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This article, published in the journal Neuropediatrics, explores the clinical and genetic spectrum of RAB3GAP1-related disorders, which are associated with neurodevelopmental disorders and other physical abnormalities. The study presents detailed information on 23 patients with biallelic RAB3GAP1 variants from multiple research sites worldwide. The findings reveal a wide range of phenotypic features, including neurological symptoms, imaging abnormalities, and multi-systemic phenotypes. The research provides valuable insights into the genotype-phenotype spectrum of these disorders and may assist in genetic counseling for affected individuals and their families. [Extracted from the article]

Serious consequences including septicemia and amputations can result from complex wounds, which is a serious healthcare concern. In addition, there are currently only a few choices for management, which justifies the search for novel, highly effective wound-healing medications. This research work was aimed at fabricating chitosan-based Alkanna tinctoria and Mupirocin nanoparticles by ionic gelation technique for burn wound management. Preliminary studies were conducted, and the prepared nanoparticles were characterized by various techniques that involve, high-performance liquid chromatography for the detection of components in A. tinctoria root extract, ATR-FTIR, particle size, zeta potential, percent drug content (DC%), percent entrapment efficiency (EE%), scanning electron microscopy, and transmission electron microscopy (TEM) for surface morphology. The optimized formulation CS-AT-MU-NPs3 shows a particle size of 340.8 ± 34.46 nm and positive zeta potential 27.3 ± 3.10 mV. In vitro drug release study was also performed, which demonstrated improved and controlled release of the drug from the nanoparticles. The CS-AT-MU-NPs3 exhibited a maximum release up to 92.61% (AT) and 88.35% (MU). Antibacterial and antifungal activities of the formulation were also accessed by utilizing the agar well diffusion technique. The combination of AT and MU in chitosan-based nanoparticles was significantly effective against bacterial and fungal strains like Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans as compared to other formulations. The skin irritation study was also conducted, which shows that the prepared formulation did not cause any observable changes to the skin in terms of inflammation, erythema, edema, or any other symptoms associated with skin irritation. All the chitosan-based nanoparticles showed almost 75% reduction in wound contraction, while the optimized formulation CS-AT-MU-NPs3 showed complete wound healing on the 15th day. Based on the results, it can be assumed that chitosan-based nanoparticles containing A. tinctoria and Mupirocin demonstrated good wound healing and could be used to effectively manage burn wounds of any description.

ladybird beetles are play vital role in agroecosystem due to successful and efficient feeding behavior against aphids, the present research experiment was carried to find out the life history and feeding efficacy of oenopiasauzetifed on Aphis gossypii,at the laboratory of Biological Control, integrated pest management programme (IPMP), National Agriculture Research Centre (NARC), Islamabad. The results of the experiment revealed that the mean developmental time of immature stage 3rd and 4th instar have a significant difference with 3.72±0.11 and 3.87±0.036 days, while the egg to adult emergence was 39±0.35 days. The longevity has significant difference in male and female with the higher values at female 34.0 days. Similarly, the feeding efficiency was maximum in O. sauzeti females which feeds on 2227.1 mean number of Aphis gossypii, while the (409.25±1.42) mean numbers of aphids were consumed by larva. The maximum aphid consumption was observed at 4th instar larva (198.98±0.51 aphid) followed by 3rd instar larva (128.57±0.59 aphid). The mean oviposition time of O. sauzetion A. gossypii was recorded as 21.36 days and average eggs laid female-1 day-1 was 20.53, while the total laid eggs given by a female were 253.60. The apparent mortality (100qx) was maximum at egg stage (24) and the mortality survival ratio (MSR) was highest at pupal stage (0.53), similarly, the indispensable mortality (IM) was also observed high at pupal stage. The maximum survival fraction (Sx) was observed at the 4th larval stage (0.91) and the maximum life expectancy (ex) was observed at 1st larval instar (4.51) days. The total killer power (k-value) of the O. sauzetifor the complete generation was 0.49. This will help to develop an ecofriendly managing approach for the minimizing he aphids infestationin economical important crops. [ABSTRACT FROM AUTHOR]

Evapotranspiration (ET) bridges the hydrological and energy cycle through vegetation transpiration (T), soil evaporation (ES), and canopy interception evaporation (EI). Transpiration to evapotranspiration ratio (T/ET) quantifies the water use efficiency of terrestrial ecosystems explaining the mechanism of vegetation water transport and water–carbon interactions. This study employed GIMMS LAI3g data to improve the CLM4.5 land surface scheme of RegCM4.6. We designed two simulation experiments, each with control (CTL) and sensitivity (SEN), simulating the interannual variability of vegetation on ET and T/ET in China from 1982 to 2015. Studies show China has experienced a greening trend, especially in mid-south China and South China. Leaf area index (LAI) increased significantly (0.002 m2m−2yr−1). ∆LAI (SEN input LAI data minus CTL input LAI data) and ∆T/ET (T/ET data output by SEN minus T/ET data output by CTL) have shown significant positive correlations. The impacts of LAI on T/ET are more prominent during spring and winter than in autumn and summer. Compared with T/ET and LAI (R = 0.70), the correlation between ET and LAI is moderate (R < 0.5), indicating that vegetation has a higher impact on T/ET than ET. The impact of vegetation anomalies (positive and negative LAI anomalies) on T/ET and ET is spatially different, mainly due to dominant factors affecting ET and T/ET changes. In spring, summer, and autumn, &T (transpiration changes corresponding to vegetation anomalies) is the leading factor affecting both ET and T/ET regionally, and &T has a stronger influence on T/ET than ET, especially in summer. Vegetation anomalies have a stronger influence on T/ET than ET; and the influence of positive vegetation anomalies on ET and T/ET is greater than that of negative vegetation anomalies, especially in spring and autumn. This study reveals the mechanisms behind vegetation processes and their influences on the water and heat fluxes at the land–atmosphere interface and provides a strong scientific basis for studying the water cycle under climate warming.

