Search

Abstract Objective This review specifically investigates ketamine’s role in SRSE management. Methods PubMed, EMBASE, and Google Scholar databases were searched from inception to May 1st, 2023, for English-language literature. Inclusion criteria encompassed studies on SRSE in humans of all ages and genders treated with ketamine. Results In this systematic review encompassing 19 studies with 336 participants, age ranged from 9 months to 86 years. Infections, anoxia, and metabolic issues emerged as the common causes of SRSE, while some cases had unknown origins, termed as NORSE (New Onset RSE) or FIRESs (Febrile Infection-Related Epilepsy Syndrome). Most studies categorized SRSE cases into convulsive (N = 105) and non-convulsive (N = 197). Ketamine was used after failed antiepileptics and anesthetics in 17 studies, while in others, it was a first or second line of treatment. Dosages varied from 0.5 mg/kg (bolus) and 0.2-15 mg/kg/hour (maintenance) in adults and 1-3 mg/kg (bolus) and 0.5-3 mg/kg/hour (maintenance) in pediatrics, lasting one to 30 days. Ketamine was concurrently used with other drugs in 40–100% of cases, most frequently propofol and midazolam. Seizure resolution rate varied from 53.3 to 91% and 40–100% in larger (N = 42–68) and smaller case series (N = 5–20) respectively. Seizure resolution occurred in every case of case report except in one in which the patient died. Burst suppression in EEG was reported in 12 patients from two case series and two case reports. Recurrence was reported in 11 patients from five studies. The reported all-cause mortality varied from 38.8 to 59.5% and 0-36.4% in larger and smaller case series., unrelated directly to ketamine dosage or duration. Significance Ketamine demonstrates safety and effectiveness in SRSE, offering advantages over GABAergic drugs by acting on NMDA receptors, providing neuroprotection, and reducing vasopressor requirement.

Abstract Background Patients with chronic kidney disease on haemodialysis (HD) were given priority COVID-19 vaccination due to increased disease risk. The immune response to COVID-19 vaccination in patients on HD was diminished compared to healthy individuals in 2-dose studies. This study aimed to evaluate seroconversion rate, neutralizing antibody (nAB) levels and longitudinal antibody dynamics to 3-dose heterologous vaccination against COVID-19 in a cohort of HD patients compared to healthy controls and assess patient factors associated with antibody levels. Methods This study was a case–control longitudinal evaluation of nAB dynamics in 74 HD patients compared to 37 healthy controls in a low/middle income setting. Corresponding samples were obtained from the two cohorts at time-points (TP) 1–1-month post 2nd dose of AZD1222 vaccine, TP2- 4 months post 2nd dose, TP4- 2 weeks post 3rd dose with BNT162b2 vaccine, TP5-5 months post 3rd dose and TP6-12 months post 3rd dose. Additional data is available at TP0- pre 2nd dose and TP3- 6 months post 2nd dose in HC and HD cohorts respectively. Anti-SARS-CoV-2 nAB were detected using Genscript cPassTM pseudoviral neutralization kit. Demographic and clinical details were obtained using an interviewer administered questionnaire. Results Cohorts were gender matched while mean age of the HD cohort was 54.1yrs (vs HCs mean age, 42.6yrs, p 0.05), MAB-1029 IU/ml vs 1538 IU/ml (p 0.05); TP6-100% vs 100%, MAB-1961 IU/ml vs 2911 IU/ml (p > 0.05). At TP2, patients aged 60 years. Conclusion Two dose vaccination of haemodialysis patients provided poor nAB levels which improved markedly following 3rd dose vaccination, the effect of which was long- lasting with high nAB levels in both patients and controls detectable at 1 year follow-up.

OBJECTIVE: To investigate the associations of miRNA-132, miRNA-182, and miRNA-124 with long-term depression and elucidate their target genes and translational implications utilizing miRabel, a bioinformatics tool. METHODS: This study is a part of a randomized controlled trial conducted in Psychiatry OPD of a teaching hospital, Peshawar, Pakistan from February-2021 till December-2021. It’s a computational study using miRabel which is a miRNA target prediction instrument. This software improves bioinformatic analysis by anticipation of microRNAs targets by grading and grouping. RESULTS: By utilizing the miRabel software, our research reveals that miRNA-132, miRNA-182, and miRNA-124 target a total of 123 genes involved in long-term depression. Out of these genes, twelve (PRKCB, PLA2G4A, PRKCG, GNAZ, GNAO1, GUCY1B3, GNAI2, PLCB3, PPP2R1A, PLCB2, GNA11, and GUCY1A2) display significant potential impact, with scores close to 1.0 (0.9). These particular genes exhibit a stronger influence compared to other target genes of miRNA-132, miRNA-182, and miRNA-124 concerning long-term depression. Our investigation also revealed that these genes target several pathways, including Beta-catenin independent WNT signaling, Corticotropin-releasing hormone relating pathway, ErbB communicating path, G protein signaling, Glutamic acid attachment, triggering of AMPA receptors, GnRH communication , Ras signaling, Serotonin and anxiety-related events, communication by WNT, Signaling by GPCR, MAPK pathway, NO/cGMP/PKG neural-preservation, Phosphodiesterases neuronal tasks, Neuroinflammation and glutamatergic signing, along with several other pathways. CONCLUSION: miRNAs such as miRNA-132, miRNA-182, and miRNA-124, identified via comprehensive bioinformatic analysis, show potential as depression biomarkers and treatment targets. Insight into their roles and target genes within depression pathways could inspire innovative treatment strategies.

