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Transcatheter aortic valve replacement (TAVR) is considered more effective than surgical aortic valve implantation for patients with a small aortic annulus (SAA), however, the comparative efficacy of different transcatheter heart valves (THVs) remains uncertain. A literature search was performed across databases from their inception until June 2024 to identify eligible randomized controlled trials (RCTs) and propensity-score matched (PSM) studies. Clinical outcomes were evaluated using a random-effects model to pool risk ratios (RRs) with 95 % confidence intervals (CIs). The analysis included 10 studies with 2,960 patients. BEVs were associated with a significantly smaller indexed effective orifice area (MD: −0.18, 95 % CI: −0.27 to −0.10), and a higher transvalvular mean pressure gradient (MD: 5.07, 95 % CI 3.43 to 6.71) than SEVs. The risk for prosthesis-patient mismatch (PPM) (RR = 1.89, 95 % CI: 1.42 to 2.51) and severe PPM (RR = 2.80, 95 % CI: 1.96 to 4.0) was significantly higher for patients receiving BEVs than those receiving SEVs. Although nonsignificant differences were observed between BEVs and SEVs regarding 30-day and 1-year all-cause mortality, 30-day stroke rates, vascular complication, paravalvular leak, and permanent pacemaker implantation (p > 0.05), patients receiving BEVs were associated with a significantly increased risk of 1-year cardiovascular mortality (RR = 1.61, 95 % CI: 1.05 to 2.47) compared to those receiving SEVs. In patients with SAA, BEVs demonstrated worse hemodynamic performance as determined by the higher risk of moderate and severe PPM compared to SEVs. Moreover, the use of BEVs was associated with a higher risk of 1-year cardiovascular mortality.

ABSTRACT Background Almost half of the US adult population has obesity, which predisposes to atherosclerosis and can lead to poor prognosis in coronary artery disease (CAD). We aim to identify CAD and obesity‐related mortality trends among adults in the United States stratified by age, sex, race and geographical location. Methods The CDC‐WONDER database was used to extract death certificate data for adults aged ≥ 25 years. Crude mortality rates (CMR) and age‐adjusted mortality rates (AAMRs) per 100,000 persons were calculated, and temporal trends were described by calculating annual percent change (APC) and the average APC (AAPC) in the rates using Joinpoint regression analysis. Results From 1999 to 2022, a total of 273,761 CAD and obesity‐related deaths were recorded in the United States. The AAMR increased consistently from 1999 to 2018 (APC: 4.3, 95% confidence interval (CI): 3.4–4.9) and surged thereafter till 2022 (APC: 11.4; 95% CI: 7.7–19.1). During the COVID‐19 pandemic (2020–2022), AAMR almost doubled that of the rest of the study period. Additionally, the AAMR for males was nearly twice that of females. Non‐Hispanic (NH) Blacks or African Americans displayed the highest AAMR, followed by NH Whites, Hispanic or Latino, and other NH populations. AAMRs showed minimal variation by census regions. Rural areas exhibited a higher AAMR (AAMR: 5.9, 95% CI: 5.8–5.9) than urban areas (AAMR: 4.4, 95% CI: 4.4–4.5). Conclusions We observed increasing trends in CAD and obesity‐related deaths throughout the study period reaching a peak during the COVID‐19 pandemic.

Background Echocardiography, cardiac magnetic resonance and cardiac 18fluorodeoxyglucose positron emission tomography (FDG-PET) imaging play key roles in the diagnosis and management of cardiac sarcoidosis (CS), but the relative value of each modality in predicting outcomes has yet to be determined. This study sought to determine the prognostic importance of multimodality imaging data over and above demographic characteristics and left ventricular ejection fraction (LVEF).Methods Consecutive patients newly diagnosed with CS were included. Parameters evaluated included echocardiographic regional wall motion abnormality (RWMA), myocardial strain, LVEF, right ventricular ejection fraction (RVEF), late gadolinium enhancement (LGE) extent, SUVmax and RV FDG uptake. The primary endpoint was a composite of all-cause mortality and serious ventricular arrhythmia.Results The study population consisted of 208 patients with mean age of 55±13 years and LVEF of 55±12%. During a median follow-up period of 46 (IQR: 18–55) months, 14 patients died and 28 suffered serious ventricular arrhythmias. On multivariable analysis, RWMA (HR for RWMA presence 2.55, 95% CI 1.27 to 5.28, p=0.008), LGE extent (HR per 1% increase 1.02, 95% CI 1.00 to 1.04, p=0.018), RVEF (HR per 1% decrease 0.97, 95% CI 0.94 to 0.99, p=0.008) and RV FDG uptake (HR for RV FDG presence 2.48, 95% CI 1.15 to 5.33, p=0.020) were independent predictors of the primary endpoint, while LVEF was not predictive. The risk of adverse events was significantly greater in those with LGE extent ≥15% (HR for ≥15% presence 3.96, 95% CI 2.17 to 7.23, p

