ai

Purpose: American expert consensus publications recommend discontinuation of antiplatelet agents 6 to 12 months after Percutaneous Coronary Intervention (PCI) in patients with Atrial Fibrillation (AF) who require chronic anticoagulation, and use of oral anticoagulant monotherapy thereafter. This study aimed to assess real-world long-term antithrombotic therapy management practices and factors associated with the continuation of antiplatelet agents past 12 months post-PCI in patients with AF requiring chronic anticoagulation. Methods: Patients with AF and a history of PCI greater than 12 months before their most recent encounter with physicians at an outpatient electrophysiology clinic were identified by chart review. Patient demographics, clinical characteristics, and current antithrombotic regimen were collected from encounters that occurred between July 2019 and June 2022. The independent predictive factors associated with the continuation of antiplatelet agents were identified using univariate and regression analyses. Results: Out of 66 patients, 67% continued antiplatelet therapy for greater than 12 months post-PCI. Patients on antiplatelets were significantly less likely to have bare metal stents (p = 0.006), be greater than five years post-PCI (p = 0.002), and have a HASBLED score of two or less (p = 0.028) when compared to patients on oral anticoagulant monotherapy. Bare metal stent history (p = 0.045) and HASBLED score of two or less (p = 0.016) were also significant in regression analysis.Conclusion: This study found that most patients with AF and a history of PCI continued antiplatelet therapy longer than 12 months post-PCI, often despite the high bleeding risk.

It was proposed to determine the response of chemical fertilization in the production of oil palm (Elaeis guineensis Jacq.) six years old in the area of Rio Negro Shambillo Padre Abad in order to have a sustainable and economic alternative of chemical fertilization in the field stage, which contributes to the survival of the palm and provides the necessary resistance against pests and diseases. A completely randomized block design (DBCA) was used with four repetitions and treatments, 96 plants / UE / treatment were used, the spacing was 9x9 in rows and plants. Results obtained indicate the treatments; T3 and T2 (16,54 – 15,48 kg / plant) obtained the highest averages by bunch weight, T1 and T3 (17,48 – 15,42 fruits / bunch) obtained the highest averages regarding number of fruit / bunch, T1 and T3 (13,93 – 11,59 to 45 cm ) obtained the highest averages for bunch length, T1 and T3 (7,33 – 5,52 cm) obtained the highest averages regarding fruit length, T1 and T3 (11.37 – 9.54 g) obtained the highest averages regarding fruit weight, T1 and T3 (10,46 – 10,37 kg) obtained the highest averages to yield per plant. The addition of chemical fertilizers or organic amendments increases the weight of the oil palm bunch, consequently the production in soils with medium, low fertility; chemical fertilization influences the number of clusters of oil palm produced on a given surface, any dose is used as an alternative to phosphorous fertilization in oil palm with a direct relationship between plant height and root length. 

Background: The Intercostal Stretch Technique is one of the physiotherapy techniques that is used to solve different respiratory problems. It is used for increasing chest expansion and diaphragm excursion improvement and also intra-thoracic lung volume. Aim: The study aims to evaluate the effectiveness of the intercostal stretch technique.Methodology: A narrative review. In this study, an RCT study was used to review the intervention.Results: Several articles are used to discuss the effectiveness of the intercostal stretch technique. In stable COPD, diaphragmatic breathing and the intercostal stretch technique both work equally well to improve chest expansion and functional capacity while lowering dyspnea. Research has shown that IC stretch outperforms the anterior basal lift technique in lowering heart and respiratory rates while increasing oxygen saturation. According to this study, IC stretching in conjunction with breathing control may improve dynamic lung parameters, particularly FEV1/FVC%, more than breathing control alone. Patients with COPD have an increased functional exercise capacity and reduced dyspnea when aerobic training and respiratory muscle stretching are combined. Conclusion: Different articles demonstrated that IC stretch improved lung function, expired tidal volume, decreased dyspnea, and increased chest expansion.

