A patient presenting with intact sensory modalities in acute spinal cord ischemia syndrome: a case report

<p>Abstract</p> <p>Introduction</p> <p>Acute spinal cord ischemia syndrome is a rare condition comprising a small fraction of neurovascular accidents, the majority of which occur within the cerebral circulation. The circulation of the spinal cord has several unique features that determine the clinical presentation.</p> <p>Case presentation</p> <p>In this case of a 67-year-old Caucasian man who came to our emergency department with sudden-onset, severe right-sided pain and bilateral upper limb weakness, an atypical pattern of sensory deficit was observed. In this case report, we review acute spinal cord ischemia syndrome and consider the pathophysiology, diagnostic measures and prognostic factors associated with patient recovery.</p> <p>Conclusion</p> <p>Acute spinal cord ischemia syndrome with atypical patterns of sensory deficit is uncommon. Clinicians must consider acute spinal cord ischemia syndrome when assessing all patients with acute neck pain and focal neurological deficits; atypical presentations can present a diagnostic challenge. Current knowledge of the long-term outcome in patients with spinal cord ischemia is based on only a few small studies, some of which are discussed here.</p

Airway Clearance in Bronchiectasis: A Randomized Control Trial of N-Acetylcysteine with 3% hypertonic saline

Background: N-Acetylcysteine and 3% hypertonic saline are being used effectively for sputum clearance in chronic cases of bronchiectasis for quite some time. However, their use in acute condition of the disease seems to be underexplored. The objective of our study is to compare the role of nebulized N-acetylcysteine and 3% hypertonic saline in clearing the airway in patients with acute exacerbation of bronchiectasis. Material and Methods: A total of 136 confirmed cases of bronchiectasis were enrolled in this study. This randomized controlled trial was done in chest ward of Nishtar Hospital Multan from January 2015 to March 2017. Sampling was done by non-probability consecutive sampling and patients were divided into two groups A and B by lottery method. Verbal informed consent was taken from all participants. Group A participants received nebulization of N acetylcysteine mixed in normal saline for ten minutes, while group B participants were nebulized with 10ml of 3% hypertonic saline for ten minutes. Group B was active control group in the study. Data was collected on pre-designed Proforma, and analyzed by SPSS version 22. Numerical variables such as saturation, weight of sputum, age and blood pressure was analyzed by using t test. These were considered significant if the p value was equal or less than 0 .05. For qualitative variables chi square test was applied. Results: The mean O2 saturation of Group A, before and after treatment, was 92.11±3.07% and 94.47±2.18%, respectively. The difference was statistically significant (p value =0.001). The sputum weight of Group A, before and after treatment, was 2.63±2.39 g and 7.41±1.38 g, respectively. The difference was statistically significant (p value =0.001). The frequency of rhonchi of Group A, before and after treatment, was 52% and 76%, respectively. The difference was statistically significant (p value =0.003). While, for Group B, the mean O2 saturation, before and after treatment, was 92.36±3.13% and 93.49±2.27%, respectively. The difference was statistically significant (p value =0.012). The sputum weight, before and after treatment, was 3.11±2.01 g and 5.56±1.02 g, respectively. The frequency of rhonchi, before and after treatment, was 45% and 74% respectively. Again, the difference was statistically significant. Conclusion: Both nebulized N-acetylcysteine and 3% hypertonic saline cause airway clearance by enhancing sputum expectoration in patients with acute exacerbation of bronchiectasis equally. Both these agents also improve oxygen saturation in acute exacerbation of bronchiectasis significantly

How climate policies can translate to tangible change: Evidence from eleven low- and lower-middle income countries

Formally adopting climate change mitigation policies does not necessarily translate to tangible change on the ground. Here, we analyse 31 semi-structured interviews with climate policy government officials and consultants from 11 low-income and lower-middle income countries (LMICs) as well as the respective climate policy context, and find high average degrees of perceived discrepancies between formally adopted climate change mitigation policies and their actual implementation. Our results suggest that for our LMIC sample, both the global political process to limit climate change and domestic environmental threats have been key to drive the formal adoption of climate change mitigation policies, but have had limited effect on implementation. By contrast, momentum for implementation of climate change mitigation initiatives and projects on the ground emerges where climate policies are firmly embedded within economic and social development policies, the economy and society are comparably well-positioned to embrace the associated change, and where they have been governed by cross-ministerial institutions capable of implementing wider climate-compatible development pathways. Thus, to help translate climate policy into action, national LMIC governments and the international community need to find context-specific ways to successfully integrate climate with economic and social development policies, identify and build on feasible opportunities and competitive advantages through which the local economy can benefit from green growth, build adequate social capital, and actively create institutional spaces and processes for well-equipped and meaningful cross-ministerial co-beneift governance. The importance of unlocking co-benefits for implementing climate policies underlines both the urgency with which the international community needs to increase finance for LMICs for climate change mitigation, as well as the associated development opportunities