Beyond hexagons, a distinctive family of pentagonal two-dimensional materials (2DMs) has emerged, featuring asymmetric geometry, exotic characteristics, and promising applications. Pentagonal tessellation of 2DMs generally leads to semiconducting bandgaps and directional electrical and optical properties. The theoretical prediction of penta-graphene and the experimental realization of materials, such as PdSe2, PdPSe, PdPS, and NiN2, have revealed a new horizon for penta-materials, showcasing high air stability and inherent auxeticity. Due to the rarity of pentagonal topology in nature, it is crucial to employ computational models and simulations to establish the stable configurations of these materials and understand their behavior in pentagonal arrangements. Consequently, the multitude of theoretically predicted penta-materials far surpasses the number of experimentally synthesized ones, numbering in the hundreds. A comprehensive catalog encapsulates recent progress, properties, and future perspectives, unlocking their full potential and paving the way for experimental realization. This review presents an extensive compilation of predicted penta-materials to date, elucidating their properties and potential applications. [ABSTRACT FROM AUTHOR]

Introduction: Those with cardiac sarcoidosis (CS) are at risk of sudden cardiac death (SCD), which may be prevented using an implantable cardioverter–defibrillator (ICD). There are limited data available that follow the post-procedural outcomes of patients with cardiac sarcoidosis (CS) who have had an ICD implanted. Areas Covered: This review highlights studies that focused on both appropriate and inappropriate therapies in those with an ICD, as well as device complications in this group. There were several variables, including age, sex, ventricular characteristics, and findings on cardiac imaging that were investigated and discussed as influencing factors in predicting appropriate and inappropriate therapies. Conclusions: Adverse events in those with an ICD and CS have been minimally reported in the literature. Individuals diagnosed with CS are at high risk of ventricular arrhythmia, with comparable rates of appropriate therapy but with a higher incidence of side effects and inappropriate therapy. The younger average age of CS patients in comparison to other ICD cohorts warrants the need for further, large-scale, prospective trials with periodic interim follow-ups focused on those with this condition.

ABSTRACT Background Sodium‐glucose cotransporter 2 (SGLT2) inhibitors improve cardiovascular (CV) outcomes in patients with or without Type 2 diabetes and heart failure (HF). However, studies have shown conflicting evidence regarding their efficacy in patients following acute myocardial infarction (MI). We conducted a pilot systematic review and meta‐analysis to synthesise the available evidence regarding the effectiveness of SGLT2 inhibitors in MI. Methods A systematic literature search was conducted using PubMed/MEDLINE, the Cochrane Library and Embase databases to identify randomised controlled trials (RCTs) that compared clinical outcomes of SGLT2 inhibitors with placebo following MI. We conducted the statistical analysis using RevMan, version 5.4 and pooled risk ratios (RRs) along the corresponding 95% confidence interval (CI) for all outcomes. Results Five RCTs reporting data for 11,211 patients were included in our study. The mean follow‐up duration was 43.8 weeks. Our pooled analysis showed that SGLT2 inhibitors significantly reduced the risk of hospitalisations for heart failure (HHF) (RR = 0.76, 95% CI: 0.61–0.88, p = 0.001) in patients with MI. However, the risk of all‐cause mortality (RR = 1.05, 95% CI: 0.78–1.41, p = 0.76), CV mortality (RR = 1.04, 95% CI = 0.84–1.29, p = 0.73) and all‐cause hospitalisations (RR = 1.06, 95% CI: 0.96–1.17, p = 0.25) remained comparable across the two groups. Conclusion SGLT2 inhibitors reduce HHF without affecting all‐cause mortality, CV mortality and all‐cause hospitalisations. However, further evidence is required to reach a definitive conclusion.