Background: Archival research has unearthed processes of exclusion impacting the experiences of Black, female, and Jewish communities at Canadian medical schools. However, the history of Muslim medical students is little known. Our research is the first known study to examine when Muslim medical students with varying identities were first admitted to the University of Toronto’s (UofT) Faculty of Medicine (FoM) and their experiences. Knowing this history can contribute to ongoing equity, diversity, and inclusion efforts in medical school admissions and curriculum development. Methods: This is an exploratory case study with no clear, single set of expected outcomes. We consulted the UofT’s Archive & Record Management Services and looked for students who self-identified as Muslim in primary documents from the FoM between 1887-1964, including admissions applications, correspondences from the Dean’s Office, photographs, and yearbooks. We analysed the archival data for emerging themes. Results: We found six medical school applicants who self-identified as Muslim (n = 6) and were admitted between 1945 and 1961 and graduated between 1948 and 1966. We also found four (n = 4) postgraduates from one South Asian country who may have been Muslim, and who were granted fellowships from the Canadian government. Conclusions: Self-identified Muslim students were first admitted to the UofT’s FoM in 1945 and continued to be admitted infrequently until 1964. These early students’ experiences included financial hardships despite having privileged backgrounds; discrimination due to being foreign; and conditional inclusion while in medical school. We discuss the study’s continuing contemporary relevance, limitations, and directions for future research.

In this study, we report the mutational profiles, pathogenicity, and their association with different clinicopathologic and sociogenetic factors in patients with Pashtun ethnicity for the first time. A total of 19 FFPE blocks of invasive ductal carcinoma (IDC) from the Breast Cancer (BC) tissue and 6 normal FFPE blocks were analyzed by whole-exome sequencing (WES). Various somatic and germline mutations were identified in cancer-related genes, i.e., ATM, CHEK2, PALB2, and XRCC2. Among a total of 18 mutations, 14 mutations were somatic and 4 were germline. The ATM gene exhibited the maximum number of mutations (11/18), followed by CHEK2 (3/18), PALB2 (3/18), and XRCC2 (1/18). Except one frameshift deletion, all other 17 mutations were nonsynonymous single-nucleotide variants (SNVs). SIFT prediction revealed 7/18 (38.8%) mutations as deleterious. PolyPhen-2 and MutationTaster identified 5/18 (27.7%) mutations as probably damaging and 10/18 (55.5%) mutations as disease-causing, respectively. Mutations like PALB2 p.Q559R (6/19; 31.5%), XRCC2 p.R188H (5/19; 26.31%), and ATM p.D1853N (4/19; 21.05%) were recurrent mutations and proposed to have a biomarker potential. The protein network prediction was performed using GeneMANIA and STRING. ISPRED-SEQ indicated three interaction site mutations which were further used for molecular dynamic simulation. An average increase in the radius of gyration was observed in all three mutated proteins revealing their perturbed folding behavior. Obtained SNVs were further correlated with various parameters related to the clinicopathological status of the tumors. Three mutation positions (ATMp. D1853N, CHEK2 p.M314I, and PALB2 p.T1029S) were found to be highly conserved. Finally, the wild- and mutant-type proteins were screened for two drugs: elagolix (DrugBank ID: DB11979) and LTS0102038 (a triterpenoid, isolated from the anticancer medicinal plant Fagonia indica). Comparatively, a higher number of interactions were noted for normal ATM with both compounds, as compared to mutants.

The presence of intestinal parasites influences equines' well-being and working performance. However, the scenario of parasitism in working horses in the lowlands of Nepal is yet to be explored. The present study aimed to reveal the prevalence and diversity of intestinal parasites (protozoa and helminths) and to list the zoonotic species in working horses in the lowlands of Nepal. Fresh fecal samples (N=102) from horses were collected at two locations (Chitwan and Birgunj) in the lowlands of Terai and were transferred to the research laboratory. Coproscopy was carried out via direct wet mount, formalin ethyl acetate (FEA) sedimentation, saturated salt flotation, and acid-fast staining techniques. Coproscopy revealed an overall prevalence rate of 90.2% (92/102) with 15 known diverse species of parasites (Protozoa: 5 and Helminths: 10) and an unknown coccidian, out of which eight possess zoonotic potential. The prevalence and diversity of intestinal parasites were higher in adult than in young animals (90.7%; 15 spp. vs. 88.9%; 11 spp.) The overall prevalence of helminths was double that of protozoa (89.2% vs. 43.1%). Furthermore, polyparasitism was much more prevalent than monoparasitism (85.3% vs 4.9%). Co-infection with two parasite species (37%) was higher in young horses. In comparison, triplet infection (34%) was higher in adults, and a maximum concurrency of up to six species of parasites at a time was recorded. Following it, the differences in the prevalence rate of parasites based on the predictor of risks, like sex, grazing, domestication type, nature of the floor, and medication practices, were statistically significant. Working horses in the lowlands of Terai harbored a significant variety of intestinal parasites with important prevalence. Since eight of the reported parasitic species were zoonotic, infected horses pose a zoonotic risk to the owners. Therefore, timely deworming, pasture management, and reduction in working pressure are highly recommended.

