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Introduction: Pyloromyotomy timing is predicated upon correction of electrolyte abnormalities. Among infants who presented with normal electrolytes, we hypothesized that pyloromyotomy the evening of presentation, rather than waiting until morning, would confer shorter length of stay (LOS). Methods: This single-center retrospective cohort study included patients who underwent pyloromyotomy from 2012 to 2021. Exposure was time of operation with nighttime considered between the times of 17:00 and 06:59 and daytime between 07:00 and 16:59. A 2:1 daytime to nighttime match was performed among patients who presented with normal electrolytes with Fisher's Exact and Student's t-test for comparisons. Results: Of 520 patients, 15 (3%) underwent pyloromyotomy overnight and were matched to 30 daytime patients. There were no differences in median age (33 days (interquartile range [IQR] 29–44) vs 32 days (IQR 25–44)), male sex (15 (100%) vs 28 (93.3%), or history of prematurity (0 (0%) vs 2 (6.7%)) for nighttime compared to daytime, respectively. Operative outcomes including conversion to open, duodenal perforation, incomplete myotomy, or surgical site infection did not differ between the groups. While the nighttime group had a significantly shorter time from presentation to operating room (OR) than the daytime group (5.3 vs 15.9 h), there were no significant differences in total LOS (45.7 vs 57.3 h, p = 0.13). Conclusion: For infants with hypertrophic pyloric stenosis who present with normal electrolytes, it is safe to offer operation same-day or following a night of hydration. There was no evidence of improved hospital utilization for patients undergoing pyloromyotomy the night of presentation.

BackgroundDespite pharmacological treatments, patients undergoing cardiac surgery experience severe anxiety and pain, which adversely affect outcomes. Previous work examining pediatric and nonsurgical adult patients has documented the effectiveness of inexpensive, nonpharmacological techniques to reduce anxiety and pain as well as health care costs and length of hospitalization. However, the impact of nonpharmacological interventions administered by a dedicated comfort coach has not been evaluated in an adult surgical setting. ObjectiveThis trial aims to assess whether nonpharmacological interventions administered by a trained comfort coach affect patient experience, opioid use, and health care utilization compared with usual care in adult cardiac surgery patients. This study has 3 specific aims: assess the effect of a comfort coach on patient experience, measure differences in inpatient and outpatient opioid use and postoperative health care utilization, and qualitatively evaluate the comfort coach intervention. MethodsTo address these aims, we will perform a prospective, randomized controlled trial of 154 adult cardiac surgery patients at Michigan Medicine. Opioid-naive patients undergoing first-time, elective cardiac surgery via sternotomy will be randomized to undergo targeted interventions from a comfort coach (intervention) versus usual care (control). The individualized comfort coach interventions will be administered at 6 points: preoperative outpatient clinic, preoperative care unit on the day of surgery, extubation, chest tube removal, hospital discharge, and 30-day clinic follow-up. To address aim 1, we will examine the effect of a comfort coach on perioperative anxiety, self-reported pain, functional status, and patient satisfaction through validated surveys administered at preoperative outpatient clinic, discharge, 30-day follow-up, and 90-day follow-up. For aim 2, we will record inpatient opioid use and collect postdischarge opioid use and pain-related outcomes through an 11-item questionnaire administered at the 30-day follow-up. Hospital length of stay, readmission, number of days in an extended care facility, emergency room, urgent care, and an unplanned doctor’s office visit will be recorded as the primary composite endpoint defined as total days spent at home within the first 30 days after surgery. For aim 3, we will perform semistructured interviews with patients in the intervention arm to understand the comfort coach intervention through a thematic analysis. ResultsThis trial, funded by Blue Cross Blue Shield of Michigan Foundation in 2019, is presently enrolling patients with anticipated manuscript submissions from our primary aims targeted for the end of 2020. ConclusionsData generated from this mixed methods study will highlight effective nonpharmacological techniques and support a multidisciplinary approach to perioperative care during the adult cardiac surgery patient experience. This study’s findings may serve as the foundation for a subsequent multicenter trial and broader dissemination of these techniques to other types of surgery. Trial RegistrationClinicalTrials.gov NCT04051021; https://clinicaltrials.gov/ct2/show/NCT04051021 International Registered Report Identifier (IRRID)DERR1-10.2196/21350

In addition to their promise in regenerative medicine, pluripotent stem cells have proved to be faithful models of many human diseases. In particular, patient-specific stem cell-derived cardiomyocytes recapitulate key features of several life-threatening cardiac arrhythmia syndromes. For both modeling and regenerative approaches, phenotyping of stem cell-derived tissues is critical. Cellular phenotyping has largely relied upon expression of lineage markers rather than physiologic attributes. This is especially true for cardiomyocytes, in part because electrophysiological recordings are labor intensive. Likewise, most optical voltage indicators suffer from phototoxicity, which damages cells and degrades signal quality. Here we present the use of a genetically encoded fluorescent voltage indicator, ArcLight, which we demonstrate can faithfully report transmembrane potentials in human stem cell-derived cardiomyocytes. We demonstrate the application of this fluorescent sensor in high-throughput, serial phenotyping of differentiating cardiomyocyte populations and in screening for drug-induced cardiotoxicity.