During the pandemic of COVID-19, a novel atypical set of clinical findings was seen among several children with recent or current exposure to the virus. It was termed the “multisystem inflammatory syndrome in children” (MIS-C). Our study used the 2021 National Inpatient Sample to study the associations of sex, race, and age with the incidence of MIS-C among COVID-19-positive children. Out of 69,440 COVID-19-positive children, 2,790 (4.0%) reported MIS-C. The incidence of MIS-C was highest among those aged 8 years old (17,130 MIS-C cases per 100,000 COVID-19 patients), Asian or Pacific Islanders (API) (5,346 MIS-C per 100,000 COVID-19 cases), and males (4,734 cases per 100,000 COVID-19 cases). Furthermore, 7.9% of MIS-C cases met the classification of Kawasaki disease.

OBJECTIVE: To predict mortality using the APACHE II score in patients presenting with peritonitis and undergoing emergency exploratory laparotomy. Methodology: The prospective study was conducted in Civil Hospital Karachi's surgery department from April to September 2021, with a non-probability sampling technique. A total of 84 patients of either sex between the age of 16-70 years who met the diagnostic criteria of peritonitis were included consecutively. Patients with incomplete laboratory records and uncorrectable preoperative comorbidities were excluded. The APACHE II score was categorized into three groups, and demographic details and outcomes were calculated using SPSS version 20 for the data analysis. Post-stratification Chi-square test was applied, taking a p-value of < 0.05 as statistically significant. RESULTS: Out of 84 patients, 38 (45.2%), 37 (44%) and 09 (10.7%) had APACHE score < 10, 11-20 and ≥ 20 respectively. The total in-hospital mortality rate was 8.3%. In the patients with the lowest APACHE score < 10, a mortality rate of 2.6% was recorded. A mortality of 5.4% was recorded in patients with APACHE II group 2, while group 3 with APACHE II score > 20 had the highest mortality rate of 44%. The difference was statistically significant. (p=0.001). CONCLUSION: The results of the APACHE II score obtained in patients classified them into three different groups based on the severity of conditions in patients with peritonitis, which validated the Prediction of increased mortality with higher scores.

Background: Dementia is a recognized complication of atrial fibrillation (AF). Oral anticoagulant (OAC) therapy can potentially be protective against this complication. Methods: A comprehensive search of MEDLINE and Embase for comparative observational studies reporting the efficacy of OAC therapy for the incidence of dementia in patients with AF was conducted from its inception until March 2023. Studies that had patients with prior use of OAC or with a previous history of dementia were excluded. Results: A total of 22 studies were included in this review involving 617,204 participants. The pooled analysis revealed that OAC therapy, including direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs), was associated with a reduced incidence of dementia in AF patients. Specifically, compared to non-OAC treatment, OACs demonstrated a significant reduction in dementia incidence (HR 0.68, 95 % CI [0.58, 0.80], p

BackgroundOptical coherence tomography (OCT) and intravascular ultrasound (IVUS) are superior to coronary angiography for guiding percutaneous coronary intervention (PCI). However, whether one technique is superior to the other is inconclusive.MethodsWe searched PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov from inception to November 2023 for randomized controlled trials (RCTs) comparing OCT and IVUS in patients undergoing PCI. RevMan 5.4 was used to pool outcomes with risk ratio (RR) as the effect measure.ResultsSix RCTs (4,402 patients) were included in this meta-analysis. There was no significant difference between the OCT- and IVUS-guided PCI groups in the risk of major adverse cardiovascular events (RR 0.87, 95% CI: 0.65, 1.16; I2 = 0%) and cardiac mortality (RR 0.73, 95% CI: 0.24, 2.21; I2 = 0%). The results were consistent across the subgroups of the presence or absence of left main disease (Pinteraction >0.1). There were no significant differences between OCT and IVUS in the risk of target lesion revascularization (RR 0.78, 95% CI: 0.47, 1.30; I2 = 0%), target vessel revascularization (RR 1.06, 95% CI: 0.69, 1.62; I2 = 0%), target-vessel myocardial infarction (RR 0.79, 95% CI: 0.40, 1.53; I2 = 0%), stent thrombosis (RR 0.59, 95% CI: 0.12, 2.97; I2 = 0%), and all-cause mortality (RR 1.01, 95% CI: 0.53, 1.90; I2 = 0%).ConclusionsOur meta-analysis demonstrated similar clinical outcomes in OCT- and IVUS-guided PCI. New large-scale multicenter RCTs with long-term follow-up are required to confirm or refute our findings and provide more reliable results.Systematic Review RegistrationPROSPERO, identifier, CRD42023486933