Gene mutations are a source of genetic instability which fuels the progression of cancer. Mutations in BRCA1 and BRCA2 are considered as major drivers in the progression of breast cancer and their detection indispensable for devising therapeutic and management approaches. The current study aims to identify novel pathogenic and recurrent mutations in BRCA1 and BRCA2 in Pakhtun population from the Khyber Pakhtunkhwa. To determine the BRCA1 and BRCA2 pathogenic mutation prevalence in Pakhtun population from KP, whole exome sequencing of 19 patients along with 6 normal FFPE embedded blocks were performed. The pathogenicity of the mutations were determined and they were further correlated with different hormonal, sociogenetic and clinicopathological features. We obtained a total of 10 mutations (5 somatic and 5 germline) in BRCA1 while 27 mutations (24 somatic and 3 germline) for BRCA2. Five and seventeen pathogenic or deleterious mutations were identified in BRCA1 and BRCA2 respectively by examining the mutational spectrum through SIFT, PolyPhen-2 and Mutation Taster. Among the SNVs, BRCA1 p.P824L, BRCA2 p. P153Q, p.I180F, p.D559Y, p.G1529R, p.L1576F, p.E2229K were identified as mutations of the interaction sites as predicted by the deep algorithm based ISPRED-SEQ prediction tool. SAAFEQ-SEQ web-based algorithm was used to calculate the changes in free energy and effect of SNVs on protein stability. All SNVs were found to have a destabilizing effect on the protein. ConSurf database was used to determine the evolutionary conservation scores and nature of the mutated residues. Gromacs 4.5 was used for the molecular simulations. Ramachandran plots were generated using procheck server. STRING and GeneMania was used for prediction of the gene interactions. The highest number of mutations (BRCA1 7/10, 70 %) were on exon 9 and (BRCA2, 11/27; 40 %) were on exon 11. 40 % and 60 % of the BRCA2 mutations were associated Grade 2 and Grade 3 tumors respectively. The present study reveals unique BRCA1 and BRCA2 mutations in Pakhtun population. We further suggest sequencing of the large cohorts for further characterizing the pathogenic mutations.

Summary: Animals constantly integrate sensory information with prior experience to select behavioral responses appropriate to the current situation. Genetic factors supporting this behavioral flexibility are often disrupted in neuropsychiatric conditions, such as the autism-linked ap2s1 gene which supports acoustically evoked habituation learning. ap2s1 encodes an AP2 endocytosis adaptor complex subunit, although its behavioral mechanisms and importance have been unclear. Here, we show that multiple AP2 subunits regulate acoustically evoked behavior selection and habituation learning in zebrafish. Furthermore, ap2s1 biases escape behavior choice in sensory modality-specific manners, and broadly regulates action selection across sensory contexts. We demonstrate that the AP2 complex functions acutely in the nervous system to modulate acoustically evoked habituation, suggesting several spatially and/or temporally distinct mechanisms through which AP2 regulates escape behavior selection and performance. Altogether, we show the AP2 complex coordinates action selection across diverse contexts, providing a vertebrate model for ap2s1’s role in human conditions including autism spectrum disorder.

Objectives: Microbes inoculated with organic and inorganic amendments influence the nutrient pool in soil. Herein, this study aimed to investigate the potential of a harmonized tripartite approach to improve nutrient accessibility, uptake, and wheat productivity in nutrient-deficient soil. Methods: The tripartite components consisted of Trichoderma harzianum (TRI), compost (Comp), and inorganic phosphorus (P) sources, including rock phosphate (RP) and single super phosphate (SSP). Under field conditions, the experiment was conducted in a randomized complete block design with three replications. The main plot treatments consist of two compost application rates: 0 and 10 tons ha−1. Subplot treatments included the application of TRI and inorganic phosphorus sources at the rates of 5 and 90 kg ha−1 for RP and SSP, respectively. Results: The findings demonstrated that the harmonized tripartite treatments significantly regulated nutrient accessibility, uptake, and wheat productivity, with promising effects observed in combinations such as TRI + SSP + Comp and TRI + RP + Comp. TRI + RP + Comp positively influenced plant height, spike length, and biomass, while TRI + SSP + Comp led to increased grain yield (4325 ± 54 kg ha−1) compared to control (2765 ± 33 kg ha−1). Moreover, TRI + SSP + Comp significantly improved soil organic matter from 1.20 ± 0.03 % (control) to 2.28 ± 0.11 % and P concentration from 3.95 mg kg−1 to 13.60 ± 0.11 mg kg−1. Notably, TRI + Comp treatment maximized the accessibility of micronutrients, including copper (Cu), zinc (Zn), and manganese (Mn), and showed the higher availability of iron (Fe) with a sole TRI application. Furthermore, TRI + RP + Comp significantly increased the uptake of P, Cu, Fe, Zn, and Mn by 510 %, 106 %, 111 %, 63 %, and 137 %, respectively. Multivariate and cluster analyses further confirmed the strong positive relationship among most variables, highlighting the efficacy of the harmonized treatments without any negative associations. Conclusion: These findings accentuated the potential of a harmonized tripartite approach to significantly improve soil fertility, nutrient uptake, and productivity in wheat crops under nutrient-deficient soil.

Purpose – This study examines whether managers adopt corporate social responsibility (CSR) disclosures to suppress earnings management practices and whether corporate governance mechanisms could limit such practices. Design/methodology/approach – A quantitative approach was followed, in which secondary data from listed firms from 2014 to 2019 were gathered. Descriptive statistics and inferential techniques were performed, which included correlation, ordered logistic regression and 2SLS panel regression analyses. Findings – The findings indicate that firms use CSR disclosure to conceal managers' opportunistic behaviour via earnings management as an entrenchment strategy and that corporate governance mechanisms could significantly constrain such behaviour. Research limitations/implications – This study goes beyond the conventional agency theory by incorporating additional theoretical perspectives from stakeholder and legitimacy theories, resulting in a multi-theoretical perspective in conceptualizing the study. Practical implications – The findings are expected to have significant policy implications, especially in limiting the opportunistic use of CSR disclosures and reducing earnings management practices to safeguard stakeholders' interests and ensure the sustainability of business entities. Originality/value – The levels of CSR and board governance practices are captured using comprehensive indices. Moreover, earnings management was operationalized using both accrual-based and real earnings management proxies. Furthermore, while addressing an empirical dearth noted, the findings provide significant policy implications for limiting managers' opportunistic and unethical use of CSR disclosures with corporate governance mechanisms.

