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Abstract Background In this report, we describe an uncommon instance of fungating synovial sarcoma affecting the posterior aspect of the neck. Although the existing literature has documented a limited number of cases, this particular case contributes to the knowledge about it, which is scarce. Case presentation A total of 5 months before the examination, a Pakistani-Asian male, age 20 years, complained of a malodorous fungating swelling on the posterior aspect of his neck. An examination revealed a foul-smelling, 10 × 13 cm fungating enlargement surrounded by maggots and hemorrhaging at the site of the incision. A hemoglobin level of 6 and a total leukocyte count (TLC) of 23,000 indicated the patient’s disoriented and pallid appearance. He was expeditiously admitted, and preoperatively, the general well-being of the patient was optimized. After a comprehensive discussion with the medical team, a strategy for marginal excision and coverage with a latissimus dorsi (LD) flap and grafting was devised. The tumor was successfully excised, and an LD flap with graft was conducted on the patient during surgery; however, the infection caused the failure of half of the graft. Following that, the lesion was debrided, and re-grafting was performed. The patient was subsequently administered 5 cycles of chemotherapy and 32 cycles of radiotherapy. He was diagnosed with pulmonary metastasis 2 years later. Sadly, the patient died during a follow-up visit 3.5 years later. Conclusions The patient’s unfavorable prognosis after surgical intervention, radiotherapy, and chemotherapy, despite undergoing all-encompassing treatments, underscores the importance of early detection and intervention in fungating tumor cases.

Background: Vascular injuries in simple close fractures are rare and low suspicion risk for primary surgeons. They include thrombus formation, hematomas, pseudoaneurysms, ischemic changes, and absent pulsations. These injuries can cause morbid sequelae, including compartment syndrome, reperfusion injury, exsanguination, and limb loss. Case presentation: Following a closed femoral shaft fracture, a 12-year-old boy came to us with a compromised superficial femoral artery (SFA). At the moment of fixing, there was no evidence of arterial involvement. He presented to the Out-patient Department (OPD) two weeks after the primary surgery with swelling at the fracture site. CT-Angiography was performed, and the swelling was diagnosed as a pseudoaneurysm of the superficial femoral artery, which was repaired using a Great Saphenous Vein (GSV) graft. Conclusion: These uncommon vascular injuries in closed fractures can be identified by a thorough clinical examination and specific diagnostic tests, and with prompt vascular repair, limb-threatening consequences are preventable. In a simple close femur fracture without suspicious signs in clinical findings, it's not a routine practice to check the vascular status by means of fancy and costly diagnostic tests.

Graphene oxide (GO) nanosheets, as one of the most studied graphene derivatives, have demonstrated an intrinsically strong physisorption-based gas–matter behavior, owing to its enhanced volume–surface ratio and abundant surface functional groups. The exploration of efficient and cost-effective synthesis methods for GO is an ongoing task. In this work, we explored a novel approach to upcycle inexpensive polyethylene terephthalate (PET) plastic waste into high-quality GO using a combination of chemical and thermal treatments based on a montmorillonite template. The obtained material had a nanosheet morphology with a lateral dimension of around ~2 µm and a thickness of ~3 nm. In addition, the GO nanosheets were found to be a p-type semiconductor with a bandgap of 2.41 eV and was subsequently realized as a gas sensor. As a result, the GO sensor exhibited a fully reversible sensing response towards ultra-low-concentration NO2 gas with a limit of detection of ~1.43 ppb, without the implementation of an external excitation stimulus including elevating the operating temperature or bias voltages. When given a thorough test, the sensor maintained an impressive long-term stability and repeatability with little performance degradation after 5 days of experiments. The response factor was estimated to be ~11% when exposed to 1026 ppb NO2, which is at least one order of magnitude higher than that of other commonly seen gas species including CH4, H2, and CO2.