Reported rates of aortic insufficiency (AI) are 25-30% within the first-year post-implantation of continuous flow left ventricular assist devices (LVADs). Abbott's HeartMate 3 (HM3) features a pump speed algorithm to help reduce aortic valve loading and AI incidence. However, current literature is limited regarding AI development in HM3, associated hemodynamic alterations, and overall impact on readmissions and survival. We retrospectively reviewed 58 patients who underwent implantation of a HM3 LVAD at our institution between June 2015 and November 2021. Aortic, mitral (MR), and tricuspid (TR) regurgitation severity was assessed on transthoracic echocardiograms (TTEs) using color doppler at 6-months, 1-, and 2-years post-implantation and defined as either none, mild, moderate, or severe. Hemodynamic values were obtained through serial right heart catheterizations performed pre- and at 6-months, 1-, and 2-years post-implantation. Readmissions were defined as those pertaining to decompensated heart failure or an LVAD complication such as driveline infections, gastrointestinal bleeding, or stroke within 1-year post-implantation. The mean age at implantation was 53 ± 12 years with 74% male. Between 6-months and 2-years, the prevalence of AI severities increased: mild 19.6% to 29.4%, moderate 3.6% to 8.8%, and severe 0% to 2.9%. During that time, the prevalence of MR increased while TR decreased: MR 43.1% to 58.6% and TR 66.0% to 57.6%. Worsening AI between 6-months and 1-year had an increased 1-year readmission rate, although not significant (1.6 ± 1.90 vs 0.9 ± 1.25, p=0.09). There was no association between AI severity at 6 months and mortality within the first year. At 1 year, compared to those with AI, patients without AI had a greater ejection fraction (23.3 ± 9.39 vs 16.8 ± 7.69, p=0.02) and decreased aortic root diameter (3.0 ± 0.36 vs 3.3 ± 0.39, p=0.01). At 2-year hemodynamics, those with AI had greater pulmonary capillary wedge pressure (19.2 ± 7.74 vs 14.9 ± 3.98, p = 0.068) and similar central venous pressures (11.27 ± 7.02 vs 11.2 ± 5.02, p=0.49). HM3 LVAD patients remain susceptible to progressive AI with significant left sided heart hemodynamic alterations, however, additional studies with larger sample sizes are needed to further investigate hemodynamic compromise, remodeling, and assess interventional requirements. [ABSTRACT FROM AUTHOR]

Chirality is vital in many living species since it is responsible for structural iridescent coloration and plays a key role in light harvesting during natural photosynthesis. Developing photoactive materials with such chiral structures is a challenging but promising strategy for energy applications. Here, we describe a straightforward method to establish an active photonic glass obtained through the co-condensation of tetramethyl orthosilicate (TMOS) and titanium diisopropoxide bis(acetylacetonate) (TAA) dissolved in a liquid crystal formed from cellulose nanocrystalline (CNC). The inorganic glass maintains a long range of chiral nematic ordering, displaying iridescent colors characterized by a Bragg peak reflection. The reflected wavelengths are tuned all over the UV-visible range, demonstrating that the replica of the chiral nematic structure generates photonic properties. Incorporation of gold nanoparticles (Au NPs) into the films is further performed by impregnation/chemical reduction. We show that the charge carrier density and photocatalytic H2 generation were amplified when the photonic band gap edges matched the absorbance of the TiO2 and localized surface plasmon resonance (LSPR) of AuNPs. This photocatalytic glass with chiral nematic ordering and a tunable photonic bandgap paves the way for the development of metamaterials with new applications, such as asymmetric photocatalysis., (© 2024 Wiley‐VCH GmbH.)

An integrated approach using geophysical and geospatial techniques was employed to model the surface and subsurface water-bearing strata and assess aquifer vulnerability in the Sehnsa town, Kotli district, State of Azad Kashmir, Pakistan. The inadequate scientific studies in the hilly terrain with such complex geological conditions has led to the failure of the boreholes for groundwater extraction. For the evaluation of groundwater potential and subsurface lithology, 30 vertical electrical soundings (VES) stations utilizing the Schlumberger electrode configuration were completed, modeled and analyzed spatially. Numerous geoelectrical parameters like true resistivity, thickness of subsurface layers and Dar-Zarrouk parameters were evaluated. The subsurface lithology delineated comprised topsoil, clayey sand, sandstone, and boulder clays which closely resemble to the borehole lithologs available in the study area. The inversion model confirms the presence of patches of high-resistivity sandstone in the southwestern part of the study area with the maximum thickness of the aquifer up to 140 m. Most aquifers were classified as unconfined with Q-type resistivity curves. The protective overburden capacity of the aquifers is rated as poor at VES 1, 3-5, 8, 10-16, 18, 19, 22-25, 27 and 30 whereas the moderate category was found at VES 2, 9 and 20 and excellent at VES 7 and 28, respectively. Therefore, the VES stations with poor and moderate ratings of overburden protective capacity are vulnerable for surface contaminants. The aquifer recharge was associated with rainfall and partly from the Poonch River. The effective integration of geophysical and geospatial techniques in this study provides sufficient information about the regional water resources and gives a preliminary model that can facilitate efficient water resource management in the area. These approaches can be successfully applied to diverse geographical and hydrogeological sites due to their versatility and reliability., (© 2024. The Author(s).)

