PURPOSE: Young-onset colorectal cancer is an emerging cause of significant morbidity and mortality globally. Despite this, limited data exist regarding clinical characteristics and outcomes, particularly in safety-net populations where... more
PURPOSE: Young-onset colorectal cancer is an emerging cause of significant morbidity and mortality globally. Despite this, limited data exist regarding clinical characteristics and outcomes, particularly in safety-net populations where access to care is limited. We aimed to study disparities in clinical characteristics and outcomes in patients with young-onset colorectal cancer in the safety-net setting. METHODS: We performed a retrospective review of patients < 50 years old diagnosed and/or treated for colorectal cancer between 2001 and 2017 at a safety-net hospital. Kaplan-Meier and Cox regression models were constructed to compare overall survival (OS), progression-free survival (PFS), and relapse-free survival (RFS) by race and ethnicity, stratifying for relevant clinical and pathologic factors. RESULTS: A total of 395 young-onset patients diagnosed at a safety-net hospital were identified and 270 were included in the analysis (49.6% Hispanic, 25.9% non-Hispanic Black, 20.0% ...
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explores three common misconceptions about CSR and explains why it should be seen as an opportunity to develop a more innovative and advanced business model.
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Objective : This paper aims to analyze the impact of non-essential purchases, particularly smartphones on self-determination and subjective well-being of bottom of pyramid customers. It also studies the impact of patience on... more
Objective : This paper aims to analyze the impact of non-essential purchases, particularly smartphones on self-determination and subjective well-being of bottom of pyramid customers. It also studies the impact of patience on self-determination and subjective well-being of such customers. Methodology : 665 questionnaires were personally administered to respondents. Partial Least Squares Structural Equation Modelling (PLS SEM) was performed using Smart PLS software to test multiple dependency relationships between non-essential purchases, self-determination, subjective well-being and patience. Main Results : Non-essential purchases, particularly smartphones, had a direct impact on self-determination and an indirect impact on subjective well-being of bottom of pyramid customers. Non-essential purchases fulfilled psychological needs for autonomy and relatedness that led to subjective well-being. Moreover, patience was established as a significant predictor of self-determination and subj...
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We study the resource allocation in an amplify and forward (AF) relay assisted orthogonal frequency division multiple access (OFDMA) system employing a shared user equipment (UE)-side distributed antenna (SUDAS). It simultaneously... more
We study the resource allocation in an amplify and forward (AF) relay assisted orthogonal frequency division multiple access (OFDMA) system employing a shared user equipment (UE)-side distributed antenna (SUDAS). It simultaneously utilizes both unlicensed (in the UE to AF relay link) and licensed frequency bands (AF relay to BS link), hence exploiting the advantages of both MIMO over licensed band with its favorable propagation conditions and millimeter wave band with larger bandwidths, to improve achievable rate of the future 5G communication systems. The users in the system have no energy of their own, so for transmitting information to the base station in the uplink, they first need to harvest energy from the AF relays in the downlink. For this purpose, we present a time switching based MIMO-OFDMA (TS) protocol. To explore the system performance limits, we formulate a non-convex optimization problem to maximize the end-to-end achievable information rate of the system. Simulation ...
In the current study, the data of last researches in the field of neuroscience and memory evolution have been presented, keeping in view the fundamental developments of neuromarketing learning and cognitive behavior. Understanding the... more
In the current study, the data of last researches in the field of neuroscience and memory evolution have been presented, keeping in view the fundamental developments of neuromarketing learning and cognitive behavior. Understanding the essential mechanisms behind customer shopping behaviors and the approach that marketing affects such actions are the essential concerns that need more research. The progression is primarily compelled by the belief that the utilization of neuroscientific approaches will add supplementary evidence to existing concepts and theories. Providentially, marketing investigation can significantly benefit from methodological progress in the field of neurosciences. The contributions of this study to the literature are to investigate the multiple and conflicting criteria of neuromarketing technology evaluation. Significant avenues of the research are what usually meant by neuromarketing, which is the concept that can be employed to understand brain neural functions ...