OBJECTIVES To determine the frequency of the Hepatitis C Virus in patients with chronic kidney disease receiving regular hemodialysis. METHODOLOGY At a tertiary care hospital in Peshawar, 211 patients were observed to ascertain the frequency of the Hepatitis C Virus in chronic kidney disease patients receiving regular hemodialysis. The technique of non-probability sequential sampling was employed to acquire samples. SPSS version 26.0 was used. RESULTS Among the CKD patients with Hepatitis C Virus (HCV) infection, a higher proportion of males (48.5%) tested positive compared to females (28.1%). Furthermore, the prevalence of HCV infection was significantly higher in CKD patients residing in urban areas (98.5%) compared to those in rural areas (1.5%). The statistical analysis indicated a significant association between the prevalence of Hepatitis and the factors of gender and residency (P value = 0.002). Out of 211, hepatitis C-positive patients 66.2% were diabetics and hypertensive were 77.9%. CONCLUSION Hospitalized CKD patients have a considerably higher frequency of hepatitis C infection. To stop the spread of the hepatitis C virus, nephrology wards should undertake strict universal infection control procedures.

This review article provides a comprehensive overview of the multidisciplinary management of giant cell tumors of the bone (GCTB). GCTB is a rare, intermediate-grade, benign, locally aggressive osteolytic neoplasm that primarily affects the epiphyses of long bones in individuals aged 20–45, with a female predominance. The article discusses the epidemiology, clinical features, and various management approaches for GCTB.The article highlights the importance of GCTB, which can resemble other bone lesions, so an accurate diagnosis is essential. A biopsy is a definitive way to diagnose GCTB. While, radiography includes MRI, PET scans, and bone scans to help diagnose and stage GCTB. The Campanacci grading system, based on radiographic appearance and soft tissue involvement, is commonly used to stage GCTB.Surgical management options for GCTB include intralesional curettage, wide marginal resection, and en-bloc resection, depending on the location and extent of the tumor. In challenging anatomical locations, such as the axial skeleton, intralesional curettage may be the only viable option to preserve function and minimize surgical morbidity. However, it is associated with a high rate of local recurrence. Wide marginal resection is effective in reducing recurrence rates but may result in significant morbidity and require bone defect reconstruction. En-bloc resection is preferred for tumors with soft tissue extension or involvement of expendable bones.In cases where complete surgical resection is not feasible or carries a high risk of morbidity, alternative treatment options such as radiation therapy, arterial embolization, and systemic therapy with bisphosphonates (zoledronic acid) and denosumab are valuable tools in achieving disease control and improving patient outcomes. Radiotherapy is employed for cases where the disease has recurred locally and cannot be removed surgically. Arterial embolization involves interrupting the blood supply to tumors in areas that cannot be operated on. Bisphosphonates are drugs that can be given before or after surgery to reduce the chances of recurrence by inhibiting osteoclast activity.Denosumab, a monoclonal antibody that targets RANKL, has shown promising results in reducing tumor size, facilitating surgical treatment, and improving outcomes. In conclusion, this review provides valuable insights into the epidemiology, clinical features, and multidisciplinary management approaches for GCTB. Accurate diagnosis, appropriate staging, and individualized treatment strategies are essential for optimizing patient outcomes in GCTB management.

Background Clavicle fracture (CF) is the tenth most prevalent fracture, accounting for an annual incidence of 37/10,000. This systematic review highlights the factors contributing to the nonunion union of the clavicular fracture.Method A systematic search was conducted using three web-based databases up to August 12, 2022, for conducting qualitative analysis. Articles were screened for relevance, and only studies that met inclusion criteria based on PECOS; P (patients): participants diagnosed with clavicular fracture; E (exposure): nonunion, C (control): not applicable; O (outcomes): factors contributing to nonunion or delayed union; S (studies): trials and observational studies. The Newcastle-Ottawa Scale was used to assess the quality of the cohort studies. The Cochrane risk of bias tool was used to assess the bias in randomized control trials.Results Ten studies were selected after the final literature search. Two thousand seven hundred and sixty-six adult participants who were radiologically and clinically diagnosed with nonunion clavicular fracture were included to pool the qualitative results. Fall was the most dominant cause of clavicular fracture, followed by road traffic collisions. Open reduction was widely used to treat nonunion correction. The qualitative results suggested a prominent correlation of nonunion with advancing age, female gender, high energy trauma, high Disabilities of the Arm, Shoulder, and Hand Score, smoking, fracture displacement, clavicular shortening, the callus on radiography, and fracture movement. The mid-shaft fracture was the most dominant type of fracture in the included studies; highly associated with nonunion in comparison to medial or lateral CF. The previous history of operation was an independent factor contributing to nonunion.Conclusion The results of this systematic review suggested the predictors contributing to nonunion in the CF. Demographic factors such as advancing age with female gender are at higher risk of developing clavicular nonunion. Smoking was the most dominantly highlighted environmental factor contributing to nonunion. Diaphyseal or midshaft fracture was the most common site for nonunion. Therefore, we suggested that patients with the predictors mentioned above require special attention to prevent nonunion of the CFs. More studies should be conducted on this subject to assess the factors that pose a risk associated with the nonunion of the bone for better clinical management and outcomes of the fracture.