Background: Optimal duration and choice of antiplatelet therapy in patients with acute coronary syndrome undergoing percutaneous coronary intervention remain controversial., Methods and Results: Digital databases (PubMed, Cochrane, and Embase) were queried to select all randomized controlled trials on a post-percutaneous coronary intervention population with acute coronary syndrome. Dual-antiplatelet therapy (DAPT) with aspirin and clopidogrel for 12 months was compared with 4 major strategies: high-potency, high- to low-potency, low-dose, and short-duration DAPT. A network meta-analysis was performed to compare the safety and efficacy of different antiplatelet strategies. This study was the second updated manuscript under the International Prospective Register of Systematic Review registration (CRD42021286552). Thirty-two randomized controlled trials comprising 103 459 (51 750 experimental, 51 709 control) patients were included. Compared with DAPT with aspirin and clopidogrel for 12 months, high- to low-potency DAPT (risk ratio [RR], 0.69 [95% CI, 0.52-0.92]) and aspirin+prasugrel containing DAPT for 12 months (RR, 0.84 [95% CI, 0.72-0.98]) had a significantly lower, whereas DAPT for 1 month followed by clopidogrel only (RR, 1.59 [95% CI, 1.06-2.39]) had a higher, incidence of major adverse cardiovascular events at 1 year (median follow-up). Prasugrel (RR, 1.35 [95% CI, 1.09-1.66]) and ticagrelor (RR, 1.38 [95% CI, 1.17-1.62]) containing DAPT for 12 months had significantly higher rates, whereas high- to low-potency DAPT (RR, 0.85 [95% CI, 0.63-1.15]) had no significant risk of major bleeding., Conclusions: Aspirin and ticagrelor for 3 months, followed by aspirin and clopidogrel for the remaining duration, can be considered the optimal strategy for treating post-percutaneous coronary intervention patients with acute coronary syndrome because of a significantly reduced risk of major adverse cardiovascular events without increasing the risk of bleeding.

Background: The Organ Procurement and Transplantation Network (OPTN) implemented modifications in 2018 to the adult heart transplant allocation system to better stratify the most medically urgent transplant candidates. We evaluated the impact of these changes on patients supported by a durable left ventricular assist device (LVAD) with chronic kidney disease (CKD)., Objective: To evaluate the impact of the OPTN policy change on patients supported by durable left ventricular assist devices (LVAD) with chronic kidney disease (CKD)., Methods: We performed an analysis of patients from the United Network of Organ Sharing Database supported by durable LVAD listed for a heart transplant (HT) between October 17, 2016 and September 30, 2021. Patients were divided into two groups: pre- and postpolicy, depending on whether they were listed on or prior to October 17, 2018. Patients who were on dialysis prior to surgery or discharge were excluded from the analysis. Patients with simultaneous heart and kidney transplants were excluded. Patients who were listed for transplant prepolicy change but transplanted postpolicy change were excluded. This cohort was then subdivided into degrees of CKD based on estimated glomerular filtration rate (eGFR), which resulted in 678 patients (23.7%) in Stage 1 (GFR ≥89.499) (Prepolicy: 345, Postpolicy: 333), 1233 (43.1%) in Stage 2 (89.499 > GFR ≥ 59.499) (Prepolicy: 618, Postpolicy: 615), 613 (21.4%) in Stage 3a (59.499 > GFR ≥ 44.499) (Prepolicy: 291, Postpolicy: 322), 294 (10.3%) in Stage 3b (44.499 > GFR ≥ 29.499) (Prepolicy: 143, Postpolicy: 151), 36 (1.3%) in Stage 4 (29.499 > GFR ≥ 15) (Prepolicy: 21, Postpolicy: 15), and 9 (0.3%) in Stage 5 (15 > GFR) (Prepolicy: 4, Postpolicy: 5). The primary outcome was 1-year and 2-year post-HT survival., Results: There were 2863 patients who met the study criteria (1422 prepolicy, 1441 postpolicy). Overall survival, regardless of CKD stage, was lower following the policy change (p < 0.01). There was a similar risk of primary graft failure (PGF) in the pre- and postpolicy period (1.8% vs. 1.2%, p = 0.26). 1-year overall survival was 93% (91, 94) and 89% (87, 91) in the pre- and postpolicy periods, respectively. 2-year overall survival was 89% (88, 91) and 85% (82, 87) in the pre- and postpolicy periods, respectively. For CKD Stages 1, 2, 3a, 3b, 4, and 5, 1 -year survival was 93% (91, 95), 92% (90,93), 89% (86, 91), 89% (86, 93), 80% (68, 94), and 100% (100, 100), respectively. For CKD Stages 1, 2, 3a, 3b, 4, and 5, 2-year survival was 91% (88, 93), 88% (86, 90), 84% (81, 88), 84% (80, 89), 73% (59, 90), and 100% (100, 100), respectively. Patients with CKD 1 and 2 had better survival compared to those with CKD 3 (p < 0.01) and CKD 4 and 5 (p = 0.03) in the pre- and postpolicy periods. Patients with CKD 3 did not have a survival advantage over those with CKD 4 and 5 (p = 0.25). On cox regression analysis, advancing degrees of CKD were associated with an increased risk of mortality., Conclusions: Patients with LVAD support had decreased overall survival after the OPTN policy change. Patients with more advanced CKD had lower survival than patients without advanced CKD, though they were not impacted by the OPTN policy change., (© 2024 The Authors. Artificial Organs published by International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)