Abstract Background Cardiac tamponade (CT) can be a complication following invasive cardiac procedures. We assessed CT following common cardiac electrophysiology (EP) procedures to facilitate risk prediction of associated morbidity and in‐hospital mortality. Methods Patients who underwent various EP procedures in the cardiac catheterization lab (ablations and device implantations) were identified using the International Classification of Diseases, Ninth and Tenth Edition, Clinical Modification (ICD‐9‐CM and ICD‐10‐CM, respectively) from the Nationwide Inpatient Sample (NIS) database. Patient demographics, presence of comorbidities, CT‐related events, and in‐hospital death were also abstracted from the NIS database. Results The frequency of CT‐related events in patients with EP intervention from 2010 to 2017 ranged from 3.4% to 7.0%. In‐hospital mortality related to CT‐related events was found to be 2.2%. Increasing age was the only predictor of higher mortality in atrial fibrillation (AF) ablation and cardiac resynchronization therapy (CRT) groups (OR [95% CI]: AF ablation = 11.15 [1.70–73.34], p = .01; CRT = 1.41 [1.05–1.90], p = .02). Conclusions In the real‐world setting, CT‐related events in EP procedures were found to be 3.4%–7.0% with in‐hospital mortality of 2.2%. Older patients undergoing AF ablation were found to have higher mortality.

Emicizumab is a humanized, bispecific monoclonal antibody that connects active factor IX and X to replace the function of absent factor VIII, restoring hemostasis. It has a long half-life with a subcutaneous route of administration and high bioavailability. Here, we assessed the efficacy of Emicizumab prophylaxis in terms of efficiency, safety, and quality of life of severe hemophilia A (HA) patients with and without inhibitors before and after this treatment. Methods In this prospective study, severe HA patients were recruited from January 2022 to June 2023. Inhibitor positive and inhibitor negative patients with annual bleeding rate (ABR) 8 or greater and past histories of bleeding like intra-cranial, intra-abdominal, and pseudo-tumors were included. Emicizumab loading dose was 3 mg/kg in the first 4 weeks, and the maintenance dose was started at week 5 at 6 mg/kg/month. Patients’ detailed bleeding history and demographics were recorded. The five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) was used to evaluate patients’ HRQoL. Furthermore, Hemophilia Joint Health Score (HJHS) and Functional Independence score in Hemophilia (FISH) were applied for the assessment of joints at different time points. Results were analyzed by SPSS version 21. Results A total of 36 HA male patients with the mean age of 19.7 ± 14.42 years were recruited in the study; among them, 19 patients were inhibitor positive, while 17 were negative. Patients clinically presented with bleeding symptoms which included: hemarthrosis 95%, GI bleeding 13.8%, and bruises and gums bleeding 13.8%. Significant reduction was observed in the bleeding episodes after the therapeutic intervention, and joints assessment and Euro-Quality-of-life Visual Analog Scale showed a significant improvement in health after treatment. Similarly, there was a remarkable reduction in bleeding episodes and improved quality of life among HA patients. The ABR decreased from 53.6% episodes per year prior to treatment to 2.4% during Emicizumab therapy. Prior to initiating Emicizumab therapy, participants exhibited an average FISH score of 16 and HJHS score of 10, indicating moderate limitations due to joint-related issues. After treatment, the mean FISH score improved to 9 and HJHS score to 4 reflecting a substantial enhancement in participants’ ability to perform daily activities ( P

