Search

Abstract Background Soluble guanylate cyclase (sGC) stimulators have been investigated for heart failure (HF) in several randomized controlled trials (RCTs). However, its place in the management guidelines of either HFrEF or HfpEF is still inconclusive. Methods We conducted a network meta-analysis synthesizing RCTs investigating sGC for HF management, which were retrieved by systematically searching five databases until January 24th, 2023. Dichotomous outcomes were pooled using risk ratio (RR) along with confidence interval (CI). Results Eight RCTs with a total of 7307 patients were included. Vericiguat 10 mg significantly reduced the composite cardiovascular (CVS) mortality and HF hospitalization in HF (RR: 0.88, 95% CI [0.79; 0.98]) and in HFrEF (RR: 0.87, 95% CI [0.78; 0.97]); however, it was not effective in HFpEF (RR: 0.69, 95% CI [0.15; 3.05]). Also, vericiguat 10 mg showed no difference compared to placebo regarding the incidence of all-cause mortality (RR: 0.96, 95% CI [0.84; 1.10]), any adverse events (AEs) (RR: 0.94, 95% CI [0.83; 1.07]), any serious AEs (RR: 0.91, 95% CI [0.81; 1.01]), and any AEs leading to drug discontinuation (RR: 1.14, 95% CI [0.92; 1.40]). Conclusion Vericiguat 10 mg was effective in reducing the composite CVS mortality and HF hospitalization, with an acceptable safety profile. This was only observed in HFrEF patients, but not in HFpEF patients. However, our data regarding other agents (riociguat and praliciguat) and HFpEF can be underpowered, warranting further RCTs to clarify vericiguat 10 mg place in HFrEF management guidelines and to investigate sGC stimulators for HFpEF in large-scale trials.

Abstract Polyethylene glycol loxenatide (PEX168) is a novel glucagon-like peptide-1 receptor agonist with a longer half-life developed by modifying the chemical structure of exenatide. This study aims to assess the efficacy and safety of PEX168 and determine the best dose. We searched PubMed, Scopus, Cochrane Library, and Web of Science databases from inception to April 25, 2023, for randomized controlled trials (RCTs) comparing PEX168 therapy alone or in combination with metformin versus other therapies. We used the risk ratio (RR) for dichotomous outcomes and the mean difference (MD) for continuous outcomes, both with 95% confidence intervals (CI). Six RCTs, including 1248 participants, were included. PEX168 added to metformin was significantly better than metformin alone regarding fasting blood glucose (MD = −1.20, 95% CI (−1.78, − 0.62), p 0.05). Body weight was significantly reduced in obese diabetic patients receiving PEX168 compared to the control group (MD = −5.46, 95% CI (−7.90, − 3.01), p

Abstract Background Genitourinary syndrome of menopause (GSM) is a common and disturbing issue in the postmenopausal period. Unlike vasomotor symptoms, it has a progressive trend. Our study aims to evaluate the efficacy and safety of oxytocin gel versus placebo gel in postmenopausal women with GSM. Methods A systematic review and meta-analysis synthesizing randomized controlled trials (RCTs) from Web of Science, SCOPUS, PubMed, and Cochrane Central Register of Controlled Trials databases on January 18, 2023. Keywords such as “oxytocin,“ “intravaginal,“ “vaginal,“ “atrophic,“ and “atrophy” were used. We used Review Manager (RevMan) version 5.4 in our analysis. We used the risk ratio (RR) for dichotomous outcomes and the mean difference (MD) for continuous outcomes; both were presented with the corresponding 95% confidence interval (CI) and were calculated with the Mantel-Haenszel or inverse variance statistical method. Cochrane’s Q test and the I2 statistic were used as measures of statistical inconsistency and heterogeneity. The Cochrane Risk of Bias Tool for RCTs was used for the quality assessment of the included studies. Results Seven studies with 631 patients were included. Regarding the maturation index, there was a statistically insignificant increase in the oxytocin arm (MD = 12.34, 95% CI (-12.52-37.19), P = 0.33). Clinically assessed vaginal atrophy showed a statistically significant reduction in the oxytocin group (RR = 0.32, 95% CI (0.23 − 0.10), P

Hashimoto’s encephalopathy (HE), a rare autoimmune disorder associated with thyroiditis, is a condition with no definitive cause. Symptoms include altered mental status, seizures, and cognitive impairment. When diagnostic criteria are met, steroids are the cornerstone of treatment with a reported good response. This report presents a 26-year-old female with HE who presented with persistent status epilepticus and altered mental status, complicated by aspiration pneumonia and laryngeal edema, and had been managed successfully. After exclusion of the common causes of acute altered mental status and seizures, early workup for treatable rare causes such as HE can help rapid recovery and avoid complications. However, proper management of complications such as lower respiratory tract infection, if happened, is necessary for good outcome.