Background: Helicobacter pylori ( H. pylori )is a Gram-negative, microaerophilic, and spiral shape bacterium that resides inside the human stomach. The human stomach serves as its primary reservoir. Complaints about stomach complication due to H. pylori infections are reported in the majority of populations around the globe. Chronic gastritis and intestinal metaplasia of the gastric mucosa are major complications of a long-term H. pylori infections that can lead to gastric cancer in severe cases. This study aims to characterize H. pylori isolates from gastroenteritis patients and to determine the resistance of H. pylori to various antibiotics., Methods: In the current study, a total of (n = 80) gastric biopsy samples were randomly collected from gastroenteritis patients in brain-heart infusion broth. These were inoculated on Columbia blood agar supplemented with Helicobacter pylori selective supplement (DENT). After culturing, Microscopy and biochemical tests were performed. The susceptibility profile of H. pylori isolates was evaluated using the Kirby Bauer disk diffusion method. On the basis of the drug resistance profile, a total of (n = 20) isolates including (n = 10) from females and (n = 10) from males were selected for the detection and characterization of resistant genes. After confirmation of H. pylori using 16s rRNA , polymerase chain reaction (PCR) was done for the detection of resistance genes including Metronidazole resistance ( rdxA gene), Clarithromycin resistance ( 23s rRNA gene) and Amoxicillin resistance (Penicillin-binding protein A1 ( pbpA1 ) gene)., Results: In a total of (n = 80) samples, H. pylori was isolated from 72.5% (n = 58) samples. Among the positive patients, there were 62% (n = 36) of female positive patients while in males, its ratio was 38% (n = 22). It was more common in the age between 30-50 years 55.17% (n = 32). It has shown the highest resistance towards Metronidazole 90% (n = 52), and the lowest toward Levofloxacin 65% (n = 38). Metronidazole resistance gene ( rdxA gene) was detected in (n = 13) isolates including (n = 9) isolates from females and (n = 4) from males. In the case of, the Clarithromycin resistance gene ( 23s rRNA ) (n = 10) was positive for H. pylori including (n = 6) isolates from females and (n = 7) were positive for Amoxicillin ( pbpA1 gene) including (n = 2) in female and (n = 5) from male patients., Conclusion: This study highlights the increasing incidence of H. pylori infections in both male and female patients. It also revealed the current status of antibiotic resistance and its resistance genes in patients facing gastrointestinal issues. Continuous surveillance of resistant clones will help in formulating strategies that can help in combating of resistant clone. It will also help clinician in proper prescription and management of H. pylori infections.

Background and Aims: Catheter ablation is superior to pharmacological therapy in controlling atrial fibrillation (AF). There are few data on the long-term outcome of AF ablation in octogenarian patients. This analysis aims to evaluate the outcome of AF ablation in octogenarians vs. younger patients., Methods: In this retrospective study in 13 centres in the UK, France, and Switzerland, the long-term outcomes of 473 consecutive octogenarian patients undergoing ablation for AF were compared to 473 matched younger controls (median age 81.3 [80.0, 83.0] vs. 64.4 [56.5, 70.7] years, 54.3% vs. 35.1% females; p-value for both < 0.001). The primary endpoint was the recurrence of atrial arrhythmia after a blanking period of 90 days within 365 days of follow-up., Results: Acute ablation success as defined as isolation of all pulmonary veins was achieved in 97% of octogenarians. Octogenarians experienced more procedural complications (11.4% vs 7.0%, p = 0.018). The median follow-up time was 281 [106, 365] days vs. 354 [220, 365] days for octogenarians vs. non-octogenarians (p < 0.001). Among octogenarians, 27.7% (131 patients) experienced a recurrence of atrial arrhythmia, in contrast to 23.5% (111 patients) in the younger group (odds ratio 1.49; 95% confidence interval 1.16-1.92; p = 0.002). In a multivariable regression model including gender, previous AF ablation, vascular disease, chronic kidney disease, CHA2DS2-VASc score, left atrial dilatation, and indwelling cardiac implantable electronic device, age above 80 remained an independent predictor of recurrence of arrhythmia., Conclusion: Ablation for AF is effective in octogenarians, but is associated with slightly higher procedural complication rate and recurrence of atrial arrhythmia than in younger patients., (© 2024. The Author(s).)

Human activities are altering the existing patterns of Land Use Land Cover (LULC) and Land Surface Temperature (LST) on a global scale. However, long-term trends of LULC and LST are largely unknown in many remote mountain areas such as the Karakorum. . The objective of our study therefore was to evaluate the historical changes in land use and land cover (LULC) in an alpine environment located in Islamabad Capital Territory, Pakistan. We used Landsat satellite pictures (namely Landsat 5 TM and Landsat 8 OLI) from the years 1988, 2002, and 2016 and applied the Maximum Likelihood Classification (MLC) approach to categorize land use classes. Land Surface Temperatures (LST) were calculated using the thermal bands (6, 10, and 11) of Landsat series data. The correlation between the Human Modification Index (HMI) and LULC as well as LST was evaluated by utilizing data from Google Earth Engine (GEE). Over the study period, the urbanized area increased by 9.94%, whilst the agricultural and bare soil areas decreased by 3.81% and 3.94%, respectively. The findings revealed a significant change in the LULC with a decrease of 1.99% in vegetation. The highest LST class exhibited a progressive trend, with an increase from 12.27% to 48.48%. Based on the LST analysis, the built-up area shows the highest temperature, followed by the barren, agricultural, and vegetation categories. Similarly, the HMI for different LST categories indicates that higher LST categories have higher levels of human alteration compared to lower LST categories, with a strong correlation (R-value = 0.61) between HMI and LST. The findings can be utilized to promote sustainable urban management and for biodiversity conservation efforts. The work also has the potential of utilizing it to protect delicate ecosystems from human interference and to formulate strategies and regulations for sustainable urban growth, including aspects of land utilization and zoning, reduction of urban heat stress, and urban infrastructure.

Background: The aim of the study was to determine national estimates for the percentage of all readmissions with demographic features, length of stay (LOS), cost analysis, comorbidities, complications, overall and gender-specific mortality and complications of transcutaneous tricuspid valve replacement/repair (TTVR) vs. open surgical tricuspid valve replacement/repair (open TVR)., Methods: Data were extrapolated from the Nationwide Readmissions Database (NRD) 2015-19. Of the 75,266,750 (unweighted) cases recorded in the 2015 - 2019 dataset, 429 had one or more of the percutaneous approach codes as per the ICD-10 dataset, and 10,077 had one or more of the open approach codes., Results: Overall, the number of cases performed each year through open TVR was higher than TTVR, but there was an increased trend towards the TTVR every passing year. TTVR was performed more in females and advanced age groups than open TVR. The LOS and cost were lower in the TTVR group than in open TVR. Patients undergoing TTVR had more underlying comorbidities like congestive heart failure, hypertension, and uncomplicated diabetes mellitus. Overall mortality was 3.49% in TTVR vs. 6.09% in open TVR. The gender-specific analysis demonstrated higher female mortality in the open TVR compared to TTVR (5.45% vs. 3.03%). Male mortality was statistically insignificant between the two groups (6.8% vs. 4.3%, P-value = 0.15). Patients with TTVR had lower rates of complications than open TVR, except for arrhythmias, which were higher in TTVR. Patients undergoing open TVR required more intracardiac support, such as intra-aortic balloon pump (IABP) and Impella, than TTVR., Conclusion: TTVR is an emerging alternative to open TVR in patients with tricuspid valve diseases, especially tricuspid regurgitation. Despite having more underlying comorbidities, the TTVR group had lower in-hospital mortality, hospital cost, LOS, and fewer complications than open TVR., Competing Interests: None to declare., (Copyright 2024, Khan et al.)