Background and Objectives: Coronavirus disease 2019 (COVID-19) caused several cardiovascular complications, including acute myocardial infarction (AMI), in infected patients. This study aims to understand the overall trends of AMI among COVID-19 patients during the first two years of the pandemic and the disparities and outcomes between the first and second years. Materials and Methods: The retrospective analysis was conducted via the 2020 and 2021 National Inpatient Sample (NIS) database for hospitalizations between April 2020 and December 2021 being analyzed for adults with a primary diagnosis of COVID-19 who experienced events of AMI. A comparison of month-to-month events of AMI and mortality of AMI patients with concomitant COVID-19 was made alongside their respective patient characteristics. Results: Out of 2,541,992 COVID-19 hospitalized patients, 3.55% experienced AMI. The highest rate of AMI was in December 2021 (4.35%). No statistical differences in trends of AMI mortality were noted over the 21 months. AMI cases in 2021 had higher odds of undergoing PCI (aOR 1.627, p < 0.01). They experienced higher risks of acute kidney injury (aOR 1.078, p < 0.01), acute ischemic stroke (aOR 1.215, p < 0.01), cardiac arrest (aOR 1.106, p < 0.01), need for mechanical ventilation (aOR 1.133, p < 0.01), and all-cause mortality (aOR 1.032, 95% CI 1.001–1.064, p = 0.043). Conclusions: The incidence of AMI among COVID-19 patients fluctuated over the 21 months of this study, with a peak in December 2021. COVID-19 patients reporting AMI in 2021 experienced higher overall odds of multiple complications, which could relate to the exhaustive burden of the pandemic in 2021 on healthcare, the changing impact of the virus variants, and the hesitancy of infected patients to seek care.

Due to a lack of authority in Roman-Dutch law in respect of claims for psychological harm, our courts in South Africa relied on English law for guidance, in particular the tort of negligence where emphasis is placed on reasonable foreseeability of harm. The courts in both jurisdictions generally face challenges with who exactly is entitled to claim, the quantification of the damages that should be awarded and how to limit delictual or tort liability emanating from these types of claims. South African law also followed English law in making the distinction between primary and secondary victims and as will be shown in this contribution, limiting liability in respect of secondary victims is problematic. The courts generally tread with caution in awarding damages for pure psychological or psychiatric harm and several policy considerations are taken into account when deciding to award damages or not. Nevertheless, as will be shown in this contribution, the courts in South Africa and the United Kingdom acknowledge these claims and have been developing the law around the cases that have come before them. What is rather interesting and prevalent though with regard to primary and secondary victim claims for psychological or psychiatric harm in these jurisdictions, is the implicit and explicit influence of "reasonableness" in determining delictual or tort liability for these types of claims. This will be explored further in this contribution.

American and French law, like South African law recognises claims for emotional or mental harm. Emotional, mental, or psychological harm was only recognised by the courts in the 1800's and even though the mind and body in a sense is considered as a unit, these types of claims are not on par with claims for physical bodily injury. In fact, these types of claims can be regarded as sui generis but within the broader ambit of delictual or tort liability. Finding delictual or tort liability for emotional, mental or psychological harm has been problematic not only in South Africa but also in the United States of America and France. Even though there are fundamental differences in the law between these jurisdictions, the broader questions the courts face is whether a claimant is entitled to claim, the amount of damages that should be awarded and how to limit liability with these types of claims. Limiting liability for emotional or mental harm is generally the main policy concern but the courts have found ways of using the elements or concepts such as reasonable foreseeability of harm to limit the claims. American, French, and South African law recognise claims for emotional, mental or psychological harm by primary and secondary victims. Thus emotional, mental, or psychological harm caused directly or indirectly is compensable. In American and French law, the concept of reasonableness plays an important role, whether it be implicit or explicit, in determining delictual or tort liability for emotional or mental harm. In a sense also, reasonableness plays an overarching role in determing the liability. In a previous contribution, the influence of reasonableness in determining delictual or tort liability for psychiatric or psychological harm in English and South African law was discussed. In this contribution, the focus is on the influence of reasonableness in determining delictual or tort liability for emotional or mental harm in American and French law.