The study develops a comprehensive scale of trust in the financial system, to account for its various dimensions. A multistage approach is adopted in the study for this purpose. After reviewing relevant literature and conducting focused group discussions, we collected data from investors through a questionnaire. Finally, we use principal component analysis (PCA) to perform exploratory factor analysis (EFA) in order to investigate the relevant items in each dimension with confirmation of reliability and validity. Our results suggest that 48 items, distributed across five sub constructs of trust, can be applied to assess trust in the financial system. Among the many sub constructs of trust, we ultimately conclude that structural assurance, competence, integrity, benevolence, and transparency are most applicable to financial trust. Because trust is an important consideration along with other barriers to financial inclusion, the study offers many insights for managers of financial institutions, regulatory authorities, and policy makers.

This paper extends the cholera human-to-human direct transmission model from a deterministic to a stochastic framework. This is expressed as mixed system of stochastic and deterministic differential equations. A Lyapunov function is created to investigate the global stability of the stochastic cholera epidemic, which shows the existence of global positivity of the solution using the theory of stopping time. We then find the threshold quantity of the extended stochastic cholera epidemic model. We derive a parametric condition $ \widetilde{R}_0 $, and for additive white noise, we establish sufficient conditions for the extinction and the persistence of the cholera infection. Finally, for a suitable choice of the parameter of the system for $ \widetilde{R}_0 $, we perform numerical simulations for both scenarios of extinction and persistence of the dynamic of the cholera infection.

Oxidative stress contributes to the pathogenesis of hypertension and studies have shown that hypertension is associated with an increase in oxidative stress. Reactive oxygen species (ROS) lead to hypertension and antioxidants may be beneficial for its prevention. The main cause of oxidative stress in hypertension is endothelial dysfunction due to the malfunctions in the vasodilator systems, specifically the molecular mechanism of ROS and nitric oxide (NO). The level of malondialdehyde (MDA), a biomarker of lipid peroxidation and oxidative stress, is found to be higher in hypertension patients. Total antioxidant capacity (TAC), which has a strong relationship with blood pressure, is determined through the ferric reducing antioxidant power (FRAP). The aim of the review article is to elucidate the role of MDA and FRAP in hypertension. Keywords: oxidative stress, hypertension, blood pressure, oxidative damage, malondialdehyde, FRAP

Abstract Background Coronary embolism is a relatively rare but important non-atherosclerotic cause of acute coronary syndrome, mainly caused by atrial fibrillation and mechanical heart valve thrombosis due to subtherapeutic anticoagulation. There have been increasing reports of bioprosthetic valve thrombosis (BPVT), but thromboembolic events are rare and mainly affect the cerebrovascular system. Coronary embolism is an extremely rare complication of BPVT. Case presentation A 64-year-old male presented with non-ST-Elevation myocardial infarction (NSTEMI) to an Australian regional health service. Three years ago, he had undergone Bentall procedure with bioprosthetic aortic valve replacement for severe aortic regurgitation and significant aortic root dilatation. Diagnostic coronary angiography revealed embolic occlusion of first diagonal branch in the absence of underlying atherosclerosis. Prior to NSTEMI presentation, the patient was clinically asymptomatic apart from the progressive increase in transaortic mean pressure gradient on transthoracic echocardiography which was first detected seven months after surgical aortic valve replacement. Transoesophageal echocardiography showed restrictions of the aortic leaflet opening but no evidence of mass or vegetation. After eight weeks of warfarin therapy, the raised aortic valve gradient returned to normal. Lifelong warfarin was prescribed, and patient remained clinically well at 39-month follow-up. Conclusion We experienced a case of coronary embolism in a patient with probable BPVT. Reversible bioprosthetic valve hemodynamic deterioration after anticoagulation strongly supports the diagnosis in the absence of histopathology. Early moderate-to-severe hemodynamic valve deterioration warrants further investigations, including cardiac computed tomography and sequential echocardiography, to investigate for probable BPVT and consideration of timely anticoagulation initiation to prevent thromboembolic events.

Background. Bilothorax is defined as the presence of bile in the pleural space. It is a rare condition, and diagnosis is confirmed with a pleural fluid-to-serum bilirubin ratio of >1. Methods. The PubMed, Embase, Google Scholar, and CINAHL databases were searched using predetermined Boolean parameters. The systematic literature review was done per PRISMA guidelines. Retrospective studies, case series, case reports, and conference abstracts were included. The patients with reported pleural fluid analyses were pooled for fluid parameter data analysis. Results. Of 838 articles identified through the inclusion criteria and removing 105 duplicates, 732 articles were screened with abstracts, and 285 were screened for full article review. After this, 123 studies qualified for further detailed review, and of these, 115 were pooled for data analysis. The mean pleural fluid and serum bilirubin levels were 72 mg/dL and 61 mg/dL, respectively, with a mean pleural fluid-to-serum bilirubin ratio of 3.47. In most cases, the bilothorax was reported as a subacute or remote complication of hepatobiliary surgery or procedure, and traumatic injury to the chest or abdomen was the second most common cause. Tube thoracostomy was the main treatment modality (73.83%), followed by serial thoracentesis. Fifty-two patients (51.30%) had associated bronchopleural fistulas. The mortality was considerable, with 18/115 (15.65%) reported death. Most of the patients with mortality had advanced hepatobiliary cancer and were noted to die of complications not related to bilothorax. Conclusion. Bilothorax should be suspected in patients presenting with pleural effusion following surgical manipulation of hepatobiliary structures or a traumatic injury to the chest. This review is registered with CRD42023438426.