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A single diode model with five parameters is the simplest and robust approach for modeling a photovoltaic (PV) module in a simulated environment. These parameters need to be accurately extracted from the specifications given in the... more
A single diode model with five parameters is the simplest and robust approach for modeling a photovoltaic (PV) module in a simulated environment. These parameters need to be accurately extracted from the specifications given in the datasheet of the PV module such that the simulation model should exhibit the same characteristics as the actual measurements. A definite set of five independent equations, that should represent the characteristics of the PV module as accurately as possible, is needed to solve for these five parameters. In literature, the first four equations are easily created from the key data points on the characteristic curve given in the datasheet of the PV module. The main challenge however is the formulation of the fifth equation. The approaches found in literature have inherent inaccuracies due to some approximations or iterative techniques leading to discrepancy in the simulated model. This paper presents a unique analytical approach for the formulation of the fif...
BACKGROUND Iron deficiency (ID) and anaemia are common in heart failure; less is known about changes over time. METHODS We investigated prevalence, incidence and resolution of ID and anaemia in 906 patients with chronic heart failure... more
BACKGROUND Iron deficiency (ID) and anaemia are common in heart failure; less is known about changes over time. METHODS We investigated prevalence, incidence and resolution of ID and anaemia in 906 patients with chronic heart failure (median age 73 (65-79) years, 70% men, 51% HFrEF) one year apart. ID was defined as serum iron ≤13 μmol/L and anaemia as haemoglobin <13.0 g/dL for men or <12.0 g/dL for women. FAIR-HF criteria for ID were also considered. RESULTS At baseline, 10% had anaemia without ID, 23% had ID without anaemia, 20% had both and 47% had neither. Percentages changed little over one year, but 157 (30%) patients had new-onset ID, 104 (16%) new-onset anaemia, whilst ID resolved in 173 (44%) and anaemia in 63 (23%). Compared to those who remained iron replete (iron >13 μmol/L), mortality was higher in those with persistent or incident ID at 1 year (respectively HR 1.81; [1.23-2.67] and HR 1.40; [0.91-2.14]) in multivariable models (p=0.02). Compared to persistent...
BackgroundThe relative risk of developing rectal cancer has quadrupled in young adults over the last 40 years and approximately 50% of patients develop recurrence within 3 years. Thus, there is a critical need for new approaches to... more
BackgroundThe relative risk of developing rectal cancer has quadrupled in young adults over the last 40 years and approximately 50% of patients develop recurrence within 3 years. Thus, there is a critical need for new approaches to improve survival but cancer Immunotherapy has had little impact on colorectal cancer. The anti-CD40 agonist immunotherapy is emerging and APX005M has shown promise in phase I and ongoing phase II trials. Anti-CD40 can stimulate both innate and adaptive immune responses and a greater response can be achieved combining anti-CD40 with radiation therapy (RT) in animal models. We developed the INNATE trial, a phase II randomized trial of neoadjuvant short course RT followed by chemotherapy with or without the addition of APX005M for rectal cancer (NCT04130854).MethodsThe INNATE trial is a multi-center, 58 patient, 3:2 randomization clinical trial, that adds APX005M to short course RT (SCRT) and subsequent FOLFOX chemotherapy prior to definitive radiation. Elig...
Background Patients admitted to hospital with heart failure will have had a chest X-ray (CXR), but little is known about their prognostic significance. We aimed to report the prevalence and prognostic value of the initial chest radiograph... more
Background Patients admitted to hospital with heart failure will have had a chest X-ray (CXR), but little is known about their prognostic significance. We aimed to report the prevalence and prognostic value of the initial chest radiograph findings in patients admitted to hospital with heart failure (acute heart failure, AHF). Methods The erect CXRs of all patients admitted with AHF between October 2012 and November 2016 were reviewed for pulmonary venous congestion, Kerley B lines, pleural effusions and alveolar oedema. Film projection (whether anterior–posterior [AP] or posterior–anterior [PA]) and cardiothoracic ratio (CTR) were also recorded. Trial registration: ISRCTN96643197 Results Of 1145 patients enrolled, 975 [median (interquartile range) age 77 (68–83) years, 61% with moderate, or worse, left ventricular systolic dysfunction, and median NT-proBNP 5047 (2337–10,945) ng/l] had an adequate initial radiograph, of which 691 (71%) were AP. The median CTR was 0.57 (IQR 0.53–0.61)...