Background: This study aimed to investigate the association between index trial participation status and 30-day unplanned readmission rates, causes, and outcomes in acute coronary syndrome (ACS) patients., Methods: The National Readmission Database was analysed for all index hospitalizations with a principal diagnosis of ACS between October 2015 to November 2019, stratified by index trial participation status (International Classification of Diseases - 10th edition code: Z00.6). The 30-day unplanned readmission rates, causes and outcomes were analysed, including the assessment of factors associated with readmission. Multivariable regression analyses were reported as adjusted odds ratios (aOR) with 95 % confidence intervals (95 % CI). All analyses were weighted and utilized hierarchical multi-level organization., Results: A total of 2,066,328 cases with a principal diagnosis of ACS were included in the study, of which there were 4061 trial participants (0.2 %) and 189,240 (9.2 %) cases experienced unplanned 30-day readmission. Rates of unplanned 30-day readmission were similar between trial participants and non-participants (9.8 % vs. 9.2 %, p = 0.16). Consistently, after multivariable adjustment, there was no significant association between trial participation and unplanned 30-day readmissions (aOR 0.96, 95 % CI 0.86-1.07, p = 0.45). Compared with trial participants, the majority of readmissions in non-participants were related to cardiovascular conditions (55.2 % vs. 46.7 %, p = 0.005, respectively). There was no significant difference in all-cause mortality (5.5 % vs. 4.6 %, p = 0.368, respectively), but trial participants were more likely to develop major bleeding (3.5 % vs. 2.1 %, p = 0.044), ischemic stroke (4.0 % vs. 2.1 %, p = 0.008) and haemorrhagic stroke (2.0 % vs. 0.6 %, p < 0.001) at readmissions., Conclusion: Overall rates of unplanned 30-day readmissions after ACS are similar between trial participants and non-participants, but non-participation in trials was associated with a higher likelihood of cardiovascular readmission., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The aim of the present research was to investigate the presence of heavy metals such as lead (Pb), copper (Cu), chromium (Cr), and cadmium (Cd) in blood samples from cows raised with irrigated wastewater, as well as in the wastewater itself, in the North-western region of Pakistan. A total of 60 blood samples were collected from five different locations in Kohat, namely Tappi Road (TR), Pindi Road (PR), Gul Malik Road (GMR), Markaz Road (MR), and a control group. The samples of both i.e. cow blood and wastewater were analyzed for the concentrations of heavy metals. The highest concentration of Cd was detected in the MR site with a mean value of 0.03 mg/L, and the highest concentration of Cu (0.04 mg/L) was recorded in the TR site, while the lowest level was found in the control group with a mean of 0.002 mg/L in blood samples. The highest Cr and Pb concentrations were found at the PR site, with mean values of 0.03 and 0.07 mg/L, respectively, whereas the control group had the lowest concentrations, with mean values of 0.002 and 0.01 mg/L. Similarly, heavy metal concentrations were analyzed in wastewater used for irrigation in the study area. Results indicated elevated concentrations of Cu and Cr in wastewater, although they remained below the World Health Organization (WHO) recommended values except for Cr (0.13 mg/L) in the GMR site, which exceeded permissible limits. Cd and Pb concentrations in wastewater were relatively low, but Cd concentration surpassed WHO limits, particularly with a mean concentration of 0.08 mg/L in the TR site. Comparison between heavy metal concentrations in blood and wastewater revealed higher values of Cd and Pb in blood samples than in wastewater, while Cu and Cr concentrations were higher in water compared to blood. Additionally, elevated levels of Super Oxide Dismutase (SOD), antioxidant enzyme Catalase (CAT), and oxidative stress marker malondialdehyde (MDA) were detected in blood samples. Cluster and principal component analyses were employed to assess heavy metal toxicity among the groups, indicating potential long-term adverse health effects on animals, transfer to humans, and toxicity in living organisms., (© 2024. The Author(s).)