OBJECTIVE: To determine the frequency of Surgical Site Infection after open appendectomy using antimicrobial sutures. METHODOLOGY: Present study design was prospective case series conducted after the approval from the Research, Training and Monitoring Cell of CPSP in Department of Surgery, Dr.Ruth K.M Pfau, Civil Hospital Karachi/ Dow University of Health Sciences Karachi from December 2017 to May 2018 with nonprobability sampling technique. All patients between the age of 15-40 years of either sex who visited the Emergency Department and were diagnosed clinically with acute appendicitis were included in the study. Patients with generalized peritonitis or per-operative findings of malignancy, perforation, or gangrenous appendix were not enrolled. Open appendectomy was carried out in all patients, antimicrobial coated sutures were used throughout the surgery, and the patient was kept under followup for 3 months in surgical OPD to detect any clinical feature of SSI. The data was analyzed using SPSS version 17. RESULTS: Among 139 studies cases, 76 (54.68%) were male, and 63 (45.32%) were females with a male to female ratio of 1.2:1. The age range was from 15 to 40 years with a mean age of 27.23±5.97 years. The majority of the patients, 88 (63.31%), were between 15 to 30 years of age. In this study, frequency of SSI after appendectomy using antimicrobial coated suture was found in 14 (10.07%) patients. CONCLUSION: The results demonstrate that the frequency of surgical site infection after incorporating antimicrobial sutures (Triclosan) is not significantly different statistically as expected in cleancontaminated abdominal surgery.

Scalp Electroencephalography (EEG) is one of the most popular noninvasive modalities for studying real-time neural phenomena. While traditional EEG studies have focused on identifying group-level statistical effects, the rise of machine learning has prompted a shift in computational neuroscience towards spatio-temporal predictive analyses. We introduce a novel open-source viewer, the EEG Prediction Visualizer (EPViz), to aid researchers in developing, validating, and reporting their predictive modeling outputs. EPViz is a lightweight and standalone software package developed in Python. Beyond viewing and manipulating the EEG data, EPViz allows researchers to load a PyTorch deep learning model, apply it to EEG features, and overlay the output channel-wise or subject-level temporal predictions on top of the original time series. These results can be saved as high-resolution images for use in manuscripts and presentations. EPViz also provides valuable tools for clinician-scientists, including spectrum visualization, computation of basic data statistics, and annotation editing. Finally, we have included a built-in EDF anonymization module to facilitate sharing of clinical data. Taken together, EPViz fills a much needed gap in EEG visualization. Our user-friendly interface and rich collection of features may also help to promote collaboration between engineers and clinicians.

Herpes simplex virus (HSV) is a rare cause of acute hepatitis in patients with chronic immunosuppression, including Crohn’s disease. HSV hepatitis has the propensity to cause acute liver failure and death. The presenting signs and symptoms can be nonspecific, thereby causing the diagnosis to go overlooked with inadequate management, leading to a high mortality rate. We report a case of a 31-year-old male on chronic prednisone treatment for Crohn’s disease who unexpectedly died. Subsequently, an autopsy showed HSV hepatitis as the cause of death. Thus, although a rare complication, HSV hepatitis should always be kept in mind as a fatal complication in patients with acute hepatitis and chronic immunosuppression.

Recent advances in artificial intelligence have greatly impacted the field of medical imaging and vastly improved the development of computational algorithms for data analysis. In the field of pediatric neuro-oncology, radiomics, the process of obtaining high-dimensional data from radiographic images, has been recently utilized in applications including survival prognostication, molecular classification, and tumor type classification. Similarly, radiogenomics, or the integration of radiomic and genomic data, has allowed for building comprehensive computational models to better understand disease etiology. While there exist excellent review articles on radiomics and radiogenomic pipelines and their applications in adult solid tumors, in this review article, we specifically review these computational approaches in the context of pediatric medulloblastoma tumors. Based on our systematic literature research via PubMed and Google Scholar, we provide a detailed summary of a total of 15 articles that have utilized radiomic and radiogenomic analysis for survival prognostication, tumor segmentation, and molecular subgroup classification in the context of pediatric medulloblastoma. Lastly, we shed light on the current challenges with the existing approaches as well as future directions and opportunities with using these computational radiomic and radiogenomic approaches for pediatric medulloblastoma tumors.

