Areca nut chewing and the risk of re-hospitalization and mortality among patients with acute coronary syndrome in Pakistan

Objectives: Areca nut is widely consumed in many parts of the world, especially in South and Southeast Asia, where cardiovascular disease (CVD) is also a huge burden. Among the forms of CVD, acute coronary syndrome (ACS) is a major cause of mortality and morbidity. Research has shown areca nut chewing to be associated with diabetes, hypertension, oropharyngeal and esophageal cancers, and CVD, but little is known about mortality and re-hospitalization secondary to ACS among areca nut users and non-users. Methods: A prospective cohort was studied to quantify the effect of areca nut chewing on patients with newly diagnosed ACS by categorizing the study population into exposed and non-exposed groups according to baseline chewing status. Cox proportional hazards models were used to examine the associations of areca nut chewing with the risk of re-hospitalization and 30-day mortality secondary to ACS. Results: Of the 384 ACS patients, 49.5% (n=190) were areca users. During 1-month of follow-up, 20.3% (n=78) deaths and 25.1% (n=96) re-hospitalizations occurred. A higher risk of re-hospitalization was found (adjusted hazard ratio [aHR], 2.05; 95% confidence interval [CI], 1.29 to 3.27; p=0.002) in areca users than in non-users. Moreover, patients with severe disease were at a significantly higher risk of 30-day mortality (aHR, 2.77; 95% CI, 1.67 to 4.59; p<0.001) and re-hospitalization (aHR, 2.72; 95% CI, 1.73 to 4.26; p<0.001). Conclusions: The 30-day re-hospitalization rate among ACS patients was found to be significantly higher in areca users and individuals with severe disease. These findings suggest that screening for a history of areca nut chewing may help to identify patients at a high risk for re-hospitalization due to secondary events

Left Ventricular Pseudoaneurysm as a Complication of Myocardial Infarction; A Case Series and Review of the Literature

Introduction: Pseudoaneurysm may occur as a rare complication of myocardial infarction (MI) when a hemorrhagic process is covered by adherence of the visceral or parietal pericardium or of both, preventing the formation of cardiac tamponade. Pseudoaneurysm is prone to rupture because they are not easy to diagnose. Case presentation: Here, we report three cases of left ventricular pseudo-aneurysm (LVP) that all were related to MI. Two patients were managed conservatively, one of them was lost to follow-up, and the other one expired one month later. One patient underwent surgery, but he expired during post-operation period. Conclusions: High mortality rate of LVP emphasizes the importance of looking for it in cardiac evaluation of patients with history of MI. Due to available non-invasive modalities, the ability to differentiate LVP from other cardiac pathologies is improving. Still, the most recommended management of LVP is early surgery

Association between the polymorphisms of matrix metalloproteinases 9 and 3 genes and risk of myocardial infarction in Egyptian patients

Abstract The present study investigated the relationship between the genetic polymorphisms in MMP-9 and MMP-3 genes and acute myocardial infarction (AMI). We examined 40 patients with acute myocardial infarction and 40 age and sex matched controls for MMP-9 functional promoter polymorphism (1562 C > T) and MMP-3 (5A/6A) deletion/insertion polymorphism using restriction fragment length polymorphism (RFLP) for amplified genomic DNA. The frequencies of the combined mutant genotypes CT and TT in the (1562 C > T) MMP9 were significantly higher in AMI patients (20%) when compared to the controls (0%) (p value = 0.005) showing an association between these genotypes and AMI. Also there was a significant difference between 5A/5A genotype and 5A allele frequencies when both are compared in the patients (25% and 35%) and the controls (2.5% and 18.75%) (p= 0.009; OR =13; CI= 1.576–107.233); and (p=0.02; OR =2.333, CI= 1.130–4.820) respectively. In conclusion, the 1562C> T polymorphism of the MMP9 gene is strongly associated with acute myocardial infarction in the Egyptian population. Furthermore, our study supported the presence of the 5A/5A genotype of MMP3 gene promoter polymorphism as a risk factor of AMI in Egyptian patients. Meanwhile, the race selection should be paid more attention since the pathogenesis of a disease might have different bases in different racial population groups.Keywords: Matrix metalloproteinase; 1562C>T; 5A/6A; RFLP; Myocardial infarctionThe Egyptian Journal of Medical Human Genetics (2013) 14, 143–14

Isolated subdural hematoma due to dengue hemorrhagic fever: surgical intervention and review of the literature

Background: Central nervous system (CNS) complications of dengue fever, a mosquito-borne single standard RNA virus illness, are reported in Case Description: A 65-year-old male patient was admitted with high-grade febrile illness and diagnosed with dengue. The patient had no focal neurology and was managed adequately following the primary survey on admission but, then, developed severe thrombocytopenia and eventually the critical phase of dengue illness. On the 5th admission day, the patient collapsed. Glasgow Coma Score was 3/15 with bilaterally dilated, fixed pupils. Immediate computed tomography head revealed a large left SDH with a significant midline shift. SDH was emergently evacuated with two units of platelets transfused peroperatively and two additional units postoperatively. Thrombocytopenia resolved within 48 h, and interval scanning showed gradual resolution of SDH. The patient was discharged 18 days later. Five months later, on follow-up, the patient is well with mild left-sided weakness and an Extended Glasgow Outcome Score of 7. Conclusion: Isolated SDH is a rare but life-threatening hemorrhagic complication of DHF. Even in the critical phase of illness, with severe thrombocytopenia, surgical evacuation should be considered if the SDH is present in isolation, within an accessible area, and can be operated on immediately

