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Previous studies highlighted the significance of tailoring alkaline activators (AA) to specific fly ash (FA) sources for optimal properties of geopolymer concrete (GPC). This study examines the influence of various AA's properties on mechanical properties and microstructures of local low-calcium FA-based GPC under varying curing conditions. A comprehensive investigation consists of several factors such as NaOH molarities (10 M, 12 M, 14 M, 16 M), Na 2 SiO 3 / N a O H ratios (1.5, 2.0, 2.5) and A A / F A ratios (0.5, 0.6). The results reveal a complex relationship, demonstrating that NaOH molarity positively influences compressive strength up to a threshold of 14 M, beyond which an adverse effect was observed while, the flexural strength was increased up to 16 M. Moreover, the study highlights the complex relationship between Na 2 SiO 3 / N a O H ratios and mechanical strengths. Notably, these properties exhibited an increase as the ratio rose up to 2.0, but a subsequent decrease was observed when the ratio reached 2.5. Moreover, proposed regression equations predict the compressive and flexural strengths of both ambient-cured GPC and heat-cured GPC with marginal statistical errors. The optimal GPC mix exhibited 49% lower embodied CO 2 emissions than the corresponding OPC concrete. GPC has higher cost, but it exhibited lower cost-to-strength ratio compared to OPC concrete., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Atrial fibrillation (AF) is a common arrhythmia associated with significant morbidity and mortality. The optimal approach to managing AF, specifically rate control versus rhythm control, remains a topic of debate in clinical practice. This systematic review aims to compare the rate control and rhythm control strategies based on their clinical outcomes, quality of life, and adverse events associated with them. A comprehensive search was conducted using PubMed, Google Scholar, Science Direct, Research Gate, MEDLINE (Medical Literature Analysis and Retrieval System Online), Scopus, and Embase (Excerpta Medica dataBASE) databases. A total of 1657 research papers were identified through the search strategy, and after applying the eligibility criteria, 28 studies were selected for the analysis. The studies encompassed a range of methodologies, including randomized controlled trials, observational studies, and meta-analyses. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for study selection, data extraction, and analysis. The outcomes of interest included all: cause mortality, stroke, bleeding events, cardiovascular hospitalizations, quality of life, and adverse effects of treatment. Data were synthesized and presented in tables, charts, and forest plots for meta-analysis where appropriate. The results indicate that both rate control and rhythm control strategies have their own merits and limitations, with the outcomes varying based on patient characteristics and comorbidities. While rhythm control strategies may lead to better symptom control and improved quality of life, rate control strategies may be associated with lower risks of adverse events and complications. This systematic review provides a comprehensive overview of the current evidence regarding rate and rhythm control strategies in AF management, offering insights for clinical decision-making and highlighting the need for individualized treatment approaches., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Olanisa et al.)

With the advent of modern antiretroviral therapy (ART), human immunodeficiency virus (HIV) infection has been modified into a chronic manageable condition, prolonging the lifespan of people living with HIV (PLHIV). This has resulted in an increased non-AIDS-related morbidity in the HIV-infected population. Our aim is to study the role of contemporary ART in tackling the risk of atherosclerosis and cardiovascular disease (CVD) in PLHIV. We searched through the databases of PubMed, PubMed Central, and Cochrane Library for pertinent articles using the medical subject headings (MeSH) "HIV infection", "Atherosclerosis", and "Antiretroviral agents". The articles published in the past five years were retrieved, screened for relevance, and assessed for quality before being included in the review. This review was performed following the PRISMA 2020 guidelines. The results indicate that the incidence of dyslipidemia with integrase strand transfer inhibitors (INSTIs) is greater than with non-nucleoside reverse transcriptase inhibitors (NNRTIs) and lesser than with protease inhibitors (PIs). INSTIs are indispensably associated with weight gain and obesity. High triglyceride (TG) and oxidized low-density lipoproteins to low-density lipoproteins (oxLDL/LDL) ratio levels and low high-density lipoprotein (HDL) levels are seen in patients taking PIs. A higher incidence of hypertension and metabolic syndrome (MetS) was noticed with INSTIs compared to NNRTIs. PI intake for >5 years increases the risk of subclinical atherosclerosis. Increased risk of myocardial infarction with INSTIs was observed in a study, while another study reported decreased risk. HIV infection independently increases the risk for atherosclerosis and CVD. Although contemporary ART decreases this enhanced risk, it inherently increases the risk for abnormal lipid profile, MetS, weight gain, and obesity. Further research into the risk of atherosclerosis and CVD with newer ART drugs is essential for decoding the underlying mechanisms and preventing adverse cardiac outcomes in PLHIV., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Vemulapalli et al.)