Background : Coronary artery bypass graft surgery (CABG) is considered the most performed cardiac surgery nowadays. The outcome of CABG surgery has been linked to several aspects. Above all is graft patency which is a crucial element contributing to success of the surgery. Early graft failure following CABG has been recorded in up to 12% of grafts (left IMA 7%; saphenous vein graft 8%). Objectives: The aim of the present study was to determine the efficacy and feasibility of the endovascular visualization to detect anastomotic errors. Patients and methods: The study included 40 patients who presented with CAD and were candidates for coronary artery bypass grafting (CABG). All anastomoses were assessed using 1.9 mm telescope and endovascular visualisation score was recorded followed by routine assessment of grafts quality using transient time flow meter. Results: In this prospective cross-sectional study, we included a total of forty patients who underwent CABG which enabled intraoperative assessment of the quality of 70 venous grafts. There is a statistically significant correlation between the endovascular visual score and the mean flow across the OM and RCA grafts. For the Diagonal grafts , the correlation was less evident due to the small sample number. Conclusion: Coronary angioscopy is a simple and safe procedure and provides clinically relevant information. It provides immediate control of anastomotic quality and it can assist in the assessment of the native coronary artery. Together with transient time flowmeter, it provides a new alternative for the quality control of CABG surgery.

Abstract Background Pneumonia is the major cause of morbidity and mortality among children worldwide. During the COVID-19 pandemic, the use of antibiotics increased which led to the development of antibiotic-resistant strains of pathogenic organisms causing pneumonia in children. So, studies should be directed to register antimicrobial resistance in each country and to develop local antimicrobial stewardship. This study aimed to identify the distribution of bacteria causing pneumonia among Egyptian children in the year 2020 and their antimicrobial sensitivity. A cross-sectional study was done, it included fifty immunocompetent children with pneumonia admitted to Children's Hospital, Ain-Shams University from June 2020 to December 2020. Bacterial cultures were done on sputum collected using cough swab, or endotracheal tube aspirate, with their antimicrobial sensitivity. Results Thirty children had Community-acquired pneumonia (CAP), while twenty had Hospital-acquired pneumonia (HAP). Streptococcus pneumonia was the most frequently cultured organism in CAP group 7/30 (23.3%). The sensitivity results found linezolid (50%), followed by fluoroquinolones to be the least resistant. While in the HAP group, Klebsiella pneumonia 9/20 (45%) was the most common organism. Colistin (90%) followed by tigecycline (50%), Amikacin (35%), fluoroquinolones (25%), gentamicin (25%), and imipenem (20%) had the least resistance in the HAP group. Conclusion No pathognomonic shift of the bacteria that causes pediatric pneumonia was detected. Although, an increase in antimicrobial resistance was noticed.

Istaroxime, an intravenous inotropic agent with a dual mechanism—increasing both cardiomyocyte contractility and relaxation—is a novel treatment for acute heart failure (AHF), the leading cause of morbidity and mortality in heart failure. We conducted a systematic review and meta-analysis that synthesized randomized controlled trials (RCTs), which were retrieved by systematically searching PubMed, Web of Science, SCOPUS, and Cochrane until 24 April 2023. We used a fixed-effect or random-effect model—according to heterogeneity—to pool dichotomous data using the risk ratio (RR) and continuous data using the mean difference (MD), with a 95% confidence interval (CI). We included three RCTs with a total of 300 patients. Istaroxime was significantly associated with an increased left ventricular ejection fraction (mL) (MD: 1.06, 95% CI: 0.29, 1.82; p = 0.007), stroke volume index (MD: 3.04, 95% CI: 2.41, 3.67; p = 0.00001), and cardiac index (L/min/m2) (MD: 0.18, 95% CI: 0.11, 025; p = 0.00001). Also, istaroxime was significantly associated with a decreased E/A ratio (MD: −0.39, 95% CI: −0.58, −0.19; p = 0.0001) and pulmonary artery systolic pressure (mmHg) (MD: 2.30, 95% CI: 3.20, 1.40; p = 0.00001). Istaroxime was significantly associated with increased systolic blood pressure (mmHg) (MD: 5.32, 95% CI: 2.28, 8.37; p = 0.0006) and decreased heart rate (bpm) (MD: −3.05, 95% CI: −5.27, −0.82; p = 0.007). Since istaroxime improved hemodynamic and echocardiographic parameters, it constitutes a promising strategy for AHF management. However, the current literature is limited to a small number of RCTs, warranting further large-scale phase III trials before clinical endorsement.

Poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) is a polyester, produced naturally by microorganisms, with excellent biocompatibility. Corona and radio-frequency (RF) plasma treatment were applied in order to improve the degradation process of PHBV. Samples were subjected to an accelerated weathering test for 500, 1000, and 2000 h of weathering exposure and to natural weathering for one year. Various analytical, spectroscopic, and microscopic techniques have been used to analyze the degradation process. This study revealed that corona and RF plasma treatment acted as a hydrolytic and ultraviolet light (UV) degradation promoter for PHBV. Both plasma treatments chemically modify the PHBV surface resulting in better wettability contributing to the hydrolytic degradation. Microscopic analysis revealed a rougher defects-containing surface of plasma-treated PHBV in comparison with untreated PHBV after the degradation process, promoting deeper water diffusion and UV penetration. The photo- and hydrolytic degradation caused significant surface changes of plasma-treated PHBV after 2000 h of accelerated weathering and one year of natural weathering. Moreover, deterioration in mechanical properties has been more pronounced in the RF plasma-treated samples. These results demonstrate the potential use of plasma treatment on improving the degradability of PHBV.

Nonlinear Schrödinger equations are a key paradigm in nonlinear research, attracting both mathematical and physical attention. This work was primarily concerned with the usage of a reliable analytic technique in order to solve two models of (2+1)-dimensional nonlinear Schrödinger equations. By applying a comprehensible wave transformation, every nonlinear model was simplified to an ordinary differential equation. A number of critical solutions were observed that correlated to various parameters. The provided approach has various advantages, including reducing difficult computations and succinctly presenting key results. Some 2D and 3D graphical representations regarding presented solitons were considered for the appropriate values of the parameters. We also showed the effect of the physical parameters on the dynamical behavior of the presented solutions. Finally, the proposed approach may be expanded to tackle increasingly complicated problems in applied science. [ABSTRACT FROM AUTHOR]

The global reliance on electric vehicles (EVs) has been rapidly increasing due to the excessive use of fossil fuels and the resultant CO2 emissions. Moreover, EVs facilitate using alternative energy sources, such as energy storage systems (ESSs) and renewable energy sources (RESs), promoting mobility while reducing dependence on fossil fuels. However, this trend is accompanied by multiple challenges related to EVs' traction systems, storage capacity, chemistry, charging infrastructure, and techniques. Additionally, the requisite energy management technologies and the standards and regulations needed to facilitate the expansion of the EV market present further complexities. This paper provides a comprehensive and up-to-date review of the state of the art concerning EV-related components, including energy storage systems, electric motors, charging topologies, and control techniques. Furthermore, the paper explores each sector's commonly used standards and codes. Through this extensive review, the paper aims to advance knowledge in the field and support the ongoing development and implementation of EV technologies. [ABSTRACT FROM AUTHOR]

Microgrids (MGs) are the new paradigm of decentralized networks of renewable energy sources, loads, and storage devices that can operate independently or in coordination with the primary grid, incorporating significant flexibility and supply reliability. To increase reliability, traditional individual MGs can be replaced by networked microgrids (NMGs), which are more dependable. However, when it comes to operation and control, they also pose challenges for cyber security and communication reliability. Denial of service (DoS) is a common danger to DC microgrids with advanced controllers that rely on active information exchanges and has been recorded as the most frequent cause of cyber incidents. It can disrupt data transmission, leading to ineffective control and system instability. This paper proposes digital twin (DT) technology as an integrated solution, with new, advanced analytics technology using machine learning and artificial intelligence to provide simulation capabilities to predict and estimate future states. By twinning the cyber-physical dynamics of NMGs using data-driven models, DoS attacks targeting cyber-layer agents will be detected and mitigated. A long short-term memory (LSTM) model data-driven digital twin approach for DoS attack detection and mitigation is implemented, tested, and evaluated. [ABSTRACT FROM AUTHOR]

The shear shallow water (SSW) model introduces an approximation for shallow water flows by including the effect of vertical shear in the system. Six non-linear hyperbolic partial differential equations with non-conservative laws make up this system. Shear, contact, rarefaction, and shock waves are all admissible in this model. We developed the finite-volume two-step scheme, the so-called generalized Rusanov (G. Rusanov) scheme, for solving the SSW model. This method is split into two stages. The first one relies on a local parameter that permits control over the diffusion. In stage two, the conservation equation is recovered. Numerous numerical instances were taken into consideration. We clarified that the G. Rusanov scheme satisfied the C-property. We also compared the numerical solutions with those obtained from the Rusanov, Lax-Friedrichs, and reference solutions. Finally, the G. Rusanov technique may be applied for solving a wide range of additional models in developed physics and applied science. [ABSTRACT FROM AUTHOR]