Potentially toxic dyes are introduced mainly to rivers through industrial effluents which have a high risk to human health and aquatic life. Activated carbon (AC) from the stem of Salvadora persica was synthesised to take off toxic industrial dyes from an aqueous solution. KOH was used as the activating agent throughout the preparation process for the AC. The morphology and composition of the prepared AC were studied by various analytical methods. From the overall results, it was found that the prepared AC is highly porous and thermal stability gained around 800 ℃. At room temperature, remediation of the dyes (cationic dye, methyl red and anionic dye, methylene blue) using the adsorption method was carried out to ascertain the impact of time and the quantity of AC on methylene blue (MB) and methyl red (MR) removal. During the initial 60 min, equilibrium was attained for the optimum dye concentration (200 mg/L). The data for adsorption on the AC obtained at equilibrium were examined by the Langmuir and Freundlich isotherm models. Both the isotherms accurately predicted the data, with regression values of 0.99 for MR and 0.90 for MB, respectively. The equilibrium adsorption data was also analysed by kinetic models. The adsorption data well fitted in 2nd order kinetic model. The results of MB and MR adsorption from solutions have demonstrated that the stem of Salvadora persica is one of the cheap and more eco-friendly options for remediation of toxic dyes from aqueous solutions., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Neutrophil to lymphocyte ratio (NLR) has been considered a prognostic biomarker of mortality and other major cardiac events. This study investigates NLR's efficacy in predicting in-hospital and long-term outcomes in patients with ST-segment elevated myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI)., Methods: Electronic databases (PUBMED, Cochrane CENTRAL, ERIC, Embase, Ovid, and Google Scholar) were searched till June 2022 to identify studies having STEMI patients who underwent PCI. Risk ratios and mean differences (MDs), along with their corresponding 95% confidence intervals (Cis) and standard deviations (SDs), were pooled using a random-effect model. This meta-analysis has been registered on Prospero (ID: CRD42022344072)., Results: A total of 35 studies with 28,756 patients were included. Pooled estimates revealed an increased incidence of primary outcomes; in-hospital all-cause mortality (RR = 3.52; 95% CI = 2.93-4.24), long-term all-cause mortality (HR = 1.07; 95% CI = 1.00-1.14), (RR = 3.32; 95% CI = 2.57-4.30); in-hospital cardiovascular mortality (RR = 2.66; 95% CI = 2.04-3.48), long-term cardiovascular mortality (RR = 6.67; 95% CI = 4.06-10.95); in-hospital major adverse cardiovascular events (MACE) (RR = 1.31; 95% CI = 1.17-1.46), long-term MACE (RR = 2.92; 95% CI = 2.16-3.94); length of hospital stay (WMD = 0.60 days; 95% CI = 0.40-0.79) in patients with high NLR compared to those with a low NLR., Conclusion: NLR might be a valuable tool for prognostication (in-hospital) and stratification of patients with STEMI who underwent PCI., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Syphilis, caused by Treponema pallidum, is resurging globally. Molecular typing allows for the investigation of its epidemiology. In Pakistan and other nations, T. pallidum subsp. pallidum has developed widespread macrolide resistance in the past decade. A study at the Peshawar Regional Blood Centre from June 2020-June 2021 analyzed serum samples from 32,812 blood donors in Khyber Pakhtunkhwa, Pakistan, to assess circulating T. pallidum strains and antibiotic resistance. Blood samples were initially screened for T. pallidum antibodies using a chemiluminescent microparticle immunoassay (CMIA). CMIA-reactive samples underwent polymerase chain reaction (PCR) targeted the polA, tpp47, bmp, and tp0319 genes. PCR-positive samples were further analyzed for molecular subtyping using a CDC-developed procedure and tp0548 gene examination. All PCR-positive samples were analyzed for the presence of point mutations A2058G and A2059G in 23S rRNA, as well as the G1058C mutation in 16S rRNA. These mutations are known to impart antimicrobial resistance to macrolides and doxycycline, respectively. Out of 32,812 serum samples, 272 (0.83%) were CMIA-reactive, with 46 being PCR-positive. Nine T. pallidum subtypes were identified, predominantly 14d/f. The A2058G mutation in 23S rRNA was found in 78% of cases, while G1058C in 16S rRNA and A2059G in 23S rRNA were absent. The research found donor blood useful for assessing T. pallidum molecular subtypes and antibiotic resistance, especially when chancres are not present. The prevalent subtype was 14d/f (51.85%), and the high macrolide resistance of 36 (78%) indicates caution in using macrolides for syphilis treatment in Khyber Pakhtunkhwa, Pakistan., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Muhammad et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: The relationships between baseline tissue local impedance (LI), contact force (CF), atrial fibrosis, and atrial rhythm are uninvestigated in a clinical setting. We compared the relationship of LI and CF between atrial fibrillation (AF) and sinus rhythm (SR) accounting for the effects of atrial fibrosis as assessed by bipolar voltage and LI., Methods: Patients undergoing persistent AF ablation were recruited. LI was recorded referenced to patient blood pool (LIr) and concurrent to changes in CF, with data collected at the same locations in AF and SR., Results: Twenty patients were recruited. 109 locations were sampled obtaining 1903 data points (SR: 966, AF: 937). CF correlated strongly with LI (repeated measures correlation = 0.64). The relationship between CF and LIr was logarithmic. Rhythm and CF had a significant main (both p < .0005) and interaction effect (p = .022) on tissue LI: AF demonstrated higher LIr values than SR for similar CF. Bipolar voltage had no effect on the relationship of CF to LIr in either rhythm. Assessing fibrosis using LIr showed an interaction effect with CF for LIr in SR and AF, (SR: p < .0005, AF: p = .01), with increased fibrosis showing lesser change in LIr per gram of CF., Conclusions: CF and rhythm significantly affect the measured LIr of LA myocardium. Optimal catheter-tissue coupling may be better achieved with higher levels of CF and in AF rather than SR. Atrial fibrosis, as assessed by LIr but not bipolar voltage, affected the CF-LI relationship., (© 2024 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.)

Background: Percutaneous left atrial appendage occlusion (LAAO) has emerged as a non-pharmacologic alternative to oral anticoagulation in reducing stroke risk in AF patients. However, patients with mitral valve disease (MVD), who are expected to have a significantly greater risk of left atrium (LA) thrombus formation and embolic stroke were excluded from randomized trials examining percutaneous LAAO. To address this gap, we present a national registry analysis of the use of LAAO among patients with MVD., Methods: Using the National Readmissions Database, we performed a retrospective review of all hospitalizations for LAAO identified between September 2015 and November 2019. Of these, patients with ICD-10 codes for MVD were identified. Propensity matched (PSM) analysis was used to compare patients with MVD with a matched sample of patients undergoing LAAO with non-valvular AF. Outcomes examined included all-cause mortality, stroke, major bleeding, pericardial effusion (PE), and tamponade., Results: 51,540 patients who underwent LAAO without a history of MVD and 3777 with a history of MVD were identified. Crude analysis demonstrated the odds of mortality, PE, and cardiac tamponade during index hospitalization to be higher in the MVD group. The length of stay and cost of index hospitalization were also slightly greater for the MVD group. A sample of 7649 patients (MVD: 3777 MVD and no MVD: 3872) were selected for PSM analysis with similar comorbidities across the two groups. In the PSM comparison, MVD was associated with higher risk of PE. The MVD group had a slightly higher rate of readmissions the association with PE remained at 30-day readmission (OR: 2.099 [1.360-3.238], p-value: <0.001)., Conclusion: To our knowledge, this is the first study examining the use of LAAO among MVD patients. Our findings suggest that patients with MVD who underwent LAAO had a higher risk of post-procedural PE without an increase in mortality, stroke, or major bleeding. These results provide a rationale for considering LAAO as part of the stroke prevention strategy among patients with valvular AF., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Steven Filby reports a relationship with Boston Scientific Corp that includes: consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