Cytotoxic Evaluation and Molecular Docking Studies of Aminopyridine Derivatives as Potential Anticancer Agents

Background: The development of resistance to available anticancer drugs is increasingly becoming a major challenge and new chemical entities could be unveiled to compensate for this therapeutic failure. Objectives: The current study demonstrated whether N-protected and deprotected amino acid derivatives of 2aminopyridine could attenuate tumor development using colorectal cancer cell lines. Methods: Biological assays were performed to investigate the anticancer potential of synthesized compounds. The in silico ADME profiling and docking studies were also performed by docking the designed compounds against the active binding site of beta-catenin (CTNNB1) to analyze the binding mode of these compounds. Four derivatives 4a, 4b, 4c, and 4d were selected for investigation of in vitro anticancer potential using colorectal cancer cell line HCT 116. The anti-tumor activities of synthesized compounds were further validated by evaluating the inhibitory effects of these compounds on the target protein beta-catenin through in vitro enzyme inhibitory assay. Results: The docking analysis revealed favorable binding energies and interactions with the target proteins. The in vitro MTT assay on colorectal cancer cell line HCT 116 and HT29 revealed potential anti-tumor activities with an IC50 range of 3.7-8.1µM and 3.27-7.7 µM, respectively. The inhibitory properties of these compounds on the concentration of beta-catenin by ELISA revealed significant percent inhibition of target protein at 100 µg/ml. Conclusion: In conclusion, the synthesized compounds showed significant anti-tumor activities both in silico and in vitro, having potential for further investigating its role in colorectal cancer

Maternal and perinatal factors associated with hospitalised infectious mononucleosis in children, adolescents and young adults: record linkage study

<p>Abstract</p> <p>Background</p> <p>There is current interest in the role of perinatal factors in the aetiology of diseases that occur later in life. Infectious mononucleosis (IM) can follow late primary infection with Epstein-Barr virus (EBV), and has been shown to increase the risk of multiple sclerosis and Hodgkin's disease. Little is known about maternal or perinatal factors associated with IM or its sequelae.</p> <p>Methods</p> <p>We investigated perinatal risk factors for hospitalised IM using a prospective record-linkage study in a population in the south of England. The dataset used, the Oxford record linkage study (ORLS), includes abstracts of birth registrations, maternities and in-patient hospital records, including day case care, for all subjects in a defined geographical area. From these sources, we identified cases of hospitalised IM up to the age of 30 years in people for whom the ORLS had a maternity record; and we compared perinatal factors in their pregnancy with those in the pregnancy of children who had no hospital record of IM.</p> <p>Results</p> <p>Our data showed a significant association between hospitalised IM and lower social class (p = 0.02), a higher risk of hospitalised IM in children of married rather than single mothers (p < 0.001), and, of marginal statistical significance, an association with singleton birth (p = 0.06). The ratio of observed to expected cases of hospitalised IM in each season was 0.95 in winter, 1.02 in spring, 1.02 in summer and 1.00 in autumn. The chi-square test for seasonality, with a value of 0.8, was not significant.</p> <p>Other factors studied, including low birth weight, short gestational age, maternal smoking, late age at motherhood, did not increase the risk of subsequent hospitalised IM.</p> <p>Conclusions</p> <p>Because of the increasing tendency of women to postpone childbearing, it is useful to know that older age at motherhood is not associated with an increased risk of hospitalised IM in their children. We have no explanation for the finding that children of married women had a higher risk of IM than those of single mothers. Though highly significant, it may nonetheless be a chance finding. We found no evidence that such perinatal factors as birth weight and gestational age, or season of birth, were associated with the risk of hospitalised IM.</p

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Securing smart healthcare cyber-physical systems against blackhole and greyhole attacks using a blockchain-enabled gini index framework

The increasing reliance on cyber-physical systems (CPSs) in critical domains such as healthcare, smart grids, and intelligent transportation systems necessitates robust security measures to protect against cyber threats. Among these threats, blackhole and greyhole attacks pose significant risks to the availability and integrity of CPSs. The current detection and mitigation approaches often struggle to accurately differentiate between legitimate and malicious behavior, leading to ineffective protection. This paper introduces Gini-index and blockchain-based Blackhole/Greyhole RPL (GBG-RPL), a novel technique designed for efficient detection and mitigation of blackhole and greyhole attacks in smart health monitoring CPSs. GBG-RPL leverages the analytical prowess of the Gini index and the security advantages of blockchain technology to protect these systems against sophisticated threats. This research not only focuses on identifying anomalous activities but also proposes a resilient framework that ensures the integrity and reliability of the monitored data. GBG-RPL achieves notable improvements as compared to another state-of-the-art technique referred to as BCPS-RPL, including a 7.18% reduction in packet loss ratio, an 11.97% enhancement in residual energy utilization, and a 19.27% decrease in energy consumption. Its security features are also very effective, boasting a 10.65% improvement in attack-detection rate and an 18.88% faster average attack-detection time. GBG-RPL optimizes network management by exhibiting a 21.65% reduction in message overhead and a 28.34% decrease in end-to-end delay, thus showing its potential for enhanced reliability, efficiency, and security. © 2023 by the authors