OBJECTIVES Haemodialysis (HD) is a form of renal replacement therapy commonly prescribed for chronic kidney disease (CKD) patients. However, it is not without deleterious haemodynamic responses which may occur either during or immediately after the termination of the procedure. These may include hypotension or hypertension. The objective of this study was to determine the frequency of intradialytic blood pressure changes in chronic kidney disease patients on maintenance hemodialysis. METHODOLOGY Patients with chronic kidney disease on maintenance hemodialysis were enrolled. Predialysis and immediate post dialysis blood pressure was recorded. Increase in postdialysis blood pressure by >20mmHg was called intradialytic hypertension and decrease by >20mmHg was called intradialytic hypotension. RESULTS A total of 203 patients on maintenance hemodialysis were enrolled. Age of the patients ranged from 18 to 50 years. Mean age of the patients was 39.80 ± 5.245 years. Male to female ratio was 1.8:1. Intradialytic hypotension was observed in 36 patients (17.7%) while intradialytic hypertension was observed in 22 patients (10.8%). CONCLUSION Intradialysis blood pressure fluctuations such as hypotension and hypertension are common complications during hemodialysis. Intradialytic hypotension is more frequent.

The use of periprocedural dual antiplatelet therapy (DAPT) has significantly evolved along with innovations in the endovascular management of intracranial aneurysms. Historically, aspirin and clopidogrel have been the most commonly employed regimen due to its safety and efficacy. However, recent studies highlight the importance of tailoring DAPT regimens to individual patient characteristics which may affect clopidogrel metabolism, such as genetic polymorphisms. In the present report, a systematic review of the literature was performed to determine optimal antiplatelet use with flow diverting stents, intracranial stents, intrasaccular devices, and stent-assisted coiling. Studies were analyzed for the number of aneurysms treated, DAPT regimen, and any thromboembolic complications. Based on inclusion criteria, 368 studies were selected, which revealed the increasing popularity of alternative DAPT regimens with the aforementioned devices. Thromboembolic or hemorrhagic complications associated with antiplatelet medications were similar across all medications. DAPT with ticagrelor, tirofiban, or prasugrel are effective and safe alternatives to clopidogrel and do not require enzymatic activation. Further clinical trials are needed to evaluate different antiplatelet regimens with various devices to establish highest-level evidence-based guidelines and recommendations.

The most completed, comprehensive and the moderate ideal are the Ahadees and the Seerat of the Holy Prophet (ﷺ) that are the source of deliverance for the whole people till Qyamah. There is no sphere of life, any part of society, individual and community problem that comes out way in which we don’t find his Ahadees Mubarkah as ideal. The nearest observance was got by Sahaba e kiram, Taabeen, Taba Tabeen, Muhddiseen one after the other. They not only learned by heart after hearing him and acted upon it but also tried their best to make reach his quotes, utterance, sayings and acts. The one of them is Allama Bahqi (r.a) that devoted his life for serving the Elm e Hades. He also founded a unique literary mood and tried to perform his obligation while claiming it his obligation to preach and to make the religion eminent. He was the man who left behind him small and large books about one hundred parts. One did not left such a huge treasure of knowledge before him.