A comprehensive understanding of water quality is essential for assessing the complex relationship between surface water and sources of pollution. Primarily, surface water pollution is linked to human and animal waste discharges. This study aimed to investigate the physico-chemical characteristics of drinking water under both dry and wet conditions, assess the extent of bacterial contamination in samples collected from various locations in District Shangla, and evaluate potential health risks associated with consuming contaminated water within local communities. For this purpose, 120 groundwater and surface water samples were randomly collected from various sources such as storage tanks, user sites, streams, ponds and rivers in the study area. The results revealed that in Bisham, lakes had the highest fecal coliform levels among seven tested sources, followed by protected wells, reservoirs, downstream sources, springs, rivers, and ditches; while in Alpuri, nearly 80% of samples from five sources contained fecal coliform bacteria. Similarly, it was observed that the turbidity level, total dissolved solids, electrical conductivity, biological oxygen demand, and dissolved oxygen in the surface drinking water sources of Bisham were significantly higher than those in the surface drinking water sources of Alpuri. Furthermore, the results showed that in the Alpuri region, 14% of the population suffers from dysentery, 27% from diarrhea, 22% from cholera, 13% from hepatitis A, and 16% and 8% from typhoid and kidney problems, respectively, while in the Bisham area, 24% of residents are affected by diarrhea, 17% by cholera and typhoid, 15% by hepatitis A, 14% by dysentery, and 13% by kidney problems. These findings underscore the urgent need for improved water quality management practices and public health interventions to mitigate the risks associated with contaminated drinking water. It is recommended to implement regular water quality monitoring programs, enhance sanitation infrastructure, and raise awareness among local communities about the importance of safe drinking water practices to safeguard public health., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Large differences in projected future annual precipitation increases in North America exists across 27 CMIP6 models under four emission scenarios. These differences partly arise from weak representations of land-atmosphere interactions. Here we demonstrate an emergent constraint relationship between annual growth rates of future precipitation and growth rates of historical temperature. The original CMIP6 projections show 0.49% (SSP126), 0.98% (SSP245), 1.45% (SSP370) and 1.92% (SSP585) increases in precipitation per decade. Combining observed warming trends, the constrained results show that the best estimates of future precipitation increases are more likely to reach 0.40-0.48%, 0.83-0.93%, 1.29-1.45% and 1.70-1.87% respectively, implying an overestimated future precipitation increases across North America. The constrained results also are narrow the corresponding uncertainties (standard deviations) by 13.8-31.1%. The overestimated precipitation growth rates also reveal an overvalued annual growth rates in temperature (6.0-13.2% or 0.12-0.37°C) and in total evaporation (4.8-14.5%) by the original models' predictions. These findings highlight the important role of temperature for accurate climate predictions, which is important as temperature from current climate models' simulations often still have systematic errors., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Lou et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Cutaneous leishmaniasis (CL), an emerging vector-borne ailment in Khyber Pakhtunkhwa (KPK), Pakistan, exhibits diverse spread patterns and outbreaks., Methods: To comprehend its epidemiology and identify parasite species, we conducted an active survey on suspected CL cases (n=8845) in KPK., Results: Microscopy and internal transcribed spacer-1 PCR-restriction fragment length polymorphism (RFLP) molecular techniques detected Leishmania spp. in blood samples. Phylogenetic analysis gauged genetic affinities with other areas. District Bannu displayed the highest CL impact (14.58%), while Swat had the lowest impact (4.33%) among cases. Annual blood examination rate, parasite incidence and slide positivity rate were 4.96 per 1000 people, 0.0233 and 0.047%, respectively. CL infections were prevalent in 1- to 20-y-olds, with males (57.17%) more vulnerable than females (42.82%). Single lesions occurred in 43.73% of patients, while 31.2% people had two lesions, 17.31% had three lesions and 7.74% had more than three lesions. Most had sand-fly exposure but lacked preventive measures like repellents and bed nets. Leishmania tropica was confirmed via RFLP analysis in amplified samples. Phylogenetic analysis unveiled genetic parallels between L. tropica of KPK and isolates from China, Iran, Afghanistan, India, Syria and Morocco., Conclusions: Urgent comprehensive control measures are imperative. Early detection, targeted interventions and raising awareness of CL and sand-fly vectors are vital for reducing the disease's impact. International collaboration and monitoring are crucial to tackle Leishmania spp.'s genetic diversity and curtail its cross-border spread., (© The Author(s) 2023. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Background: Ultra high-density mapping systems allow for comparison of atrial electroanatomical maps in unprecedented detail. Atrial scar determined by voltages and surface area between atria, rhythm and atrial fibrillation (AF) types was assessed., Methods: Left (LA) and right atrial (RA) maps were created using Rhythmia HDx in patients listed for ablation for paroxysmal (PAF, sinus rhythm (SR) maps only) or persistent AF (PeAF, AF and SR maps). Electrograms on corresponding SR/AF maps were paired for direct comparison. Percentage surface area of scar was assigned low- (LVM, ≤ 0.05 mV), intermediate- (IVM, 0.05-0.5 mV) or normal voltage myocardium, (NVM, > 0.5 mV)., Results: Thirty-eight patients were recruited generating 96 maps using 913,480 electrograms. Paired SR-AF bipolar electrograms showed fair correlation in LA (Spearman's ρ = 0.32) and weak correlation in RA (ρ = 0.19) and were significantly higher in SR in both (LA: 0.61 mV (0.20-1.67) vs 0.31 mV (0.10-0.74), RA: 0.68 mV (0.19-1.88) vs 0.47 mV (0.14-1.07), p < 0.0005 both). Voltages were significantly higher in patients with PAF over PeAF, (LA: 1.13 mV (0.39-2.93) vs 0.52 mV (0.16-1.49); RA: 0.93 mV (0.24-2.46) vs 0.57 mV (0.17-1.69)). Minimal differences were seen in electrogram voltages between atria. Significantly more IVM/LVM surface areas were seen in AF over SR (LA only, p < 0005), and PeAF over PAF (LA: p = 0.01, RA: p = 0.04). There was minimal difference between atria within patients., Conclusions: Ultra high-density mapping shows paired electrograms correlate poorly between SR and AF. SR electrograms are typically (but not always) larger than those in AF. Patients with PeAF have a lower global electrogram voltage than those with PAF. Electrogram voltages are similar between atria within individual patients., (© 2023. The Author(s).)