Flow Analysis of Various Inlet Velocity Profiles on Indoor Temperature for Energy Conservation of HVAC System Using CFD

Energy conservation has been the most popular topic of the modern world. Heating, Ventilation and Air Conditioning (HVAC) systems consume approximately 10 % of the total energy of world. In order to improve the efficiency of HVAC systems, two dimensional (2D) room with inlet, outlet and heat source has been modeled. ANSYS Fluent has been used for numerical analysis of air flow in a 2D room. User Defined Functions (UDFs), which are coded in C language and hooked in ANSYS fluent, have been used for recording temperature variations and for heat generation within 2D room. Besides studying velocity fields and temperature distributions within indoor environment under specified boundary conditions, reference region for comparative analysis is also selected during Steady State (SS) numerical simulations. During transient analysis, temperature variations of a selected location are recorded for four different scenarios under varying inlet velocity profiles i.e. three for 0°, 30°, 60° angle with 1.3661 m/s velocity and fourth 0° with 2.7322 m/s velocity. Temperature profile of reference region after 1500 sec of transient simulations are compared with the steady state. Temperature profile of the scenario once the air is injected at 30° closely matched with the steady state temperature profile of the selected region. Time for attainment of SS temperature is also measured and compared after transient simulations. SS temperature value was attained twice, first at 240 seconds when the air was injected at 0° with 2.7322 m/s and secondly at 522 seconds when inlet air entered at velocity of 1.3361 m/s at 30°. The power consumption by increasing the fan speed is much higher as compared to the power consumed for changing direction only. Full Tex

Flow Analysis of Various Inlet Velocity Profiles on Indoor Temperature for Energy Conservation of HVAC System Using CFD

Energy conservation has been the most popular topic of the modern world. Heating, Ventilation and Air Conditioning (HVAC) systems consume approximately 10 % of the total energy of world. In order to improve the efficiency of HVAC systems, two dimensional (2D) room with inlet, outlet and heat source has been modeled. ANSYS Fluent has been used for numerical analysis of air flow in a 2D room. User Defined Functions (UDFs), which are coded in C language and hooked in ANSYS fluent, have been used for recording temperature variations and for heat generation within 2D room. Besides studying velocity fields and temperature distributions within indoor environment under specified boundary conditions, reference region for comparative analysis is also selected during Steady State (SS) numerical simulations. During transient analysis, temperature variations of a selected location are recorded for four different scenarios under varying inlet velocity profiles i.e. three for 0°, 30°, 60° angle with 1.3661 m/s velocity and fourth 0° with 2.7322 m/s velocity. Temperature profile of reference region after 1500 sec of transient simulations are compared with the steady state. Temperature profile of the scenario once the air is injected at 30° closely matched with the steady state temperature profile of the selected region. Time for attainment of SS temperature is also measured and compared after transient simulations. SS temperature value was attained twice, first at 240 seconds when the air was injected at 0° with 2.7322 m/s and secondly at 522 seconds when inlet air entered at velocity of 1.3361 m/s at 30°. The power consumption by increasing the fan speed is much higher as compared to the power consumed for changing direction only. Full Tex

Numerical Analysis of Impact of Relative Humidity on Crossflow Heat Exchangers with Staggered Configuration at Maximum Operating Temperature

Heat exchangers are employed in numerous applications of industry, automotive and air conditioning systems. The efficacy of heat exchangers depends upon various factors e.g., Reynolds number (Re) of the fluids, geometry of heat exchanging surfaces, and the Prandtl number of the cooling air. In this paper, the working of a crossflow heat exchanger with elliptical tubes is simulated numerically for 5000 &lt; Re &lt; 20000 at its maximum operating temperature of 323K. The tubes were arranged in a staggered way. The radical investigations were done at one-of-a-kind relative humidity ranges within the cooling air ranging from 0% to 80%. The relative humidity was modeled in the shape of mass fractions of water vapors in the air. The thermos-physical properties of dry and moist air were employed for the analysis. The impact of this changing of relative humidity on forced convection heat transfer of heat exchangers is examined in the form of percentage change in Nusselt number. With the increase in moisture content in the air, the Nusselt number was observed increased up to 4.5%. The paper provides a tool to analyze the Nusselt number of the elliptical-shaped heat exchanger while operating in moist atmospheric conditions. Full Tex