Industrial wastewater effluent containing dyes and hazardous waste, such as olive waste, pose serious threat to health and environment. This work investigated the removal of azo and non-azo dyes from a single and binary aqueous system using hydrochar produced from hazardous olive waste using hydrothermal carbonization (HTC). Optimisation suggested hydrochar obtained at 250°C (HC-9) exhibited best physiochemical, structural properties and around 300% increase in carboxylic and carbonyl groups indicated by nuclear magnetic resonance spectroscopy. HC-9 removed ∼100% of Methylene blue and Congo red in single (120 and 180 min) and binary system (60 min), respectively. Ex situ X-ray photon electron spectroscopy and surface area analysis after adsorption suggested chemisorption supported by pseudo-second order reaction, Langmuir, and Redlich-Peterson model. HC-9 exhibited around 80% reusability in three adsorption cycles. Thus, better working efficiency of our hydrochar in the complex wastewater make it a potential candidate to be employed in commercial plants.

2D metal sulphides (MSs) have attracted enormous amounts of attention in developing high‐performance gas sensors. 2D noble metal sulphides and their derivatives, however, have been less studied due to their predominant nonlayered crystal structures for inefficient exfoliation, despite their surface and peculiar optoelectronic properties. Herein, we successfully synthesize 2D palladium sulphate (PdSO4) from palladium sulphide (PdS) bulk crystals by liquid‐phase exfoliation, in which the presence of oxygen species in the exfoliation solvent plays a key role in the sulphate transformation. Ultrathin 2D PdSO4 planar nanosheets, with thicknesses of ≈3 nm and submicrometer lateral dimensions, exhibit a broad absorption across the visible spectrum, a narrow bandgap of ≈1.35 eV, and a nanosecond scaled long exciton lifetime, which are all suitable for the visible‐light‐driven optoelectronic gas sensing applications. The 2D PdSO4‐based sensor demonstrates a reversible, selective, and sensitive response toward ppb‐leveled NO2 gas at blue light irradiation, featuring a response factor of ≈3.28% for 160 ppb NO2, a low limit of detection of 1.84 ppb, and a > 3 times response factor enhancement over other gases. Herein, the possibility of realizing 2D ultrathin noble metal sulphide compounds from their nonlayered crystal structures and strong potentials in developing high‐performance chemical sensors is explored.

The synthesis methodology, particle size and shape, dose optimization, and toxicity studies of nano-fertilizers are vital prior to their field application. This study investigates the comparative response of chemically synthesized and biologically synthesized iron oxide nanorods (NRs) using moringa olefera along with bulk FeCl3 on summer maize (Zea mays). It is found that FeCl3 salt and chemically synthesized iron oxides NRs caused growth retardation and impaired plant physiological and anti-oxidative activities at a concentration higher than 25 mg/L due to toxicity by over accumulation. While iron released form biologically synthesized NRs have shown significantly positive results even at 50 mg/L due to their low toxicity, an improved leaf area (13%), number of leaves per plant (26%), total chlorophyll content (80%) and nitrate content (6%) with biologically synthesized NRs are obtained. Moreover, the plant anti-oxidative activity also increased on treatment with biologically synthesized NRs because of their ability to form a complex with metal ions. These findings suggest that biologically synthesized iron oxides NRs are an efficient iron source and can last for a long time. Thus, proving that nanofertilizer are required to have specific surface chemistry to release the nutrient in an appropriate concentration for better plant growth.

Phosphides of transition metals (TMPs) are a developing class of materials for hydrogen evolution reaction (HER) as an alternative to expensive noble metals to produce clean energy. Herein, the nitrogen-doped molybdenum oxide (MoOx) is developed via a facile and simple hydrothermal method, followed by annealing in the N2 atmosphere and phosphorization to form a nitrogen-doped oxygenated molybdenum phosphide (N-MoP) sphere-shaped structure. The developed N-doped phosphide structure depicts enhanced HER activity by reaching a current density of 10 mA cm−2 at a very low overpotential of only 87 mV, which is much better than annealed nitrogen-doped molybdenum oxide (A-MoOx) 138 mV in alkaline medium. N-MoP is a highly efficient electrocatalyst for HER attributed to a more exposed surface, large electrode/electrolyte interface and appropriate binding energies for reactants. This study extends the opportunity of developing nitrogen-doped TMPs, which can display exceptional properties as compared to their oxides.