Acceptance of Smart Technologies in Blended Learning: Perspectives of Chinese Medical Students

Smart technologies are essential in improving higher education teaching and learning. The present study explores the factors that influence students’ behavioural intentions to adopt and use smart technologies in blended learning. Based on the Unified Theory of Acceptance and Use of Technology (UTAUT2) model, a survey of 305 students was conducted to collect data. A structural equation model was applied to analyse the data. The findings show that adopting smart technologies requires appropriate social context and organizational support. Moreover, the data indicated that performance expectancy, effort expectancy, social influence, hedonic motivation, and habit are vital in determining students’ behavioural intention to use smart technologies. However, facilitating conditions and price value were found to have no significant impact on the students’ behavioural intention to use smart technologies. The study contributes to a better understanding of the nexus of blended learning and smart technologies, thus improving students’ experiences in blended learning settings

Detection Antibiotic Resistance of Enviromental Bacterial Strains

المضادات الحيويه توصف بشكل عشوائي للعلاج البشري والبيطري. هنالك عدد قليل من المضادات الحيوية المستعملة من قبل البشر والحيوانات تهضم بشكل غير تام في الجهاز الهضمي وتنتهي في نظام التصريف والمستشفيات وفي النهايه تطرح الى مصادر المياه في البيئه مباشره دونما اي معالجه.      ان المياه نفسها تعتبر عامل رئيسي في نشر البكتريا بين مكونات البيئه المختلفه ، اضافه الى احتواء البكتريا على عناصر وراثيه قابله للانتقال بين اماكن مختلفه من التربه، المياه والبشر.      جمعت مسحات بيئيه محليا متضمنه 50 مسحه من بيئه المستشفى ،15مسحه من مخلفات الدواجن واحشاء الدجاج، 20 عينه من المياه الثقيله، 15 عينه من احواض الاسماك لتكشف عن 16 عزله من بكتريا Staphylococcus (4عزلات من Staphylococcus aureus و 12 عزله من بكتريا Staphylococcus السالبه لاختبار Coagulase)، 19 عزله من بكتريا Enterococcus spp.، 7 عزلات من بكتريا Pseudomonas  و5 عزلات بيئيه لكل من بكتريا Shigella و Salmonella.     اختبار الحساسيه لمضادي التيكوبلانين والفانكومايسين للعزلات تم اجراؤه ليظهر ان 2 من اصل 16 عزله (12.5%) من بكتريا Staphylococcus كانت مقاومه للفانكومايسين و 3 من اصل 19 عزله(15.7%) من بكتريا Enterococcus كانت مقاومه للفانكومايسين ، بينما كانت بقيه العزلات حساسه للفانكومايسين.     كل العزلات كانت حساسه لمضاد التايكوبلانين عدا عزله واحده من بكتريا Enterococcus spp.  كانت متوسطه التأثر به. مدى التركيز المثبط الادنى للفانكومايسين كان بين (64-6)مايكروغرام/مل. اظهرت بعض العزلات البكتيريه المقاومه لمضاد الفانكومايسين حزمه بلازميديه واحده بعد استخلاص الدنا الخاص بها.     Antibiotics are randomly prescribed  for veterinary and human medication. Antibiotics by little number are used by human , animals are digested uncompletely  in their digestive system and ended up in communal sewage and hospitals, eventually discharge in environmental water sources directly with no processing.     Water itself consider as major factor of dispersal of bacteria between different environmental components. Besides, bacteria had  transferable genetic mobile elements to different sites of soil, water and humans.       Environmental swabs were collected locally including 50 swabs of hospital environment , 15 samples of poultry feces and chicken guts , 20 sample of heavy water and 15 sample of fish tank to identify16 isolate of Staphylococcus (4 isolate of Staphylococus aureus and 12 isolate of coagulase –ve Staphylococcus) , 19 isolate of Enterococcus spp. , 7 isolates of Pseudomonas and 5 environment isolates for each Shigella spp.  and Salmonella spp. .           Teicoplanin and Vancomycin sensitivity test of isolates was done , showing that 2out of 16 isolates of Staphylococcus (12.5%) were Vancomycin-resistant , and 3out of 19 isolates of Enterococcus (15.7 %) were Vancomycin-resistant, while the rest of isolates were Vancomycin- sensitive. From other side , all isolates was Teicoplanin- sensitive except only 1 Enterococcus spp. Isolate which was intermediate . The range of the Vancomycin MIC were (6-64) µg/ml . Vancomycin resistant isolates , showed that some isolates have one plasmid band after Extraction of their DNA

Detecting fake news and disinformation using artificial intelligence and machine learning to avoid supply chain disruptions