Calcineurin inhibitors (CNIs) are typically used to prevent organ rejection and their use has significantly improved allograft and survival rates with a marked reduction in rejection rates. However, CNIs have been associated with various side effects including nephrotoxicity, hypertension, gingival hyperplasia, hypertrichosis, hepatotoxicity, hyperkalemia, and neurotoxicity. Significant intra-patient and interpatient pharmacokinetic variability and narrow therapeutic indices make the therapy complicated. Although CNIs are essential in preventing organ rejection, higher doses could lead to toxicity, which can reduce patient tolerability and negatively affect long-term allograft survival and patient mortality. As individual patients respond differently to comparable drug levels, attaining the optimal drug level range does not ensure lack of drug toxicity or complete immunosuppressant viability. One to two adverse effects are commonly observed in patients using CNIs. However, no case about CNI-induced gingival hyperplasia, hypertrichosis, tremors, facial nerve palsy, and blepharospasm after kidney transplantation in a single patient has been reported. Our report describes the unusual case of a patient presenting with CNI-induced multiple adverse reactions.

Background Marfan syndrome (MFS) is an autosomal dominant connective tissue disorder affecting multiple systems, particularly the cardiovascular system. The leading causes of death in MFS are aortopathies and valvular disease. We wanted to identify the frequency of arrhythmia and postural orthostatic tachycardia syndrome, length of hospital stay, health care–associated costs (HAC), and in‐hospital mortality in patients with MFS. Methods and Results The National Inpatient Sample database from 2005 to 2014 was queried using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) codes for MFS and arrhythmias. Patients were classified into subgroups: supraventricular tachycardia, ventricular tachycardia (VT), atrial fibrillation, atrial flutter, and without any type of arrhythmia. Data about length of stay, HAC, and in‐hospital mortality were also abstracted from National Inpatient Sample database. Adjusted HAC was calculated as multiplying HAC and cost‐to‐charge ratio; 12 079 MFS hospitalizations were identified; 1893 patients (15.7%) had an arrhythmia; and 4.9% of the patients had postural orthostatic tachycardia syndrome. Median values of length of stay and adjusted HAC in VT group were the highest among the groups (VT: 6 days, $18 975.8; supraventricular tachycardia: 4 days, $11 906.6; atrial flutter: 4 days, $11 274.5; atrial fibrillation: 5 days, $10431.4; without any type of arrhythmia: 4 days, $8336.6; both P=0.0001). VT group had highest in‐patient mortality (VT: 5.3%, atrial fibrillation: 4.1%, without any type of arrhythmia: 2.1%, atrial flutter: 1.7%, supraventricular tachycardia: 0%; P

The kidney is the most vulnerable organ in coronavirus disease-2019 (COVID-19) patients besides the lungs, with evidence of acute kidney injury (AKI). We aimed to find the prevalence of AKI among COVID-19 patients and further evaluate the association of between COVID-19 and AKI along with an understanding of mortality. A prospective observational study was conducted among COVID-19 patients admitted to a tertiary care hospital, Hayatabad Medical Complex, between March 2020 and June 2020. Chi-square test was applied for comparative analysis, whereas for predictors of mortality, odds ratios (OR) were calculated using logistic regression. A total of 606 patients with COVID-19 were admitted to the dedicated ward, of which 250 (41.3%) had AKI and 190 (31.4%) died, whereas, patients having AKI presented 62.1% of mortality. Our study revealed a statistically significant association between AKI and mortality (OR = 3.5; P

We propose a novel neural network architecture, SZTrack, to detect and track the spatio-temporal propagation of seizure activity in multichannel EEG. SZTrack combines a convolutional neural network encoder operating on individual EEG channels with recurrent neural networks to capture the evolution of seizure activity. Our unique training strategy aggregates individual electrode level predictions for patient-level seizure detection and localization. We evaluate SZTrack on a clinical EEG dataset of 201 seizure recordings from 34 epilepsy patients acquired at the Johns Hopkins Hospital. Our network achieves similar seizure detection performance to state-of-the-art methods and provides valuable localization information that has not previously been demonstrated in the literature. We also show the cross-site generalization capabilities of SZTrack on a dataset of 53 seizure recordings from 14 epilepsy patients acquired at the University of Wisconsin Madison. SZTrack is able to determine the lobe and hemisphere of origin in nearly all of these new patients without retraining the network. To our knowledge, SZTrack is the first end-to-end seizure tracking network using scalp EEG.