The development of sodium and potassium ion batteries (SIBs/KIBs) has seen tremendous growth in recent years due to their promising properties as a potential replacement for lithium-ion batteries (LIBs). Here, we report ultrafine iron selenide (Fe3Se4) nanoparticles embedded into one-dimensional (1D) carbon fibers (Fe3Se4@CFs) as a potential candidate for SIBs/KIBs. The Fe-based metal-organic framework particles (MOFP) are used as a Fe source to obtain highly dispersed Fe3Se4 nanoparticles in the product. The Fe3Se4@CF consisted of ultrafine particles of Fe3Se4 with an average particle size of ~10 nm loaded into CFs with an average diameter of 300 nm. The product exhibited excellent specific activity of ~439 and ~435 mAh/g at the current density of 50 mA/g for SIBs and KIBs, respectively. In addition, the as-prepared anodes (Fe3Se4@CFs) exhibited excellent capacity retention up to several hundred cycles (700 cycles for SIBs and 300 cycles for KIBs). The high activity and excellent stability of the developed electrodes make Fe3Se4@CFs a promising electrode for next-generation batteries.

The use of cloth face coverings and face masks has become widespread in light of the COVID-19 pandemic. This paper presents a method of using low cost wirelessly connected carbon dioxide (CO2) sensors to measure the effects of properly and improperly worn face masks on the concentration distribution of exhaled breath around the face. Four types of face masks are used in two indoor environment scenarios. CO2 as a proxy for exhaled breath is being measured with the Sensirion SCD30 CO2 sensor, and data are being transferred wirelessly to a base station. The exhaled CO2 is measured in four directions at various distances from the head of the subject, and interpolated to create spatial heat maps of CO2 concentration. Statistical analysis using the Friedman’s analysis of variance (ANOVA) test is carried out to determine the validity of the null hypotheses (i.e., distribution of the CO2 is same) between different experiment conditions. Results suggest CO2 concentrations vary little with the type of mask used; however, improper use of the face mask results in statistically different CO2 spatial distribution of concentration. The use of low cost sensors with a visual interpolation tool could provide an effective method of demonstrating the importance of proper mask wearing to the public.

Background: Aerobic Exercise is a host of health benefits to reduce vigor risk and maintain body weight. The purpose of the present investigation is to determine the influence of aerobic exercises on body weight and Metabolic Equivalent of Task (MET) activity among cardiac rehabilitation phase II patients. The objective of the study is to investigate the impact of obesity on the efficacy of aerobic capacity. Methods: Fifteen obese (ten males, five females) and fifteen non-obese (eleven males, four females) participants of phase II cardiac rehabilitation were selected from a tertiary care hospital by their Body Mass Index (BMI). They were divided into two groups by simple random technique. Aerobic exercises were given for 12 weeks for post-CABG cardiac rehabilitation phase II obese and non-obese (healthy and overweight) patients. BMI and the Metabolic equivalent of task activity of cardiac rehabilitation phase II patients are measured by enrolling a patient in 12 weeks of aerobic exercises program. Results: The aerobic exercise shows a positive result in both obese and non-obese patients. Aerobic exercises improved metabolic equivalent of task in both obese(4.6667+_0.65134 ;< 0.05) and non-obese patients (4.6923+_.48038 ;< 0.05) significantly.But aerobic exercises were more effective in enhancing the efficacy of aerobic capacity in obese patients. Conclusion: It is evident that aerobic exercises are more effective for obese patients to maintain or reduces weight. Higher MET activity was observed in obese patients.