BackgroundGray zone lymphoma (GZL) is a rare lymphoma subtype characterized by features intermediate between diffuse large B-cell lymphoma (DLBCL) and classic Hodgkin lymphoma (cHL). The optimal first-line treatment for GZL remains undefined, particularly for patients with poor performance status or baseline organ impairment. Brentuximab vedotin (BV), a targeted therapy that binds to CD30, a TNFR superfamily member involved in NF-kB signaling, has shown promise in the treatment of CD30-positive lymphomas. However, its use in GZL, especially in patients with severe liver impairment, has not been reported previously.Case descriptionWe present a case of a 37-year-old male with GZL and severe liver impairment at initial presentation. The patient initially received monotherapy with BV, which resulted in a marked improvement in liver enzymes and bilirubin levels. Subsequently, combination cytotoxic chemotherapy consisting of dose-adjusted etoposide, prednisone, cyclophosphamide, and doxorubicin (DA-EP_CH) was added. Repeat imaging revealed near complete resolution of lymphadenopathy and significant reduction in hepatosplenomegaly. The patient completed a full course of chemotherapy and achieved a complete response. Follow-up examinations showed no evidence of recurrent disease, and the patient resumed full-time work.DiscussionGZL poses diagnostic challenges due to its overlapping features with DLBCL and cHL. Accurate diagnosis relies on comprehensive histopathological evaluation, immunophenotyping, and molecular analysis. The optimal first-line treatment for GZL remains uncertain. BV shows promise as an addition to chemotherapy in GZL, even in the presence of severe liver impairment. The molecular pathogenesis of GZL is complex and heterogeneous, frequently involving aberrant NF-kB signaling and impaired apoptosis regulation via loss of TP53 expression. Understanding the underlying molecular mechanisms is essential for developing targeted therapies and identifying predictive biomarkers for treatment response.ConclusionThis case demonstrates the successful use of BV as a bridge to cytotoxic chemotherapy in a GZL patient with severe liver impairment, highlighting its potential safety and efficacy even in the setting of end-organ failure. Further investigation is warranted to define optimal treatment strategies, identify predictive biomarkers, and improve outcomes for patients with this rare and challenging lymphoma subtype.

This method article describes the fabrication of graphene-epoxy nanocomposites using two different solvents, dimethylformamide (DMF) and acetone, and validates the resulting thermal conductivity improvements. The study compared the two solvents at a filler composition of 7 wt% and found that DMF resulted in more uniform dispersion of graphene nanoparticles in the epoxy matrix, leading to a 44% improvement in thermal conductivity compared to acetone. Laser scanning confocal microscopy (LSCM) imaging showed that DMF-based composites had more evenly dispersed graphene nanoplatelets than acetone-based composites, which exhibited larger graphene agglomerations. Effective medium theory calculations showed that DMF led to almost 35% lower interface thermal resistance between graphene and epoxy compared to acetone. The validated fabrication method and findings provide new possibilities for developing high thermal conductivity graphene-epoxy nanocomposites for various thermal management applications. • This article describes methods for fabricating graphene-epoxy composites using acetone and DMF as solvents, and validates that DMF is better for achieving higher thermal conductivity in the composite.

The COVID-19 pandemic has created a severe impact on the business field in the world as a whole. Nevertheless, there is a dearth of studies that synthesize the literature on the COVID-19 impact on corporate governance. The purpose of this study is to highlight the key issues and current trends in the area of COVID-19’s effects on corporate governance and to offer suggestions for future research paths. This study performs a bibliometric analysis using a sample of 137 studies from the SCOPUS database to ascertain the volume of research on COVID-19 and corporate governance between 2020 and 2022. Based on their citations and the number of publications, researchers in this study identified the most significant authors, sources, countries and documents using Biblioshiny software. Additionally, evaluate the themes that already exist, point out any barriers to the literature’s expansion, and offer suggestions for future research directions. There is a dearth of research studies conducted on this area, but China and India published the highest number of articles. The majority of research on COVID-19’s impact on corporate governance focuses on the qualitative approach and is frequently investigated based on agency theory. Finally, the research suggests potential directions for future studies by the researchers and helps practitioners and policymakers to understand the impact of the COVID-19 pandemic on corporate governance and take necessary actions.

Background: Central obesity is a leading cause of insulin resistance, type 2 diabetes mellitus, dyslipidemia, and Cardiovascular Disease (CVD). Central obesity may act as an independent predictor for CVD. Aim and Objectives: To study the correlation of central obesity among obese patients with the risk factors for CVD. Material and Methods: In this case-control study, 50 non-obese and 50 obese subjects aged between 30-70 years were enrolled. Biochemical parameters: Fasting Blood Sugar (FBS), Glycated Hemoglobin (HbA1c), Total Cholesterol (TC), Triglyceride (TG), High-Density Lipoprotein-Cholesterol (HDL-C) and Low-Density Lipoprotein-Cholesterol (LDL-C) were estimated along with Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Body Mass Index (BMI) and Waist Circumference (WC). Value of p less than 0.05 was considered statistically significant. Results: Mean of FBS, HbA1c, TC, TG, LDL-C, SBP, DBP, BMI, and WC were significantly raised in obese compared to non-obese (p

Purpose – The purpose of this study is to provide fresh insights into whether there is an expectation gap between external auditors' and other stakeholders' perceptions of external auditors' responsibilities in an emerging economy, in light of recent changes to the global audit landscape. Design/methodology/approach – A quantitative approach in the positivistic paradigm was adopted, and a structured questionnaire was used to gather data. Findings – The findings suggested that there was a statistically significant discrepancy between external auditors' and social groups' perceptions of the responsibilities of external auditors. More than half of the gap was due to deficiency in standards, 19% due to unreasonable expectations by society, while 25% of the gap was found to be due to deficient performance. Research limitations/implications – The study focused on the duties of external auditors and not on the duties of other types of auditors while examining the audit expectation-performance gap (AEG), and this was due to the drastic differences in the scope of their duties. Practical implications – The findings of this study are likely to have direct policy implications for regulators, authorities, educators and auditing professionals, who should take immediate actions and measures to reduce the AEG in light of the current global audit landscape advancements and changes. Originality/value – The present study used a substantially updated model to measure the AEG to suit the contemporary changes in the auditing landscape, and could be considered as a pioneering study that measures the AEG in an emerging economy amid recent changes.