Objective: Inflammatory and immunologic cytokines and vagal activity have important roles in health and mental health, and may influence each other. The authors assessed relationships of representative biomarkers linked to disaster exposure-heart rate variability (HRV) with Interleukin-2 (IL-2, cell-medicated immunity) and Interleukin-6 (IL-6, pro-inflammatory and pro-immunologic), stratified by psychiatric diagnosis., Design: Participants were assessed for psychiatric diagnosis, IL-2, IL-6, HRV, and HR reactivity to trauma reminders., Setting: Outpatient university psychiatry clinics in Oklahoma City and Tulsa., Participants: Relocated Katrina survivors and demographically matched controls, not on psychiatric, cardiovascular, or inflammatory medications., Main Outcome Measures: SCID-IV, baseline serum IL-2 and IL-6, HRV through power spectral analysis., Results: Survivors had higher sympathetic and lower parasympathetic activity at baseline and lower parasympathetic HR reactivity than controls, with flattened parasympathetic reactivity in the presence of depression and of post-traumatic stress disorder (PTSD). Survivors' IL-2 and IL-6 did not differ from controls and did not differ in PTSD or depression. Depressed survivors' sympathetic reactivity correlated negatively with IL-2 and parasympathetic reactivity correlated positively with IL-2., Conclusions: HRV differed after hurricane exposure and with survivors& depression and/or PTSD, more sensitively capturing somatic sequelae than assessed cytokines. Higher sympathetic HR reactivity associated with lower immuno-logic IL-2 may indicate a double biological "hit" in depressed disaster survivors, possibly rendering them more vulnerable to cardiovascular and immunologic illness as well as depression. Associations of HRV with IL-2 may support reciprocal influences of cytokines and vagal activity. Lack of significant correlations of IL-6 with HRV measures is consistent with its pleiotropic role.

We present a case of priapism in a homeless patient with a psychiatric history of major depression, PTSD, polysubstance abuse (alcohol and cocaine) and past psychotropic medication use who was admitted to a local hospital for suicidal ideation. Priapism is a serious urological and a medical emergency which has often been associated with psychotropic medications (including the antidepressant trazodone), use of marijuana and alcohol, and other factors. This clinical case highlights the additive risks of medications and comorbid conditions in contributing to onset of priapism, emphasizing the importance of any pre-existing medical illness, diagnoses, and comorbid mental illnesses. Moreover, clinicians should consider potential side effects of all medications used and their drug interactions as they manage patients who develop this condition.

Introduction: Bispectral index (BIS) and state entropy (SE) are prone to artifacts, especially due to electrocautery (EC). We compared the incidence of artifacts in BIS and SE during surgery under local anesthesia and sedation., Methods: 28 females undergoing breast surgery under local anesthesia and sedation were studied. Simultaneous BIS and SE measurements were recorded every 10 seconds. Artifact was defined as a failure of the device to display a numerical value while the electrodes remained appropriately attached to the patient's forehead. Ratio of artifact to good signal was compared between BIS and SE in the presence or absence of EC use., Results: 7679 data points were collected from 28 patients. Overall, artifact incidence was similar in BIS and SE (6.2% and 6.3%, resp.). In the presence of EC (1370 data points), BIS had significantly more artifact compared to SE (18.6% versus 6.4%, P < 0.0001). Without EC (6309 data points), BIS had significantly less artifact compared to SE (4.1% versus 7.3%, P < 0.0001)., Discussion: BIS and SE were comparable for incidence of artifacts in patients under sedation. Use of EC lead to more artifact in BIS than SE. Conversely, BIS had fewer artifacts than SE when there was no EC use.

