/or morphology is alternating in the frontal plane leads. Since its original description in association with digitalis,1 numerous cases of this fascinating tachycardia with disparate etiologies and mechanisms have been postulated. We report a patient with BVT in association with non-ST elevation myocardial infarction and severe cardiomyopathy in the absence of digoxin toxicity.

Patient: Male, 41 Final Diagnosis: Sick Sinus Syndrome and absent left main coronary artery • separate ostia of left anterior descending and circumflex arteries in Holt-Oram Syndrome Symptoms: Conduction disturbance • seizure-like activity • upper extremity malformations Medication: — Clinical Procedure: Electro physiology study • coronary catheterization • pacemaker Specialty: Cardiology Objective: Congenital defects/diseases Background: Holt-Oram syndrome (HOS) is a rare but significant syndrome consisting of structural heart defects, conduction abnormalities, and upper extremity anomalies. It was first described in the British Heart Journal in 1960 by Mary Holt and Samuel Oram as a report of atrial septal defect, conduction disturbances, and hand malformations occurring in family members. Patients can present with heart blocks or symptoms of underlying congenital heart defects. Case Report: A 41-year-old man with Holt-Oram syndrome presented with seizure-like activity and was found to have an underlying conduction disturbance. Physical exam showed bilateral atrophic upper extremities with anatomic disfiguration, and weakness of the intrinsic hand muscles. Cardiovascular exam revealed a slow heart rate with irregular rhythm. EKG showed sinus arrest with junctional escape rhythm. Cardiac catheterization revealed coronary anomalies, including absent left main coronary artery and separate ostia of the left anterior ascending and left circumflex coronary artery. Coronary arteries were patent. Following electrophysiology study, sick sinus syndrome and AV block were diagnosed, and the patient received implantation of a permanent pacemaker. Conclusions: This patient presented with a seizure-like episode attributed to hypoxia during asystole from an underlying cardiac conduction defect associated with Holt-Oram syndrome. Arrhythmias and heart blocks are seen in these patients, and conduction defects are highly associated with congenital heart defects. Holt-Oram syndrome rarely presents with coronary artery anomalies. There is no reported case of separate coronary ostia and absent left main coronary artery. Prompt diagnosis is important since anomalies in coronary and upper extremity vasculature might be challenging for invasive procedures.

OBJECTIVE: The primary aim of our study was to assess the variation of PEFR with various medical students of Karachi, Pakistan DESIGN: Cross-sectional study Setting: Medical students of Karachi Medical and Dental College Participants: 276 non-smoker healthy medical students composed of 168 females and 108 males. VARIABLE PARAMETERS: They include mean age, body height and body weight and PEFR. They were marked separately for each gender RESULTS: The mean waist hip ratio in females was observed to be 0.843±0.111in relation with that of mean PEFR value 452.97±65.84 L/min, whereas in males the mean waist hip ratio was 0.864±0.028 in relation with that of mean PEFR value 445.93±66.49 L/min. Also there is a statistically significant variation in PEFR with an increase in waist hip ratio . The mean height of males was 173.63 ±7.5 cm and weight was 61.81 ±11.25 Kg while mean height of females was 158.56±7.3 cm and weight was 49.33±9.04 Kg. PEFR is positively correlated with increase in height and weight up to a certain limit. CONCLUSION: The study concludes that PEFR is affected positively by variation in waist hip ratio; moreover young females have more waist hip ratio and PEFR values than their young male counterparts. A large sample size with accurate peak flow meter is required along with ethnic consideration of the study population for better, accurate and clear results.

We report a case of 78-year-old man admitted to the hospital due to palpitations and lightheadedness. On EKG advanced atrioventricular block with ventricular rate of 37 beats per minute was noted. On electrophysiology study a common type of atrioventricular nodal reentrant tachycardia was inducible with maintenance of advanced AV block. Radiofrequency ablation of slow pathway followed by placement of a permanent pacemaker resulted in elimination of tachycardia and resolution of symptoms.