Summary: Eco-friendly, efficient, and durable electrocatalysts from earth-abundant materials are crucial for water splitting through hydrogen and oxygen generation. However, available methods to fabricate electrocatalysts are either hazardous and time-consuming or require expensive equipment, hindering the large-scale, eco-friendly production of artificial fuels. Here, we present a rapid, single-step method for producing MoSx/NiF electrocatalysts with controlled sulfur-vacancies via electric-field-assisted pulsed laser ablation (EF-PLA) in liquid and in-situ deposition on nickel foam, enabling efficient water splitting. Electric-field parameters efficiently control S-vacancy active sites in electrocatalysts. Higher electric fields yield a MoSx/NiF electrocatalyst with a larger density of S-vacancy sites, suited for HER due to lower Gibbs free energy for H∗ adsorption, while lower electric fields produce an electrocatalyst with lower S-vacancy sites, better suited for OER, as shown by both experimental and theoretical results. The present work opens a horizon in designing high-efficiency catalysts, for a wide range of chemical reactions.

Abstract Organizing pneumonia (OP) is one of the rare pulmonary manifestations of systemic lupus erythematosus (SLE) which is infrequently reported as a presenting manifestation. Early diagnosis of lupus‐related OP with the help of imaging, can drive to prompt initiation of immunosuppressive therapy leading to a better prognosis. We present a case of a 34‐year‐old young male who presented with fever, myalgia, and a dry cough for 1 month and was later diagnosed as SLE‐related organizing pneumonia.

Painful tonic spasms initially described in association with multiple sclerosis are actually more common in patients with neuromyelitis optica spectrum disorder. Characterized by fierce pain and tonic posture of limbs, painful tonic spasms are common in patients during the recovery phase after the first episode of myelitis. A 68-year-old man presented with painful tonic spasm after 2 months of diagnosis of neuromyelitis optica spectrum disorder. Eventual use of eslicarbazepine resulted in significant control of spasms. Early recognition of painful tonic spasms and appropriate therapeutic medications can significantly decrease the impact it can have on the quality of life among neuromyelitis optica spectrum disorder patients.

Study Design Prospective, randomized, placebo-controlled, double-blind exploratory study. Purpose To compare effects of dexmedetomidine or a subanesthetic dose of ketamine on the amplitude and latency of transcranial electrically generated motor evoked potentials. Overview of Literature Total intravenous anesthesia (TIVA) is a standard anesthesia technique for transcranial electrical motor evoked potential monitoring in spine surgery. We aimed to determine whether the use of dexmedetomidine and ketamine as a component of TIVA exerted any beneficial effect on the quality of monitoring. Methods A total of 90 American Society of Anesthesiologist grade I–III patients, aged 18–65 years, with a motor power of ≥4/5 grade as per the Medical Research Council Scale in all four limbs who were scheduled for elective spine surgery under transcranial electrical motor evoked potential monitoring were enrolled. The subjects were randomly allocated into the following three groups: group PD who received 0.5 μg/kg/hr dexmedetomidine infusion, group PK who received 0.5 mg/kg/hr ketamine infusion, and group PS who received normal saline infusion, along with standard propofol–fentanyl based TIVA regime. Amplitude and latency of bilateral motor evoked potentials of the tibialis anterior and abductor halluces muscle were recorded at Ti (at train-of-four ratio >90%), T30 (30 minutes post-Ti), T60 (60 minutes post-Ti), and Tf (at the end of spine manipulation). Results Baseline median amplitudes were comparable among the study groups. In group PK, we noted a gradually enhanced response by 24%–100% from the baseline amplitude. The median amplitudes of all the muscles were higher in group PK than those in groups PS and PD at time points T60 and Tf (p

Introduction: Adiponectin (APN) is an adipose-derived protein. It has shown a variety of functions such as anti-inflammatory, anti-atherogenic, antidiabetic, and insulin-sensitizing and lipid-oxidation-enhancing activities. The APN levels have shown a significant relationship with the risk factors for type 2 diabetes mellitus (T2DM). As per the Madras Diabetes Research Foundation-Indian Diabetes Risk Score (MDRF-IDRS), Asian Indians have high risk factors for T2DM and its complications. APN levels influence the risk factors for T2DM and its complications. Its circulatory level also varied with the age, family history of T2DM, waist circumference, and level of physical activity. Aim: The purpose of this narrative review is to find the association of circulatory APN with the parameters of MDRS-IDRS. Materials and Methods: Articles were searched by various databases such as PubMed, MEDLINE, Scopus, Web of Science, and Google Scholar. Abstract, free full-text, and full-text articles were searched from the year 2003 to 2022. For this review, observational study, original articles, narrative review, systematic review, and meta-analysis articles published in the English language were included. It is needed to establish the association between the APN levels and the parameters of MDRF-IDRS. The modifiable risk factors of MDRF-IDRS may play a significant role to regulate the level of APN. The non-modifiable risk factors of MDRF-IDRS may help in the better management of APN levels and reduce the prevalence of T2DM. It is needed to clear that the APN levels influence the disease severities or not. It is also needed to improve the physical activity to regulate the APN level and to reduce the systemic inflammation and insulin resistance in Asian Indian population. Conclusion: Improvement in modifiable risk factors of MDRF-IDRS and level of APN may play a significant role in the therapeutic approach to prevent and/or delay the development of T2DM and its complications.