Identifying precursor events that allow the timely forecasting of landslides, thereby enabling risk reduction, is inherently difficult. Here we present a novel, low cost, flow visualization technique using time-lapsed imagery (TLI) that allows real time analysis of slope movement. This approach is applied to the Rest and Be Thankful slope, Argyle, Scotland, where past debris flows have blocked the A83 or forced preemptive closure. TLI of the Rest and Be Thankful are taken from a fixed station, 28 mm lens, time lapse camera every 15 min. Imagery is filtered to counter the effects of misalignment from wind induced vibration of the camera, asymmetric lighting, and fog. Particle image velocimetry (PIV) algorithms are then run to produce slope movement velocity vectors. PIV generated vectors are automatically post-processed to separate vectors generated by slope movement from false positives generated by harsh environmental conditions. Results for images over a 20-day period indicated precursor slope movement initiated by a rainfall event, a period of quiescence for 10 days, followed by a large landslide failure during proceeding rainfall where over 3000 tons of sediment reached the road. Results suggest low cost, live streamed TLI and this novel PIV approach correctly detect and, importantly, report precursor slope movement, allowing early warning, effective management and landslide impact mitigation. Future applications of this technique will allow the development of an effective decision-making tool for asset management of the A83, reducing the risk to life of motorists. The technique can also be applied to other critical infrastructure sites, allowing hazard risk reduction.

Fungal endocarditis is a rare entity which has a poor outcome. Our case reports an atypical presentation of similar pathology now presenting with femoral artery ischemia in an immune competent individual. A 62-year Asian male presented with sudden onset of right sided lumbar pain. Initial clinical exam was consistent with right sided renal colic. Intravenous analgesia did not relieve the pain. Repeat clinical examination revealed absent right femoral artery pulsation. The patient underwent a Computerized tomography angiography of right lower extremity. Echocardiogram revealed valvular vegetations that were later revealed to be because of Aspergillus Terreus. This case highlights the atypical presentation of a rare fungal endocarditis in an immune competent individual presenting with right sided lumbar pain. This case is of particular interest for emergency physicians who are at the forefront and may require to deal with such presentations. Keywords: Fungal endocarditis, Femoral artery, Thromboembolism, Emergency department

Purpose: This study aims to evaluate the adherence of orthopedic surgeons towards the BOAST and Rehabilitation guidelines for the diagnostic, surgical, and rehabilitation in the management of ACL injury. Methods: The clinical audit included 82 patients who had ACL reconstruction from August 1, 2018 to October 31, 2023. The retrospective data was collected for the clinical assessment, MRI timing, meniscus repair considerations, graft selection, and adherence to the rehabilitation guidelines to assess the adherence to the ACL reconstruction protocol provided by the BOAST and rehabilitation guidelines. Results: Prompt clinical assessments were observed, however, variability in MRI timings indicates concerns in the standard protocol. Meniscal repair considerations were present in 70.73 % of cases. Patient involvement in graft selection discussions favored the quadruple hamstring graft. Positive early-phase outcomes in Rehabilitation Protocol were noted, but non-compliance in later stages poses a significant challenge. Conclusion: The results showed adherence towards diagnostics methods, surgical interventions, and early rehabilitation, however, patient non-compliance after phase I was a major concern and requires special attention to addressing factors like patient education and socioeconomic barriers is crucial for comprehensive care.

The present study is aimed to investigate the phytochemical screening and biological activities of methanolic extract of Cyperus scariosus roots. Dried plant was grounded and extracted with methanol to prepare methanol crud extract. In vitro biological tests were conducted using this methanolic extracts according to the standard procedure. 100% death rate of brine shrimp was perceived at 3 mg/mL of plant extract after 72 hours. The extract showed action against Aspergillus flavius i.e. 90% followed by A. niger (91%) while the highest activity was shown against A. fumegatrus (94%). Important scavenging results were detected during scavenging of free radicals viz; 92.2% against DPPH, 82.2% to ABTS, 75.8% to hydrogen peroxide, 88.1% to ?-carotene, 86.1% to hydroxyl radical and 89.4% against phosphomolybdate at 3 mg/mL were obtained. The results obtained in this study point out that extract showed significant biological activities which might be due to the presence of bioactive constituents.

Abstract A recent study of randomized controlled trials showed favorable outcomes with use of decompressive craniectomy in managing and treating uncontrolled intracranial pressures accompanied with cerebral edema due to trauma. We present the details of bicompartmental decompressive craniectomy on two patients who presented with severe head trauma of supra- and infratentorial pathologies. The surgical management techniques and long-term follow-up are discussed in detail.