A significant obstacle to agricultural productivity that jeopardizes the availability of food is crop diseases and farmer livelihoods by reducing crop yields. Traditional visual assessment methods for disease diagnosis are effective but complex, often requiring expert observers. Recent advancements in deep learning indicate the potential for increasing accuracy and automating disease identification. Developing accessible diagnostic tools, such as web applications leveraging CNNs, can provide farmers with efficient and accurate disease identification, especially in regions with limited access to advanced diagnostic technologies. The main goal is to develop a productive system that can recognize tomato plant diseases. The model was trained on a collection of images of healthy and damaged tomato leaves from PlantVillage using transfer learning techniques. The images from the dataset were cleansed by resizing them from 256 × 256 to 224 × 224 to match the dimensions used in pre-trained models using min-max normalization. An evaluation of VGG16, VGG19, and DenseNet121 models based on performance accuracy and loss value for 7 categories of tomatoes guided the selection of the most effective model for practical application. VGG16 achieved 84.54% accuracy, VGG19 achieved 84.62%, and DenseNet121 achieved 98.28%, making DenseNet121 the chosen model due to its highest performance accuracy. The web application development based on the DenseNet121 architecture was integrated using the Django web framework, which is built on Python. This enables real-time disease diagnosis for uploaded images of tomato leaves. The proposed system allows early detection and diagnosis of tomato plant diseases, helping to mitigate crop losses. This supports sustainable farming practices and increases agricultural productivity.

Conventionally, concrete strength depends on the bonding interface, especially in hydrated products such as calcium silicate hydrate (CSH). As a result, concrete is sensitive under tensile load. With its unique properties, a low fraction of carboxylated nitro-oxidized cellulose nanofibrils (NOCNF) from the banana rachis is employed to improve the mechanical performance of the concrete nano structurally. Compressive and flexural strength using the NOCNF content at 0, 0.05, and 0.1 wt. % cured in 7 and 28 days were evaluated. Notably, the compressive strength increased by 16% and flexural strength by 13% at 0.1% NOCNF compared to plain concrete after the 28 curing days. A low NOCNF fraction achieved a good, albeit impossible, performance with the microscale fibers. The nanostructured effect was discussed twofold: an excellent interaction between the NOCNF and the hydrated products and the carboxylic groups on the NOCNF surface enhanced the cement hydration. These data are better than the literature based on the small-diameter cellulose nanofibrils without the carboxyl groups. As a sustainable nanocomponent, NOCNF could be a perfect candidate to improve concrete performance under mechanical load.

Wheat bran and groundnut shell powder have been used to study the mechanism of diclofenac sodium adsorption from aqueous solution using batch as well as column modes and maximum uptake is 84.3% for wheat bran and 82.4% for groundnut shell powder at pH 6, drug concentration 1mg/L at 298 K for 30min. Isotherm and error analysis reveals that Freundlich and Langmuir isotherms fitted well. Kinetic studies show that the adsorption process follows second-order kinetics and thermodynamic study shows endothermic adsorption process. Column adsorption study is important for industrial scale adsorption and column studies have been carried out using vertical bed and sequential bed adsorption columns at pH 6 which is the optimum pH for maximum adsorption for batch experiments. Vertical and sequential bed columns setup is simple and economical which provides flow under gravity. The effect of varying inlet feed concentration and flow rate on the breakthrough and exhaustion time of columns has been studied to determine the bed capacities of both columns. Thomas model and Yoon-Nelson models fitted well with experimental data for continuous flow column studies.

Latent fingerprints are a common source of information for forensic experts and law enforcement agencies. The thin layer chromatography (TLC) plates that are prepared in this work are made with silica gel G powder. Latent fingerprint remnants are made up of secretions from the nose, palm, and sebaceous, apocrine, and eccrine glands (sweat). However, the quest for more versatile and effective techniques persisted, leading to the emergence of innovative approaches like Silica Gel G powder. The silicon atoms are linked to –OH groups at the silica gel’s surface. A latent fingerprint is an imprint left by direct contact with a surface or object that is not apparent to the unaided eye. The advantages of using Silica Gel G powder for latent fingerprint visualization underscore its significance as an innovative technique in forensic science. The latent fingerprints were developed on each of the several substrates using Merck Specialties Private Limited’s white-coloured silica gel G powder. There are several techniques in the literature for creating latent fingerprints. The emergence of Silica Gel G powder in forensic science represents a significant breakthrough in the visualization of latent fingerprints. The process of using Silica Gel G powder for latent fingerprint visualization exemplifies the precision and attention to detail required in forensic investigations.