The impact of economic development in Lahore has resulted in increased motorized traffic, which in-turn has increased the chances of the roadside accidents. A questionnaire was designed consisting of personal attributes of the drivers, attitudinal and behavioral aspects of driving. Considering the feasibility and constraints, a total of 200 samples were obtained. The collected data showed that most of the young drivers had habit of looking outside right and left while driving. Most significant distraction factors include listening music, using mobile phone and watching at the rear view mirror, eating and smoking. The inside activities and outside attraction were the major factors of accidents. Using factor analysis technique, two factors including internal distraction elements and external distraction elements were explored. The results revealed that two extracted factors were significant determinants of drivers experiencing crash during driving. These findings implicate that the traffic safety policies should address distracted driving behavior of drivers in order to reduce traffic accidents and related social evils during driving. [ABSTRACT FROM AUTHOR]

Purpose: This article aims to illustrate that stress is not always a negative experience as it can have both positive and negative outcomes. The term "eustress" describes positive stress, while the term "distress" describes negative stress. To date, research on eustress is in the infancy stage. There are approximately 306 items that can be found in the Web of Science core collection for "eustress", while there are 184,714 items found for "distress". Few studies have examined the relationship between presenteeism, stress, and innovative behavior. Thus, the mechanism underlying this pathway still needs to be fully understood., Materials and Methods: A survey was conducted among 350 medical healthcare professionals from Pakistan. With the help of SPSS and AMOS, the data were analyzed and the combined effects of the variables were also investigated., Results: According to the current study, a mediation effect has been observed between innovative behavior and stress (eustress and distress). However, supervisor support moderates the relationship between stress and presenteeism and, likewise, between presenteeism and innovative behavior., Conclusion: Our analysis of variables establishes empirically robust relationships between the innovative behavior of medical healthcare professionals and the two different dimensions of stress. In addition, it describes a hypothetical alternative situation that explains how employees' innovative work behavior is affected by eustress and distress in the presence of supervisor support. This study could have implications for improving medical healthcare professionals' ability to incorporate innovative behavior into their practice in an effective manner in the future.

Introduction Increased levels of homocysteine (Hcy) may lead to endothelial damage and increase the risk of cardiovascular and renal malfunction. The current study aimed to evaluate the association of serum Hcy levels with gender, body mass index (BMI), duration of diabetes mellitus type 2 (DMT2), hemoglobin A1c (HbA1c), and blood pressure (BP).  Methodology  A prospective observational study was conducted at Hayatabad Medical Complex in Peshawar, Pakistan in the department of endocrinology from June 2020 to June 2021. All patients with diagnosed DMT2 above the age of 18 years were included in the study. Individuals with unconfirmed diagnoses with ages over 75 years were excluded from the study. All data including the patient's age, gender, and medical history were recorded. Height and weight were used to calculate the BMI. BP was examined thrice and a mean value was recorded for each patient. For laboratory investigation, a vial of 3 ml blood was extracted keeping sterile and aseptic conditions by a trained nurse. The sample was sent for the determination of HbA1c and serum Hcy levels. Measurement of serum Hcy was done by chemiluminescent microparticle immunoassay. All data were documented by the researchers on a predefined pro forma.  Results A total of 188 patients with DMT2 were included in the study with a mean age ± SD of 54.65 ± 8.42 years. Normal (<15 micromoles per liter [mcmol/l]) serum Hcy levels were reported in 75 (39.89%) individuals, while in 47 (41.59%) individuals, there was severe (>100 mcmol/l) hyperhomocysteinemia. More than half of the patients, i.e. 157 (83.52%), had HbA1c of greater than 7%, which indicated poor glycemic control. The study revealed that the majority of the female patients, i.e. 37 (78.72%), had severe hyperhomocysteinemia (p<0.0001). Similarly, there was a direct correlation between HbA1c levels and serum Hcy. Severe hyperhomocysteinemia was found in over 80% of the patients with poor glycemic control, i.e. HbA1c >7% (p<0.0001). Furthermore, the duration of DMT2 and hypertension were both significantly associated with increased levels of Hcy with p-values of <0.0001 and <0.0001, respectively. However, no association was found between hyperhomocysteinemia and BMI.  Conclusion The study revealed that increased levels of serum Hcy were associated with female gender, poor glycemic control (HbA1c >7%), BP, and duration of DMT2. However, the study failed to find an association between serum Hcy and BMI. It is recommended that patients with poor glycemic control or those with the duration of DMT2 of more than five years must be regularly checked for hyperhomocysteinemia and renal function tests.  Large-scale and multi-center studies are required in order to determine the validity of these findings. The current study suggests that patients with diabetes mellitus and hypertension are likely to have increased levels of Hcy and, therefore, must be regularly screened for hyperhomocysteinemia., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Noor et al.)