Objective: To determine the utility of postmortem CT (PMCT) examination in establishing the cause of death among male prisoners dying in Karachi jails., Methods: A descriptive study was carried out from February 2006 to September 2007, CT Scan section, Civil Hospital Karachi and the Mortuary, Dow Medical College, Dow University of Health Sciences, Karachi. Adult male prisoners dying in the Karachi central prison and referred to the study setting for determining the cause of death for medico legal purpose were included. Female prisoners and those cases where the final report of cause of death was not available were excluded. CT scan of the vital body regions (head, neck, thorax, abdomen and pelvis) was carried out in all cases. The scan was read and reported by two radiologists. Anatomical dissection based autopsy was carried out by the forensic expert. Final report regarding the cause of death was issued by the forensic expert based on the combined findings, histopathology, toxicology results and circumstantial evidence. The CT scan and autopsy findings were compared and percentage agreement was determined using kappa statistics., Results: There were 14 cases in all with mean age of 41.2 +/- 17 years. The alleged mode of death was custodial torture in all cases. CT scan determined the cause of death to be natural cardio-respiratory failure in 10, strangulation in 01, pulmonary tuberculosis (TB) in 02 and trauma to spine in 01 case. The autopsy determined natural death in 11 and pulmonary TB in 02 and asphyxia in 01. The percentage agreement between CT and autopsy was 92% (k = 0.92) and between CT and finalized cause of death was 100% (k = 1.0)., Conclusion: PMCT is as effective as dissection autopsy in identifying pulmonary infections and natural causes of death. It is more effective in identifying vertebral fractures which may exclude hanging and corroborate trauma to spine.

Background: Introducing sustainability and self-reliance is essential in chronic humanitarian emergencies before financial assistance is phased out. In Pakistan-based Afghan refugee camps, this was attempted through shifting from indoor residual spraying (IRS) to the subsidized sale of insecticide-treated nets (ITNs) for prevention of malaria and anthroponotic cutaneous leishmaniasis (ACL). Here we outline the strategy and document the progress to provide guidance for replication of similar approaches in other chronic refugee situations., Methods: The operational monitoring data presented were collected through: (i) two surveys of knowledge, attitude and practice (KAP); (ii) routine sales reporting of health-care providers; (iii) records completed during field visits; and (iv) registers used during annual re-treatment campaigns., Results: From 2000 until 2003, subsidized ITN sales expanded from 17 to 44 camps. Based on 2003 sales records, maximum coverage from subsidized sales exceeded 50% in 13 camps and 20% in an additional 14 camps. Free annual treatment campaigns showed that many refugees were in possession of non-programme nets, which were either locally-made or had leaked from an ITN programme in Afghanistan. Estimated re-treatment coverage of sold and existing nets through annual campaigns exceeded 43% in all camps and was above 70% in the majority., Conclusion: Subsidized sales of ITNs have effectively introduced the components of sustainability and self-reliance to the prevention of malaria and ACL in Afghan refugee camps. Similar approaches should be investigated in other chronic refugee situations to discourage expectations of continuing humanitarian donations that cannot be fulfilled.

A 48 year-old white male with basal cell nevus syndrome presented with a metastatic basal cell carcinoma with neuroendocrine features. The tumor manifested aggressive behavior, having deep local invasion and metastases to para-aortic lymph nodes and bone. Neuroendocrine differentiation has rarely been associated with basal cell carcinoma. The histologic, immunohistochemical, and electron microscopic studies of this rare tumor are described.