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The addition of macro-polypropylene fibres improves the stress-strain performance of natural aggregate concrete (NAC). However, limited studies focus on the stress-strain performance of macro-polypropylene fibre-reinforced recycled... more
The addition of macro-polypropylene fibres improves the stress-strain performance of natural aggregate concrete (NAC). However, limited studies focus on the stress-strain performance of macro-polypropylene fibre-reinforced recycled aggregate concrete (RAC). Considering the variability of coarse recycled aggregates (CRA), more studies are needed to investigate the stress-strain performance of macro-polypropylene fibre-reinforced RAC. In this study, a new type of 48 mm long BarChip macro-polypropylene fibre with a continuously embossed surface texture is used to produce BarChip fibre-reinforced NAC (BFNAC) and RAC (BFRAC). The stress-strain performance of BFNAC and BFRAC is studied for varying dosages of BarChip fibres. Results show that the increase in energy dissipation capacity (i.e., area under the curve), peak stress, and peak strain of samples is observed with an increase in fibre dosage, indicating the positive effect of fibre addition on the stress-strain performance of concre...
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Background: We studied the effect of race and ethnicity on disease characteristics and survival in gastrointestinal neuroendocrine tumors. Methods: The Surveillance, Epidemiology, and End Results database was used to select patients with... more
Background: We studied the effect of race and ethnicity on disease characteristics and survival in gastrointestinal neuroendocrine tumors. Methods: The Surveillance, Epidemiology, and End Results database was used to select patients with non-pancreatic gastrointestinal neuroendocrine tumors diagnosed between 2004 and 2015. Trends in survival were evaluated among three groups: Hispanic, non-Hispanic White, and non-Hispanic Black. Kaplan–Meier and Cox regression methods were performed to calculate overall survival and cause-specific survival after adjusting for patient and tumor characteristics. Results: A total of 26,399 patients were included in the study: 65.1% were non-Hispanic White, 19.9% were non-Hispanic Black, and 15% were Hispanic. Non-Hispanic White patients were more likely to be male (50.0%, p < 0.001), older than 60 years (48.0%, p < 0.001), and present with metastatic disease (17.7%, p < 0.001). Non-Hispanic White patients had small intestine neuroendocrine tum...
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Background: We aimed to study the effect of socioeconomic differences and molecular characteristics on survival in patients with young-onset pancreatic neuroendocrine tumors (YOPNET) and typical-onset PNET (TOPNET). Methods: We identified... more
Background: We aimed to study the effect of socioeconomic differences and molecular characteristics on survival in patients with young-onset pancreatic neuroendocrine tumors (YOPNET) and typical-onset PNET (TOPNET). Methods: We identified the patients with YOPNET (<50 years) and TOPNET (≥50 years) who underwent definitive surgery diagnosed between 2004 and 2016 using the National Cancer Database. We evaluated overall survival (OS) using the Kaplan–Meier and Cox regression methods before and after propensity score matching. A publicly available genomic dataset was used to compare mutation frequencies among the two groups. Results: A total of 6259 patients with PNET were included, of which 27% were YOPNET. Patients with YOPNET were more likely to be Black, Hispanic, female, and have private insurance versus patients with TOPNET (all p < 0.001). Patients with YOPNET had a lower comorbidity score, but higher stage and tumor size (all p < 0.001). YOPNET was associated with a gre...