Background: Many analgesic modalities have been investigated in pediatrics for thoracotomy. We studied the analgesic efficacy of unilateral continuous ultrasound-guided erector spinae plane block (ESPB) compared to a thoracic epidural in pediatric patients undergoing thoracotomy. Materials and Methods: A prospective, randomized, observer-blinded, controlled study. Pediatric patients (2–7 years) scheduled for right or left thoracotomy under general anesthesia (GA) were enrolled in the study. We randomly assigned patients into two groups: The thoracic epidural analgesia (TEA) group received GA with an epidural catheter. The ESPB group received GA with a unilateral ultrasound-guided erector spinae plane catheter. The primary outcome was postoperative cumulative opioid consumption for 24 h. Results: The total intraoperative fentanyl requirement was 35.4 ± 11.44 μg in the TEA group and 30.4 ± 9.08 μg in the ESPB group (t-value − 1.53013, P value: 0.134). The total postoperative fentanyl requirement was comparable in both the groups and clinically nonsignificant (44 ± 2.82 in the TEA group vs. 44.25 ± 13.72 in the ESPB group, t-value = −0.02412, P = 0.981). The median (IQR) Face, Legs, Activity, Cry, and Consolability (FLACC) score at 0, 2, 4, 8, 12, and 24 h time points in the ESPB was equivalent to the TEA group. At 6 h time point, the TEA group had a significantly lower FLACC score than the ESPB group (1[1.75, 1] in the TEA group and 2 [2, 1] in the ESPB group, P value = .02, U = 117.5, z-score = −2.218). The complications were higher in the TEA group (urine retention 20% and hypotension 40%) than in the ESPB group (0 and 0%). Conclusions: This study shows that the ESPB provides similar postoperative analgesia to the TEA in pediatric patients undergoing thoracotomy. The ESPB is simpler, faster, and has a lower complication rate.

The eye is the window through which light is transmitted and visual sensory signalling originates. It is also a window through which elements of the cardiovascular and nervous systems can be directly inspected, using ophthalmoscopy or retinal imaging. Measurements of ocular parameters may therefore offer important information on the physiology and homeostasis of these two important systems. Here we report the results of a genetic characterisation of retinal vasculature. Four genome-wide association studies performed on different aspects of retinal vasculometry phenotypes, such as arteriolar and venular tortuosity and width, found significant similarities between retinal vascular characteristics and cardiometabolic health. Our analyses identified 119 different regions of association with traits of retinal vasculature, including 89 loci associated arteriolar tortuosity, the strongest of which was rs35131825 (p = 2.00×10-108), 2 loci with arteriolar width (rs12969347, p = 3.30×10-09 and rs5442, p = 1.9E-15), 17 other loci associated with venular tortuosity and 11 novel associations with venular width. Our causal inference analyses also found that factors linked to arteriolar tortuosity cause elevated diastolic blood pressure and not vice versa.

As a strategy for minimizing microbial infections in fish hatcheries, we have investigated how putatively probiotic bacterial populations influence biofilm formation. All surfaces that are exposed to the aquatic milieu develop a microbial community through the selective assembly of microbial populations into a surface-adhering biofilm. In the investigations reported herein, we describe laboratory experiments designed to determine how initial colonization of a surface by nonpathogenic isolates from sturgeon eggs influence the subsequent assembly of populations from a pelagic river community, into the existing biofilm. All eight of the tested strains altered the assembly of river biofilm in a strain-specific manner. Previously formed isolate biofilm was challenged with natural river populations and after 24 hours, two strains and two-isolate combinations proved highly resistant to invasion, comprising at least 80% of the biofilm community, four isolates were intermediate in resistance, accounting for at least 45% of the biofilm community and two isolates were reduced to 4% of the biofilm community. Founding biofilms of Serratia sp, and combinations of Brevundimonas sp.-Hydrogenophaga sp. and Brevundimonas sp.-Acidovorax sp. specifically blocked populations of Aeromonas and Flavobacterium, potential fish pathogens, from colonizing the biofilm. In addition, all isolate biofilms were effective at blocking invading populations of Arcobacter. Several strains, notably Deinococcus sp., recruited specific low-abundance river populations into the top 25 most abundant populations within biofilm. The experiments suggest that relatively simple measures can be used to control the assembly of biofilm on the eggs surface and perhaps offer protection from pathogens. In addition, the methodology provides a relatively rapid way to detect potentially strong ecological interactions between bacterial populations in the formation of biofilms.

PurposeTo evaluate the test performance of the QUARTZ (QUantitative Analysis of Retinal vessel Topology and siZe) software in detecting retinal features from retinal images captured by health care professionals in a Danish high street optician chain, compared with test performance from other large population studies (i.e., UK Biobank) where retinal images were captured by non-experts.MethodThe dataset FOREVERP (Finding Ophthalmic Risk and Evaluating the Value of Eye exams and their predictive Reliability, Pilot) contains retinal images obtained from a Danish high street optician chain. The QUARTZ algorithm utilizes both image processing and machine learning methods to determine retinal image quality, vessel segmentation, vessel width, vessel classification (arterioles or venules), and optic disc localization. Outcomes were evaluated by metrics including sensitivity, specificity, and accuracy and compared to human expert ground truths.ResultsQUARTZ's performance was evaluated on a subset of 3,682 images from the FOREVERP database. 80.55% of the FOREVERP images were labelled as being of adequate quality compared to 71.53% of UK Biobank images, with a vessel segmentation sensitivity of 74.64% and specificity of 98.41% (FOREVERP) compared with a sensitivity of 69.12% and specificity of 98.88% (UK Biobank). The mean (± standard deviation) vessel width of the ground truth was 16.21 (4.73) pixels compared to that predicted by QUARTZ of 17.01 (4.49) pixels, resulting in a difference of -0.8 (1.96) pixels. The differences were stable across a range of vessels. The detection rate for optic disc localisation was similar for the two datasets.ConclusionQUARTZ showed high performance when evaluated on the FOREVERP dataset, and demonstrated robustness across datasets, providing validity to direct comparisons and pooling of retinal feature measures across data sources.