Objectives: This study aims to introduce and differentiate between traditional craze lines and a newly identified type of line in enamel, termed an “internal craze line.” This novel classification enhances diagnostic precision and carries significant clinical implications for treatment strategies. The goal is to provide a clear description of these two types of lines, discuss their unique clinical implications, and highlight their differing appearances and staining characteristics, contributing to improved understanding and management of enamel anomalies.Method and materials: Four extracted teeth exhibiting visible and internal craze lines were selected and examined using a stereo microscope to observe the structural characteristics of the lines. Cross-sections of the coronal parts of the teeth were prepared to document the differences between traditional craze lines (extending from the dentin-enamel junction [DEJ] to the enamel surface) and internal craze lines (originating at the DEJ but terminating midway through the enamel). Additionally, intraoral observations were conducted under high magnification to identify the visual differences between the two types of lines, noting that traditional craze lines can be stained while internal craze lines cannot.Results: Microscopic examination revealed two distinct types of lines: traditional craze lines extending from the DEJ to the enamel surface and internal craze lines terminating within the enamel. Intraoral observations confirmed that these lines could be distinguished under high magnification. Traditional craze lines appear as continuous lines reaching the enamel surface and can be stained, whereas internal craze lines are shorter, do not extend to the surface, and cannot be stained.Conclusion: The identification of internal craze lines presents significant clinical implications. Differentiating between traditional and internal craze lines can enhance diagnostic accuracy and inform treatment decisions. Recognizing internal craze lines might indicate different etiologies or risk profiles compared to traditional craze lines, influencing preventive and therapeutic strategies in dental practice. Further research is needed to explore the prevalence, causes, and long-term impacts of internal craze lines.

Objective: This study aims to compare the short-, medium-, and long-term efficacy of trigger point local anesthetic injection and stabilization splint use for myofascial orofacial pain.Materials and methods: Group 1 comprised 15 patients who received trigger point local anesthetic injections (LAI), while Group 2 comprised 15 patients who were treated with a stabilization splint (SS). Analysis of pain-free maximum mouth opening (MMO) measurements, jaw disability checklists (JDC), short-form McGill pain questionnaires (SF-MPQ), and Visual analog scales (VAS) were used for comparison between the groups.Results: The LAI group showed a significantly greater increase in pain-free MMO in all terms (p < 0.001) and had significantly lower values on the JDC in both the medium (p = 0.026) and the long term (p = 0.006). The SF-MPQ was significantly lower in the medium term (p = 0.001) in the LAI group; the VAS showed a significantly greater decrease in the short (p = 0.016) and medium terms (p < 0.001) in the LAI group.Conclusion: The results indicate that a treatment choice can be made between TN lidocaine injection and occlusal splint based on patient tolerance.

Background: Human 30kb coronaviruses entered through the ACE-2 receptors causing fibrosis of the lungs and causing six million deaths worldwide. Here, we have investigated the mutations, deletions and insertions of the recent JN.1 omicron coronaviruses to demonstrate that coronaviruses have reached the pre-elimination stage. Methods: We multi-aligned the genomes of recent JN.1 variants using NCBI Virus Portal and CLUSTAL-Omega. The spike proteins are multi-aligned using MultAlin software and CLUSTAL-Omega.Results: The 17MPLF spike insertion was confirmed to compensate 24LPP, 31S, 69HV, 145Y, 211N and 483V deletions. The 49nt deletions in the 3’-UTR were found in 4997 JN.1 sequences although 26nt deletion was initiated previously in JN.1 as well as BA.5, BF.7, BQ.1 and XBB.1.5 omicron viruses. We first compare 3-D structures of spike proteins with or without 17MPLF four amino acids insertion and nine amino acids deletions using SWISS MODELLING. The JN.1 viruses caused a more stable trimeric spike involving Thr342, Lys436, Lys440, His441, Ser442, Gly443, Tyr445, Lys479, Ser489, Tyr490, Arg493, Pro494, Thr495, and Gln501 amino acids to interact with ACE-2 receptors. The FLiRT spike mutations were found in most KP.2 variants and other changes occurred at the NH2 terminus.Conclusion: We claimed that pre-death changes were initiated in JN.1 COVID-19 lineages and computer simulation showed that the Howard spike with 17MPLF spike insertion appeared more stable than the Oppentrons-spike without 17MPLF insertion. Surely, conflicts of COVID-19 spike sequences must be resolved.

Treatment for HIV-associated neurocognitive disorders (HAND) remains elusive. 7,8-dihydroxyflavone (DHF), an analog of brain-derived neurotrophic factor (BDNF) and a high-affinity TrkB agonist, has been proposed as a viable therapeutic alternative to BDNF in crossing the Blood-Brain Barrier (BBB) and promoting growth, differentiation, maintenance, and survival of neurons. Here, we expand on our previous study investigating the therapeutic role of DHF on the cortical and hippocampal brain regions of the Tg26 mice, an animal model of HAND. We detected increased immunoreactivity for ion channels (SUR1, TRPM4) and the water channel aquaporin-4 (AQP4), suggesting an ionic and osmotic imbalance in the brains of Tg26 mice. Tg26 mice also exhibited loss of synaptic stability (SYN, SYP) and nicotinamide metabolism (NAMPT, SIRT1) that were associated with astrogliosis. Furthermore, Tg26 mice demonstrated increased iNOS and reduced HO-1/NRF2 expressions, implicating increased ER and oxidative stress. DHF treatment in Tg26 mice reversed these pathological changes. These data suggest crosstalk among TrkB, Akt, and related transcription factors (NF-κB, STAT3, and NRF2) as an underlying mechanism of Tg26-associated pathology in the brain. Finally, taken together with our prior study, these results further highlight a therapeutic role of DHF in promoting neuroprotection in HAND that may be applied in conjunction with current antiviral therapies.