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The integration of commercial onshore large-scale wind farms into a national grid comes with several technical issues that predominately ensure power quality in accordance with respective grid codes. The resulting impacts are complemented... more
The integration of commercial onshore large-scale wind farms into a national grid comes with several technical issues that predominately ensure power quality in accordance with respective grid codes. The resulting impacts are complemented with the absorption of larger amounts of reactive power by wind generators. In addition, seasonal variations and inter-farm wake effects further deteriorate the overall system performance and restrict the optimal use of available wind resources. This paper presented an assessment framework to address the power quality issues that have arisen after integrating large-scale wind farms into weak transmission grids, especially considering inter-farm wake effect, seasonal variations, reactive power depletion, and compensation with a variety of voltage-ampere reactive (Var) devices. Herein, we also proposed a recovery of significant active power deficits caused by the wake effect via increasing hub height of wind turbines. For large-scale wind energy pene...
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Acute myeloid leukemia (AML) is characterized by the clonal proliferation of malignant myeloid blast cells in the marrow along with impaired normal hematopoiesis. With an almost stagnant approach for the management of patients with AML in... more
Acute myeloid leukemia (AML) is characterized by the clonal proliferation of malignant myeloid blast cells in the marrow along with impaired normal hematopoiesis. With an almost stagnant approach for the management of patients with AML in the last three decades, the main purpose of this paper is to increase our understanding of recent scientific advancements for the enhanced diagnosis and treatment of AML. Existing research data related to different approaches for a possible improvement in AML management has been collected and discussed. The identification of recurrently mutated genes, such as CCAAT-enhancer-binding proteins α (CEBPα), Fms-related tyrosine kinase 3 (FLT3), and nucleophosmin 1 (NPM1) along with the classic diagnostic karyotype has improved prognostic-risk stratification. Moreover, mutations affecting cellular metabolism like isocitrate dehydrogenase (IDH1), lysine-specific demethylase 1 (LSD 1), and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) have become a huge success by providing targets for novel therapeutic drugs. Checkpoint inhibitors (CPI) and vaccination against tumor-associated antigen are added options considered, which require further trials before their efficacy can be determined. An important tool in monitoring early response to therapy, minimal residual disease (MRD) assays can be further refined by including pretreatment parameters such as cytogenetic and molecular markers. Potential side effects and resistance to treatment remains a huge barrier in completely finding success against AML and work needs to be done to find combinations of immunotherapies to possibly reduce adaptive resistance by AML.
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Background: Complementary & alternative medicine is very popular among people due to it being cheap, readily available, religious and cultural associations, and having the least side effects. In KSA, so far, no study on CAM usage in... more
Background: Complementary & alternative medicine is very popular among people due to it being cheap, readily available, religious and cultural associations, and having the least side effects. In KSA, so far, no study on CAM usage in public has been conducted in Majmaah governorate. Objective: The objectives of the study were to determine the prevalence and perception of CAM usage among the general population of Majmaah city KSA. Methods: The study was conducted from January to March 2016 on 208 individuals. A self-reporting questionnaire was filled in by the participants of both genders above 15 years of age. Results: The prevalence of CAM usage was 66.3%. The primary type of CAM practice was herbal remedies (68.4%) followed by Hijamma (25%) and acupuncture (4.4%). There was no statistical association between CAM usage and gender, age, or nationality. However, the level of education had a linear relationship with the use of CAM. The majority of participants who used CAM were more than 35 years (n=60, 43.7%) and the main reason for CAM use was the treatment of chronic ailment and body pains (33% & 13%). Conclusion: Majority of participants exercise and advocate CAM in Majmaah city. Therefore, physicians should also encourage safe CAM practices in patients.
The modern distribution networks under the smart grid paradigm have been considered both interconnected and reliable. In grid modernization concepts, the optimal asset optimization across a certain planning horizon is of core importance.... more
The modern distribution networks under the smart grid paradigm have been considered both interconnected and reliable. In grid modernization concepts, the optimal asset optimization across a certain planning horizon is of core importance. Modern planning problems are more inclined towards a feasible solution amongst conflicting criteria. In this paper, an integrated decision-making planning (IDMP) approach is proposed. The proposed methodology includes voltage stability assessment indices linked with loss minimization condition-based approach, and is integrated with different multi-criteria decision-making methodologies (MCDM), followed by unanimous decision making (UDM). The proposed IDMP approach aims at optimal assets sitting and sizing in a meshed distribution network to find a trade-off solution with various asset types across normal and load growth horizons. An initial evaluation is carried out with assets such as distributed generation (DG), photovoltaic (PV)-based renewable D...