The coronavirus is currently extremely contagious for humankind, which is a zoonotic tropical disease. The pandemic is the largest in history, affecting almost the whole world. What makes the condition the worst of all is no specific effective treatment available. In this article, we present an extended and modified form of SIR and SEIR model, respectively. We begin by investigating a simple mathematical model that describes the pandemic. Then we apply different safety measures to control the pandemic situation. The mathematical model with and without control is solved by using homotopy perturbation method. Obtained solutions have been presented graphically. Finally, we develop another mathematical model, including quarantine and hospitalization.

Background: The MDR (multidrug resistance) tuberculosis is a serious public health concern. Fluoroquinolones are in use to treat tuberculosis, but M. tuberculosis strains have now become resistant due to several mutations in different genes. We evaluated mutations in gyrB gene at amino acid positions G481A and D505A of M. tuberculosis by semi-multiplex allele specific (MAS) PCR., Methods: The information on gender, age, type of tuberculosis (TB), positive/negative for MDR-TB and HIV infection was gathered. The genomic DNA isolation from sputum culture samples (n=53) was carried out by non-column based method. The gyrB mutations were investigated by using self-designed primers in semi MAS-PCR, at mentioned amino acid positions., Results: There were 38% male patients and 62% were female patients. Most of MDR-TB patients (58.5%) were in the age between 16-30years. There were 90.5% cases of pulmonary TB and 9.4% cases of extra pulmonary TB. Only 1.8% patients were co-infected with HIV. The 24 samples had mutation in gyrB gene out of 53 (45.28%), on both of positions of amino acids Gly481Ala and Asp505Ala. All samples had mutations at Gly481Ala, whereas, 24 samples (45.28%) had mutations at Asp505Ala., Conclusion: Mutations at amino acids positions 481 and 505 were involved in MDR-TB, which could further develop into an extensively-drug resistance (XDR) TB. Therefore, there is a need to explore all mutations in gyrB gene in MDR-TB, because it can result in a Fluoroquinolones resistance., (Copyright © 2019. Published by Elsevier Ltd.)

Background: The incidence of obesity in women of reproductive age group has encountered problems of infertility with frequent referral to reproductive clinics. In order to know whether increase in body mass index (BMI) is associated with poor reproductive outcome, current study was aimed to relate women's BMI, estradiol (E2) levels, and clinic pregnancy rates after intra cytoplasmic sperm injection (ICSI)., Methods: Quasi experimental design of 323 women was conducted from June 2010 till August 2011. Women were grouped on the basis of BMI; Group A, BMI < 18 (underweight); Group B, BMI 18-22.9 (normal weight); Group C, BMI 23-25.9 (overweight); and Group D, BMI > or = 26 (obese). Procedure of ICSI commenced by down regulation of ovaries followed by controlled ovarian stimulation. Oocyte pickup was done 36 hours after ovulation induction by hCG, eggs fertilised in vitro were graded and only blastocysts were transferred. Serum samples of basal E2, peak E2 (day of hCG administration) and mid-luteal E2 (7 days after egg collection) measured by ELISA were compared in all BMI groups. Pregnancy outcome of these was categorised as: no conception beta-hCG < 5 mlU/ml, preclinical abortion with beta-hCG > 5 mlU/ml, no cardiac activity on transvaginal scan (TVS) and clinical pregnancy with beta-hCG >5 mlU/ml and cardiac activity on trans-vaginal scan., Results: Obese women with BMI > or = 26 had lowest basal, peak and mid-luteal E2 with minimum clinical pregnancy rates compared to rest of the groups., Conclusion: A high BMI is associated with decreased E2 levels in all phases of ovarian cycle and has a negative impact on pregnancy outcome.