Background: Literature regarding outcomes associated with surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) among amyloidosis (AM) with aortic stenosis (AS) is limited., Objectives: We aim to study the mortality and in-hospital clinical outcomes among AM with AS associated with SAVR or TAVR., Methods: We performed a retrospective study of all hospitalisation encounters associated with a diagnosis of AM with AS, using the Nationwide Readmissions Database for the years 2012-2019. Primary outcomes were in-hospital mortality, and 30-day readmissions., Results: A total of 4,820 index hospitalisations of AS (mean age 78.35±10.11 years; female 37.76%) among AM were reported. Total 464 patients had mechanical intervention, 251 patients (54.1%) TAVR and 213 patients (45.9%) SAVR. A total of 317 patients (6.77%) with AS died; TAVR 4.4%, SAVR 11.9% (p=0.01) and 6.66% died among the subgroup who did not have any mechanical intervention. Higher complication rates were observed among patients who had SAVR than those who had TAVR including acute kidney injury (39.8% vs 22.4%; p=0.01), septic shock (12.1% vs 4.4%; p=0.05) and cardiogenic shock (22% vs 4.4%; p<0.001). Acute heart failure was higher among patients who had TAVR (40.2% vs 27.5%; p=0.04) than those who had SAVR. All conduction block and ischaemic stroke were similar between the two groups (p=0.09 and p=0.1). The overall 30-day readmission rate among AM with AS encounters was 16.82%, higher among TAVR compared to SAVR subgroups (21.25% vs 11.17%; p=0.001)., Conclusions: Among AM with AS hospitalisations, TAVR had mortality benefits compared to SAVR and non-mechanical intervention subgroups. Moreover, higher 30-day mortality rate were observed among SAVR subgroup, which may suggest that TAVR should be strongly considered in AM patients complicated by AS., (Copyright © 2023 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)

In this study, we used in silico techniques to identify available parasite treatments, representing a promising therapeutic avenue. Building upon our computational initiatives aimed at discovering natural inhibitors for various target enzymes from parasites causing neglected tropical diseases (NTDs), we present novel findings on three turmeric-derived phytochemicals as inhibitors of Leishmania pteridine reductase I (PTR1) through in silico methodologies. PTR1, a crucial enzyme in the unique folate metabolism of trypanosomatid parasites, holds established therapeutic significance. Employing MOE software, a molecular docking analysis assesses the efficacy of turmeric phytochemicals against Leishmania PTR1. Validation of the docking protocol is confirmed with an RMSD value of 2. Post-docking, compounds displaying notable interactions with critical residues and binding affinities ranging between -6 and -8 kcal/mol are selected for interaction pattern exploration. Testing twelve turmeric phytochemicals, including curcumin, zingiberene, curcumol, curcumenol, eugenol, bisdemethoxycurcumin, tetrahydrocurcumin, tryethylcurcumin, turmerones, turmerin, demethoxycurcumin, and turmeronols, revealed binding affinities ranging from -5.5 to -8 kcal/mol. Notably, curcumin, demethoxycurcumin, and bisdemethoxycurcumin exhibit binding affinities within -6.5 to -8 kcal/mol and establish substantial interactions with catalytic residues. These phytochemicals hold promise as lead structures for rational drug design targeting Leishmania spp. PTR in future applications. This work underscores the potential of these identified phytochemicals in the development of more effective inhibitors, demonstrating their relevance in addressing neglected tropical diseases caused by parasites., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Anthropogenic climate change has amplified human thermal discomfort in urban environments. Despite the considerable risks posed to public health, there is a lack of comprehensive research, evaluating the spatiotemporal changes in human thermal discomfort and its characteristics in hot-hyper arid regions, such as the Arabian Peninsula (AP). The current study analyzes spatiotemporal changes in human thermal discomfort categories and their characteristics in AP, using the newly developed high-resolution gridded ERA5-HEAT (Human thErmAl comforT) dataset for the period 1979-2022. In addition, the study assesses the interplay between the Universal Thermal Climate Index (UTCI) and El Niño-Southern Oscillation (ENSO) indices for the study period. The results reveal a significant increase in human thermal discomfort and its characteristics, with higher spatial variability in the AP region. The major urban centers in the southwestern, central, and southeastern parts of AP have experienced significant increases in human thermal discomfort (0.4-0.8 °C), with higher frequency and intensity of thermal stress during the study period. The temporal distribution demonstrates a linear increase in UTCI indices and their frequencies and intensities, particularly from 1998 onward, signifying a transition towards a hotter climate characterized by frequent, intense, and prolonged heat stress conditions. Moreover, the UTCI and ENSO indices exhibit a dipole pattern of correlation with a positive (negative) pattern in the southwestern (eastern parts) of AP. The study's findings suggest that policymakers and urban planners need to prioritize public health and well-being in AP's urban areas, especially for vulnerable groups, by implementing climate change adaptation and mitigation strategies, and carefully designing future cities to mitigate the effects of heat stress., (© 2024. The Author(s).)