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Background Chromosomal analysis using conventional cytogenetics (CC) and interphase fluorescence in situ hybridization (FISH) identifies a high risk multiple myeloma population (HR-MM) characterized by poor response to chemotherapy and... more
Background Chromosomal analysis using conventional cytogenetics (CC) and interphase fluorescence in situ hybridization (FISH) identifies a high risk multiple myeloma population (HR-MM) characterized by poor response to chemotherapy and shorter survival. The objective of this study was to compare outcomes of autologous hematopoietic stem cell transplantation (ASCT) at our institution in HR-MM and standard risk MM (SR-MM) patients (pts) identified through CC and FISH. Methods Metaphase CC and FISH data was collected from medical records of MM pts who underwent ASCT at our institution between Jan 2005 to Dec 2009. HR-MM pts were defined if CC revealed deletion (del) of chromosome 13/13q, del17/17p, t(4;14), t(14;16), hypoploidy (<45 chromosomes excluding –Y), or chromosome 1 abnormalities [+1, -1, t(1;x)] in at least 2 metaphases; or if FISH showed del 17p, t(4;14). Kaplan & Meier method was used for assessing progression free survival (PFS) and overall survival (OS); log-rank test ...
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4156 Background: Chromosomal abnormalities detected either by conventional cytogenetics (CC) or interphase fluorescence in situ hybridization (FISH) have emerged as important prognostic markers in patients with multiple myeloma (MM) and... more
4156 Background: Chromosomal abnormalities detected either by conventional cytogenetics (CC) or interphase fluorescence in situ hybridization (FISH) have emerged as important prognostic markers in patients with multiple myeloma (MM) and are used to stratify patients into standard-risk (SR) or high-risk (HR) disease. HR myeloma is associated with shorter remission and survival even with novel agents and autologous hematopoietic stem cell transplantation (auto-HCT). In this report, we describe the outcome of patients with myeloma who received auto-HCT at our institution between January 2008 and December 2009, and had CC and FISH analyses available before auto-HCT to identify HR or SR disease. Methods: Primary objective was to compare the response rate, transplant-related mortality (TRM), time to progression (TTP), progression-free survival (PFS) and overall survival (OS) between HR and SR myeloma. HR myeloma was defined as having deletion of chromosomal 13 or 13q, t(4;14), and del17p ...
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BACKGROUND Loop diuretics are given to the majority of patients with chronic heart failure (HF). Whether the different pharmacological properties of the three guideline-recommended loop diuretics result in differential effects on survival... more
BACKGROUND Loop diuretics are given to the majority of patients with chronic heart failure (HF). Whether the different pharmacological properties of the three guideline-recommended loop diuretics result in differential effects on survival is unknown. METHODS 6293 patients with chronic HF using either bumetanide, furosemide or torasemide were identified in three European HF registries. Patients were individually matched on both the respective propensity scores for receipt of the individual drug and dose-equivalents thereof. RESULTS During a follow-up of 35,038 patient-years, 652 (53.7%), 2179 (51.9%), and 268 (30.4%) patients died amongst those prescribed bumetanide, furosemide, and torasemide, respectively. In univariable analyses of the general sample, bumetanide and furosemide were both associated with higher mortality as compared with torasemide treatment (HR 1.50, 95% CI 1.31-1.73, p < 0.001, and HR 1.34, CI 1.18-1.52, p < 0.001, respectively). Mortality was higher in bumetanide users when compared to furosemide users (HR 1.11, 95% CI 1.02-1.20, p = 0.01). However, there was no significant association between loop diuretic choice and all-cause mortality in any of the matched samples (bumetanide vs. furosemide, HR 1.03, 95% CI 0.93-1.14, p = 0.53; bumetanide vs. torasemide, HR 0.98, 95% CI 0.78-1.24, p = 0.89; furosemide vs. torasemide, HR 1.02, 95% CI 0.84-1.24, p = 0.82). The results were confirmed in subgroup analyses with respect to age, sex, left ventricular ejection fraction, NYHA functional class, cause of HF, rhythm, and systolic blood pressure. CONCLUSIONS In patients with HF, mortality is not affected by the choice of individual loop diuretics.