Chronic obstructive pulmonary disease (COPD) is a heterogeneous, progressive disease characterized not only by pathological changes in the lungs but also by significant extrapulmonary manifestations and serious concomitant diseases. The current problem for the study is the features of the relationship between COPD and adipose tissue since there are contradictory data in the literature. This review presents studies that claim that obesity aggravates the course of COPD, as well as the results of studies that describe the “obesity paradox” in patients with COPD. Due to the lack of unambiguous data, it is necessary to continue studying this problem to optimize the tactics of managing this group of patients and draw up clear recommendations for patients with COPD.

Verrucous hyperplasia is a wart-like lesion that can develop on amputation stumps, often due to poor-fitting prostheses, venous stasis, friction, and bacterial infections. While surgical excision is sometimes necessary for intractable cases, many instances can be managed non-surgically. We present the case of a 35-year-old male with a slowly growing verrucous plaque on his amputated stump that had caused repeated infections. His prosthesis was loose, allowing the stump to hang loosely inside the socket. After histological confirmation of verrucous hyperplasia, he was advised to change his prosthesis and use compression bandaging. Over 5 months, the lesion resolved without surgery. Early recognition and non-surgical management, including proper prosthetic fit, compression, and hygiene, can often successfully treat verrucous hyperplasia of amputation stumps. This avoids the need for excision in many cases. Patients and clinicians should be aware of this condition and the importance of prosthetic fit and limb care to prevent and treat it.

The gut microbiome is a complex network of interactions between the brain and the gastrointestinal tract, playing a pivotal role in human health and disease. The microbiota-gut-brain axis (GBA) serves as a crucial connector between the brain’s emotional and cognitive centers and the peripheral intestinal functions, emphasizing the profound impact of gut health on overall well-being. The GBA is characterized by a symbiotic relationship between the gut and the brain, regulating the expression of inflammatory cytokines and neurotransmitters. The MGBA is also regulated by microbial metabolites, such as short-chain fatty acids (SCFAs) and fatty acid derivatives. This paper focuses on the importance of the GBA in regulating gut health and the potential for targeted therapeutic interventions to improve health outcomes. The implications of this research are vast, suggesting that future strategies aimed at modulating the gut biome may offer promising avenues for the development of personalized medicine and dietary interventions.

Background: Non-Communicable Diseases (NCDs) in India have increased from 37.9% in 1990 to 61.8% in 2016. They are slowly progressive are of long duration and are responsible for more than 50% of the global burden of disease Very few studies have been conducted that studied the prevalence of risk factors in non-communicable diseases among medical students. The authors observed that most of the students are at risk of developing NCDs, and the cumulative effect of risk factors bundles up and eventually leads to disease as students advance through their lives.Aim and objectives: (i) To estimate the prevalence of risk factors of NCD amongst medical students, (ii) To study the association between various risk factors and NCDs in study subjects.Settings and design: A cross-sectional analytical study involving 362 undergraduate students of Rama Medical College using simple random sampling.Material and methods: The study used a pretested structured questionnaire which was conducted by using the WHO NCD steps approach.Statistical analysis used: Data analysis was done by using M S Excel and software SPSS version 26.Results: Our study results showed that physical activity is Prevalent in female students at 51% and in male students at 48.9%, almost equal. Junk food consumption had an overall prevalence of 69.34% of females outnumbering males in junk food consumption. The association of BMI with NCD as a risk factor was statistically significant in the current 75 smokers only.Conclusion: There is a huge opportunity to reduce modifiable risk factors and NCD among our future doctors by encouraging them to change their behavior-related lifestyles such as smoking habits, alcohol use, junk food, etc.