The continuous dissemination of coronavirus disease of 2019 (COVID-19) literature can inform decision-makers and the public. Since the widespread use of COVID-19 vaccines, more systematic reviews have summarized the effectiveness and reported adverse events associated with vaccination. Previous systematic and scoping reviews on COVID-19 summarized various aspects surrounding COVID-19, however, a scoping review is needed to summarize the characteristics of COVID-19 vaccines and associated adverse events reported in systematic reviews and meta-analyses to provide comprehensive evidence for informed medical decision-making. We will conduct a scoping review concerning COVID-19 vaccines and adverse events from vaccines. We will search from December 2019 to present in Epistemonikos, Campbell Library, CINAHL (Ovid), MEDLINE (Ovid), Scopus, CENTRAL (Ovid), Web of Science, WHO COVID-19 database, Joanna Briggs Institute of Excellence, and COVID-19 Evidence Reviews resource. We will include systematic reviews, meta-analyses, or both of randomized controlled trials and observational studies and exclude individual randomized controlled trials and observational studies. Abstracts and full-texts will be screened prior to selection. Investigators will independently use a calibrated quantitative and qualitative data extraction sheet and rate the quality of articles with AMSTAR, resolving disagreements to aim for good agreement (≥80%). An updated scoping review of the characteristics and safety of COVID-19 vaccines would highlight the accuracy of the evidence to inform decision-making concerning COVID-19 vaccination.

Abstract An infrequent form of ectopic pregnancy, pregnancy in an isthmocele can be hazardous due to hemorrhage or uterine rupture. With no clear guidelines for the management of this condition, surgery is the preferred option.

Polycystic ovary syndrome (PCOS) is a metabolic and endocrine disorder affecting the global population, originally named as “schlerocystic ovaries”, “multicystic ovaries”, “Stein Leventhal Syndrome”. Obesity is believed to play a central role in the development of PCOS, as women with this condition are reported to be overweight or obese and the effect of excess weight is inconsistent. Numerous hormonal imbalances, including hyperandrogenism, insulin resistance (IR), and hyperinsulinemia, are reported to be present. The hypothalamus-hypophysis-ovary axis appears to be disrupted by insulin, and insulin resistance in ovarian tissue leads to impaired metabolic signalling but intact mitogenic and steroidogenic activity, favouring hyperandrogenemia, is thought to be the primary cause of PCOS. The metabolic issues of PCOS seem to have IR as a common pathophysiologic mechanism, which is described as a metabolic state marked by a reduction in cellular responsiveness to insulin signalling. Despite the fact that IR plays a role in the development of PCOS, patients exhibit unique ovarian dysfunction-causing processes that are unrelated to IR. PCOS is a polygenic and multifactorial syndrome/disorder and many genes have been associated with PCOS such as fat mass and obesity-associated (FTO) gene. The review article presents the current understanding of the disease and the clinical spectrum and genetic variants associated with PCOS. The mechanisms by which variants in the genes confer risk of PCOS and the genetic elements underlying PCOS remain to be determined. Elucidation of genetic markers and cellular pathways underlying PCOS will be useful in understanding the pathophysiology of this syndrome.

Abstract Rete ovarii giving rise to cysts, and benign and malignant tumors is a rare entity. Radiological and histopathological examinations can be used to make the diagnosis of rete cyst and differentiate it from cystic tumor of ovarian origin, with surgery being the treatment of choice.

Genitogluteal porokeratosis is a rare localized disorder of keratinization. Due to the rarity of the case and non-specific keratotic lesion, it is often misdiagnosed until a histological examination is performed. Treatment of this condition can be challenging, which comprises various topical and systemic drugs, lasers, cryotherapy, phototherapy, and also surgical intervention. Regular follow-up is necessary in the view of this disorder being a premalignant condition.

4-H academics responded to the COVID pandemic by rapidly adapting CDC and other resources for virtual delivery. A statewide epidemiology project was taught to 48 youth with the goal of minimizing fears and confusion, increasing prevention measures, leveraging current topics for education, and bolstering the social-emotional health of youth participants. Results indicated that youth enjoyed the project and adopted behaviors to reduce the spread of infectious diseases, such as increased mask-wearing.

BackgroundThe relationship between hemorrhoid recurrence and poor defecation habits is poorly understood. This study aimed to analyze the effects of poor defecation habits on postoperative hemorrhoid recurrence.Materials and MethodWe performed a retrospective study on 1,162 consecutive patients who underwent a surgical procedure for hemorrhoids at the Sixth Affiliated Hospital of Sun Yat-Sen University from December 2016 to May 2020. All patients were followed for 12 months post-operatively. Patients were monitored for disease recurrence. Patient defecation habits were assessed using an obstructive defecation syndrome (ODS) score.ResultsPatients with a score of 0–4 had a mild defecation disorder, 5–8 a moderate defecation disorder, and 9 or more ODS. Of the 1,162 patients, 1,144 (98.45%) had a mild defecation disorder, 13 (1.12%) had a moderate defecation disorder, and 9 (0.43%) had ODS. Older patients were significantly more likely to have worse defecation habits (P