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ObjectiveTo describe the epidemiology, long-term outcomes and temporal trends in mortality in ambulatory patients with chronic heart failure (HF) with reduced (HFrEF), mid-range (HFmrEF) or preserved ejection fraction (HFpEF) from three... more
ObjectiveTo describe the epidemiology, long-term outcomes and temporal trends in mortality in ambulatory patients with chronic heart failure (HF) with reduced (HFrEF), mid-range (HFmrEF) or preserved ejection fraction (HFpEF) from three European countries.MethodsWe identified 10 312 patients from the Norwegian HF Registry and the HF registries of the universities of Heidelberg, Germany, and Hull, UK. Patients were classified according to baseline left ventricular ejection fraction (LVEF) and time of enrolment (period 1: 1995–2005 vs period 2: 2006–2015). Predictors of mortality were analysed by use of univariable and multivariable Cox regression analyses.ResultsAmong 10 312 patients with stable HF, 7080 (68.7%), 2086 (20.2%) and 1146 (11.1%) were classified as having HFrEF, HFmrEF or HFpEF, respectively. A total of 4617 (44.8%) patients were included in period 1, and 5695 (55.2%) patients were included in period 2. Baseline characteristics significantly differed with respect to type...
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Compared to other direct oral anticoagulants, betrixaban has a longer half-life, smaller peak-trough variance, minimal renal clearance, and minimal hepatic Cytochrome P (CYP) metabolism. The Acute Medically Ill VTE Prevention with... more
Compared to other direct oral anticoagulants, betrixaban has a longer half-life, smaller peak-trough variance, minimal renal clearance, and minimal hepatic Cytochrome P (CYP) metabolism. The Acute Medically Ill VTE Prevention with Extended Duration Betrixaban (APEX) trial evaluated the efficacy and safety of extended duration betrixaban compared to standard duration enoxaparin in acutely ill hospitalized patients. Areas covered: This article describes the role of betrixaban in the prevention of venous thromboembolism (VTE) in acutely ill medical patients. This article provides a consolidated summary of the primary APEX study findings as well as prespecified and exploratory substudies. This article also provides a review of the results of studies in which other direct factor Xa inhibitors have been evaluated in an extended duration regimen in this patient population. Expert commentary: While previous agents have demonstrated that extended duration VTE prophylaxis can be efficacious, ...
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Differentiating heart failure from chronic obstructive pulmonary disease (COPD) in a patient presenting with breathlessness is difficult but may have implications for outcome. We investigated the prognostic impact of diagnoses of COPD... more
Differentiating heart failure from chronic obstructive pulmonary disease (COPD) in a patient presenting with breathlessness is difficult but may have implications for outcome. We investigated the prognostic impact of diagnoses of COPD and/or heart failure in consecutive patients presenting to a secondary care clinic with breathlessness. In patients with left ventricular systolic dysfunction (LVSD) by visual estimation, N-terminal pro B-type natriuretic peptide (NTproBNP) levels and spirometry were evaluated (N = 4986). Heart failure was defined as either LVSD worse than mild (heart failure with reduced ejection fraction) or LVSD mild or better and raised NTproBNP levels (> 400 ng/L) (heart failure with normal ejection fraction). COPD was defined as forced expiratory volume in 1 s (FEV) to forced vital capacity (FVC) ratio < 0.7. The primary outcome was all-cause mortality. 1764 (35%) patients had heart failure alone, 585 (12%) had COPD alone, 1751 (35%) had heart failure and C...