This article examines the relationship between Premenstrual Dysphoric Disorder (PMDD), neurovascular dynamics, and sensory sensitivities in autistic women during menstruation. The redirection of blood flow to the uterus during the menstrual cycle has been found to exacerbate cerebral perfusion deficits in neurodivergent individuals, particularly in the Prefrontal Cortex (PFC), which contributes to the mood dysregulation and emotional instability characteristic of PMDD. Autistic women, who often exhibit heightened sensory sensitivities, experience intensified discomfort during menstruation, as sensory overload and altered pain perception compound the emotional challenges of PMDD. These findings emphasize the need for neurodivergent-friendly menstrual products that mitigate both physical and emotional discomfort. Additionally, innovations using biodegradable materials, smart fabrics, and custom-fit menstrual solutions are discussed as potential breakthroughs to improve the quality of life for autistic women managing PMDD. This research highlights the importance of addressing both neurobiological and sensory aspects when designing interventions for PMDD in neurodivergent populations.

Uvular injuries are uncommon after general anesthesia and can result from direct trauma to the posterior part of the soft palate or compression and restriction of blood flow to the uvula caused by the inadvertent placement of the airway or suction devices in the oral cavity. There have been cases of inflammation and ulceration occurring in the midline oropharyngeal structures such as the uvula after general anesthesia with a tube or laryngeal mask airway, even in the absence of direct trauma or infection, presumably due to compression ischemia. While sore throat following general anesthesia is a common symptom, it is important to evaluate any severe or persistent pain to exclude uvulitis. Here we present a case of uvulitis that developed after the insertion of a flexometallic endotracheal tube using the midline technique during C-Mac video laryngoscopy. We also emphasize the measures that can be implemented to prevent such a complication. The entrapment of the uvula during intubation often goes unnoticed due to limited oral space after insertion of the video laryngoscope blade, with the intubating anesthetist staying focused on the monitor. This complication following the use of a C-Mac video laryngoscope has not been previously documented.

Chronic obstructive pulmonary disease (COPD) is associated with numerous comorbidities, including muscle involvement which consists of changes in the structure and function of peripheral and respiratory muscles. Ultrasound can provide a non-invasive assessment of muscle damage. Ultrasound assessment of the quadriceps contractility index (Qci) is feasible, rapid, simple, and reliable. Numerous studies have demonstrated that Qci is linked to the severity of COPD, clinical symptoms, and respiratory muscle activity. Furthermore, ultrasound makes it possible to observe the dynamics of the diaphragm by measuring its amplitude, its contraction speed, and the duration of each contraction phase. Ultrasound examination of muscle damage in COPD could constitute a promising new tool to assess the severity of the disease.

Probiotic gummy candy is an innovative food that can be used as a carrier to deliver probiotics. This study aimed to manufacture healthy gummy candy (HGC) as a carrier for probiotic capsules. The ingredients' effect on the viability of probiotic capsules and free cells was evaluated for 48 days under refrigerated conditions. Also, the textural properties, overall acceptability of products, and physicochemical properties were tested. The encapsulation probiotics in sodium alginate and chitosan provided a high efficiency of 88.16%. At the same time, the encapsulated cells-based HGC (HGC-C) had higher counts of probiotics than free cells-based HGC, and it remained above the 3 log CFU/g at the end of the 48-day storage period in HGC-C, while the free cells reached zero at 30 days. The HGC product showed a low hardness value and high antioxidant capacity as well as, and the colour coordinates for the product showed more yellow, with an intense red colour. Using mango pulp and probiotics in gummy candies is an innovative and viable alternative to the confectionery industry; therefore, combining fruits as a source of prebiotics and probiotic bacteria could be a promising formula for probiotics gummy supplement preparation.

According to a 2022 systematic review on the prevalence of psychiatric disorders in general hospitals, it was estimated that approximately one-third of medical inpatients present with a coinciding psychiatric condition. However, other studies have reported that a low rate of patients actually obtain an inpatient psychiatric consult; and even fewer patients receive a consultation when it would not be traditionally indicated. Therefore, we have seen an emergence of the use of Proactive Consultation-Liaison (C-L) Psychiatry across many hospital settings. This model of care utilizes systematic screening for active mental health concerns, proactive interventions tailored to individual patients, team-based delivery, and care integration with primary services to provide psychiatric consultation earlier. This study conducted a focused PubMed search to review the research to date on proactive C-L psychiatry and its impact on hospital length of stay (LOS) in patients over 18 years old. Results show a consequential reduction in average hospital LOS when proactive C-L psychiatry services are used compared to reactive, on-request consultation services. A shortened LOS is seen with this practice when there is a quicker time for consultation or referral. Thus, there is evidence of proactive C-L psychiatry’s success in decreasing average hospital LOS and improving patient care. Additional studies are necessary to determine its significance, as little research to date has been completed on the topic. It is recommended to expand the scope of investigation to different patient populations, including but not limited to pediatrics and patients without an underlying mental health illness.