OBJECTIVE: To compare mean post-operative pain score in midline laparotomy incisions made using scalpel versus mono-polar diathermy. METHODOLOGY: Present study was Randomized Controlled trial conducted at Department of Surgery, Dr. Ruth Katherina M. Pfau Civil Hospital Karachi from July 2016 to June 2017. A total 80 patients were randomly divided in two equal groups. Group A patients underwent exploratory laparotomy with scalpel with disposable blade while Group B with monopolardiathermy in cutting mode. Postoperatively pain score was measured using Visual Analogue Scale. RESULTS: Mean age was 31.45±9.69. Mean pain score on post operative day 1 was 8.60±0.92 in group A (Scalpel) and 5.98±0.26 in group B (Diathermy). Mean pain score on day 2 and 3 was 7.25±0.8 vs 3.80±0.9 and 5.5±0.6 vs 2.7±0.8 in group A and B respectively. P-value was found to less than 0.001 and therefore greatly significant. CONCLUSION: The findings of this study show that incision made by diathermy is safe and effective in terms of post-operative pain as compared to scalpel incision.

The standard of the reasonable person or its equivalent, in general, is used in many jurisdictions to determine fault in the form of negligence. Although the standard is predominantly objective it is also subjective in that the subjective attributes of the person against whom the standard applies as well as the subjective circumstances present at the time of the delict or tort lend themselves to an objective-subjective application. In South African law, before a person can be judged according to the standard of the reasonable person, the person must first be held accountable. If a person cannot be held accountable, then the standard does not apply at all. The general standard of the reasonable person cannot be applied to children, the elderly, persons with physical disabilities, persons with mental impairments or experts. Therefore, depending on the subjective attributes of the person against whom the standard is being applied, the standard may have to be adjusted accordingly. The general standard of the reasonable person would be raised when dealing with experts, for instance, and lowered when dealing with persons with physical disabilities. This contribution considers whether the current application of the standard of the reasonable person in South African law is satisfactory when applied generally to all persons, no matter their age, experience, gender, physical disability and cognitive ability. The application of the standard of the reasonable person in South African law is compared to the application of the standard of the reasonable person or its equivalent in the United Kingdom, the United States of America and France. Just as South African law applies the standard of the reasonable expert to experts, this contribution explores whether the South African law should be developed to use similar adjusted standards when dealing with children, the elderly, persons with physical disabilities and so on. The general standard of the reasonable person cannot be applied to children, the elderly, persons with physical disabilities, persons with mental impairments as well as experts. Thus depending on the subjective attributes of the person against whom the standard is being applied, the standard may have to be adjusted accordingly or if the person cannot be held accountable, not applied at all. The general standard of the reasonable person would for example be raised when dealing with experts and lowered when dealing with persons with physical disabilities. This contribution considers whether the current application of the standard of the reasonable person in South African law is satisfactory when applied generally, to all persons, no matter their age, experience, gender, physical disability and cognitive ability. The application of the standard of the reasonable person in South African law is compared to the application of the standard of the reasonable person or its equivalent in the United Kingdom, the United States of America and France. Just as South African law applies the standard of the reasonable expert to experts, this contribution explores whether the South African law should be developed to use similar adjusted standards when dealing with children, the elderly, persons' with physical disabilities and so on. [1] In French law bonus pater familias as three separate words is encountered (see para 3.4 below) whereas in South African law, bonus paterfamilias, as two separate words is encountered (see for example, Neethling and Potgieter Law of Delict 142-143). In this contribution, for the sake of uniformity and convenience, bonus pater familias as three separate words will be used.