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Our present investigation aims at the synthesis and application of new, symmetric bridged bis-pyrazolone based acid dyes. The bis-pyrazolone compounds were accomplished from bis- hydrazine of 4,4'-Diaminostilbene-2,2'-disulfonic... more
Our present investigation aims at the synthesis and application of new, symmetric bridged bis-pyrazolone based acid dyes. The bis-pyrazolone compounds were accomplished from bis- hydrazine of 4,4'-Diaminostilbene-2,2'-disulfonic acid and ethyl acetoacetate. The bis-pyrazolones have been coupled with diazonium salts of o-hydroxyl aromatic amines which resulted in ligand dyes. The intermediate ligand dyes were treated with 3d transition metals to achieve the targeted metal complex acid dyes. The structures of investigated compounds were confirmed with the help of spectroscopic techniques. Dyes were applied on leather and their application parameters including their light fastness, wash fastness and rubbing fastness were determined. Graphical Abstract Symmetric brymmetric Bridged bis-Pyrazolone based Metal Complex Acid.
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Cerebral malaria is one of the most common causes of non-traumatic encephalopathy. A 25-year-old man who is a known intravenous and oral drug abuser presented to our clinic with fever and sore throat for two days prior and an altered... more
Cerebral malaria is one of the most common causes of non-traumatic encephalopathy. A 25-year-old man who is a known intravenous and oral drug abuser presented to our clinic with fever and sore throat for two days prior and an altered level of consciousness for one day. On examination, the patient was icteric, and his Glasgow coma scale score on arrival was 10/15; he had dilated pupils reactive to light and a positive corneal reflex. All cranial nerves were intact; however, signs of meningeal irritation were positive. Motor examination showed an increased tone and rigidity in all limbs, patellar reflex was 3+, plantars were down-going, and clonus was negative. A fundoscopic examination was unremarkable. Additional investigations revealed he was positive for Plasmodium falciparum, HIV, hepatitis B, and hepatitis C. In addition, a test of his cerebrospinal fluid revealed evidence of cerebral malaria. We initiated artemether 120 mg, intravenous ceftriaxone 2 g, and 5% dextrose saline fo...
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is the most common etiological agent of UTI and accounts for more then 100, 0000 hospitalization annually. The objective of this study was to investigate the antimicrobial activity of aqueous and ethanolic extracts of against from urinary... more
is the most common etiological agent of UTI and accounts for more then 100, 0000 hospitalization annually. The objective of this study was to investigate the antimicrobial activity of aqueous and ethanolic extracts of against from urinary tract infection patients. Urine samples of forty four suspected patients from Tertiary Care Hospital Faisalabad were used in this study. Ethanolic and aqueous extracts of (PV), a medicinal plant was evaluated for its ability to inhibit the growth of 38 resistant isolates of strains and compared to Ciprofloxacin, Ofloxacin, Cefixime and Tobramycin by well diffusion method. Minimum inhibitory concentration was measured by using broth micro dilution method. PV showed antibacterial activity against strains, however Tobramycin at 10 microgram (10μg) inhibited the resistant to a greater extent as compared to other antibiotics and was resistant to twice less number of strains, about 82% of isolates have MDR pattern. Ciprofloxacin has more efficacy than PV...
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Low serum chloride is common in patients with chronic heart failure (CHF) and is associated with worse outcomes. We investigated the clinical and prognostic associations, including cause of death associations, of low serum chloride in... more
Low serum chloride is common in patients with chronic heart failure (CHF) and is associated with worse outcomes. We investigated the clinical and prognostic associations, including cause of death associations, of low serum chloride in patients referred to a secondary care clinic with suspected heart failure. Patients with echocardiogram and serum chloride were evaluated (n = 5613). CHF was defined as signs and symptoms of the disease and either left ventricular systolic dysfunction (LVSD) worse than mild [heart failure with reduced ejection fraction (HFrEF)] or LVSD mild or better and raised amino-terminal pro-B-type natriuretic peptide (NT-proBNP) levels (>125 ng/L) [heart failure with preserved ejection fraction (HFpEF)]. Hypochloraemia was defined as greater than two standard deviations below the mean in the local normal distribution (<96 mmol/L). Of the 5613 patients referred, 908 patients did not have CHF, 1988 had HFrEF, and 2717 had HFpEF. Compared to patients in the fo...