Fake news and disinformation (FNaD) are increasingly being circulated through various online and social networking platforms, causing widespread disruptions and influencing decision-making perceptions. Despite the growing importance of detecting fake news in politics, relatively limited research efforts have been made to develop artificial intelligence (AI) and machine learning (ML) oriented FNaD detection models suited to minimize supply chain disruptions (SCDs). Using a combination of AI and ML, and case studies based on data collected from Indonesia, Malaysia, and Pakistan, we developed a FNaD detection model aimed at preventing SCDs. This model based on multiple data sources has shown evidence of its effectiveness in managerial decision-making. Our study further contributes to the supply chain and AI-ML literature, provides practical insights, and points to future research directions.© The Author(s) 2022. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.fi=vertaisarvioitu|en=peerReviewed

Detecting fake news and disinformation using artificial intelligence and machine learning to avoid supply chain disruptions

Peer reviewedPostprin

Azygos lobe in a South African cadaveric population

Knowledge of the prevalence, morphology and location of the azygos lobe is essential for diagnostic and surgical procedures of the lungs related to mediastinal pathologies, especially to minimize intraoperative vascular injuries, shock, possible thoracotomy and even the possibility of pulmonary torsion. Reports on the prevalence of the azygos lobe vary between 0.11% and 0.43%. The aim of the current study was to record the prevalence and morphological description of the azygos lobe in the South African cadaveric population. A total of 704 adult cadavers dissected over a ten-year period by students in the Department of Human Anatomy at the Medunsa Campus, University of Limpopo, were studied. The prevalence and dimensions of the azygos lobe were determined with a 95% confidence interval. Results indicate that an azygos lobe was present in the right lung in only four cases (prevalence 0.57%, 95% Confidence Interval [CI]: 0.2%-1.6%). The mean height and width were 6.7 cm (95% CI: 4.4-9.2) and 4.5 cm (95% CI: 3.7-5.2) respectively. Observations on the morphology of the azygos lobe showed that it was rectangular (n=3) and triangular (n=1) in shape with smooth margins. In conclusion, the azygos lobe is a rare anomaly in the South African cadaveric population. The present results are comparable with those reported in the literature for other populations. Future radiological studies on the azygos lobe on living subjects in South Africa will be useful for further understanding of this rare but significant anomaly.http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1098-2353hb2013ay201

Phytochemical Analysis, Antimicrobial and Antioxidant Properties of Thymus zygis L. and Thymus willdenowii Boiss. Essential Oils

Essential oils (EOs) are chemical products produced by odoriferous glands from a variety of plants. These essential oils have many health benefits: antiseptic, anti-inflammatory and antimicrobial activities. So due to these medicinal properties, the present study was designed to analyze essential oils of Thymus zygis L. and Thymus willdenowii Boiss. for their chemical composition and biological activities. These two thyme species were collected from the region of Ifrane, Middle Atlas of Morocco. The EO was obtained by hydrodistillation, and the yields were 5.25% for T. zygis and 3.00% for T. willdenowii. The chemical composition of the EOs was analyzed by gas chromatography coupled with mass spectrometry (GC-MS), and the results showed that T. zygis EO is dominated by carvacrol (52.5%), o-cymene (23.14%), and thymol (9.68%), while the EO of T. willdenowii contains germacrene D (16.51%), carvacrol (16.19%), and geranyl acetate (8.35%) as major compounds. The antioxidant activity assessed by Diphenylpicrylhydrazyl (DPPH) and ferric reducing antioxidant power (FRAP) assays revealed that both EOs have excellent antioxidant activities; by DPPH it resulted in IC50 = 6.13 ± 0.11 for T. zygis and 6.78 ± 0.3 µg/mL for T. willdenowii, while the one by FRAP yielded EC50 = 2.46 ± 0.01 (T. zygis) and 5.17 ± 0.2 (T. willdenowii) µg/mL. The antimicrobial activity of the two essential oils was evaluated against six bacterial strains and five fungal strains by the disk diffusion method to determine the Minimum Inhibitory Concentration (MIC), Minimum Bactericidal Concentration (MBC) and Minimum Fungicidal Concentration (MFC). The EOs revealed variable antimicrobial activities against the different tested microbial strains and showed strong antimicrobial activities, even against strains known as multi-resistant to antibiotics (Acinetobacter baumannii) at low concentrations (2 µL/mL). T. zygis EO showed the most powerful activity against all the studied bacteria, while that of T. willdenowii recorded moderate activity when tested against Shigella dysenteriae and Salmonella Typhi. With inhibition diameters that vary between 75 mm and 84 mm for concentrations of 2 µL/mL up to 12 µL/mL, S. aureus was shown to be the most sensitive to T. zygis EO. For the antifungal activity test, T. zygis EO showed the best inhibition diameters compared to T. willdenowii EO. These results showed that T. zygis EO has more powerful antioxidant and antimicrobial activities than T. willdenowii EO, therefore, we deduce that thyme EOs are excellent antioxidants, they have strong antimicrobial properties, and may in the future represent new sources of natural antiseptics that can be used in pharmaceutical and food industry