Structural elucidation and development of azelaic acid loaded mesoporous silica nanoparticles infused gel: Revolutionizing nanodrug delivery for cosmetics and pharmaceuticals

This research aimed to enhance dermal delivery and optimize depigmentation therapy by designing mesoporous silica nanoparticles (MSNs) encapsulating azelaic acid (AZA) within a gel matrix. The MSNs were prepared using the sol-gel method. After subsequent processes, including acid extraction and drug loading, were then elucidated through PDI, size, zeta-potential, entrapment efficiency, nitrogen adsorption assay, FE-SEM, thermogravimetric analysis, differential scanning calorimetry, Fourier transform infrared spectroscopy, X-ray diffraction, and tyrosinase inhibition assay, were employed to assess the formulation. In-vitro stability tests for both AZA-MSN gel (AZCG) and AZA-loaded mesoporous silica gel (AZMG) were conducted at 8 °C, 25 °C, 40 °C, and 40 °C + 75 % RH, encompassing assessments of color, liquefaction, pH, and conductivity. Our findings showed a notable entrapment efficiency of 93.46 % for AZA-MSNs, with FE-SEM illustrating porous spherical MSNs. The particle size of AZA-MSNs was determined to be 211.9 nm, with a pore size of 2.47 nm and XRD analysis confirmed the amorphous state of AZA within the MSN carriers. Rheology examination indicated a non-Newtonian flow, while ex-vivo rat skin permeation studies conducted in a phosphate buffer (pH = 5.5) demonstrated a biphasic release pattern with 85.53 % cumulative drug permeation for AZA-MSNs. Overall, the study endorse the potential of AZA-MSNs as an efficacious and stable formulation for AZA delivery, highlighting their promise in addressing pigmentation concerns compared to conventional approaches.

Machine learning-based prognostication of mortality in stroke patients

Objectives

Predicting stroke mortality is crucial for personalized care. This study aims to design and evaluate a machine learning model to predict one-year mortality after a stroke.

Materials and methods

Data from the National Multiethnic Stroke Registry was utilized. Eight machine learning (ML) models were trained and evaluated using various metrics. SHapley Additive exPlanations (SHAP) analysis was used to identify the influential predictors.

Results

The final analysis included 9840 patients diagnosed with stroke were included in the study. The XGBoost algorithm exhibited optimal performance with high accuracy (94.5%) and AUC (87.3%). Core predictors encompassed National Institutes of Health Stroke Scale (NIHSS) at admission, age, hospital length of stay, mode of arrival, heart rate, and blood pressure. Increased NIHSS, age, and longer stay correlated with higher mortality. Ambulance arrival and lower diastolic blood pressure and lower body mass index predicted poorer outcomes.

Conclusions

This model's predictive capacity emphasizes the significance of NIHSS, age, hospital stay, arrival mode, heart rate, blood pressure, and BMI in stroke mortality prediction. Specific findings suggest avenues for data quality enhancement, registry expansion, and real-world validation. The study underscores machine learning's potential for early mortality prediction, improving risk assessment, and personalized care. The potential transformation of care delivery through robust ML predictive tools for Stroke outcomes could revolutionize patient care, allowing for personalized plans and improved preventive strategies for stroke patients. However, it is imperative to conduct prospective validation to evaluate its practical clinical effectiveness and ensure its successful adoption across various healthcare environments.

Epidemiological profile of stroke in Qatar: Insights from a seven-year observational study

OBJECTIVES

Stroke prevalence is progressively increasing in developing countries due to increased vascular risk factors. This study aims to describe the epidemiology, prevalent risk factors, and outcomes of stroke in a multi-ethnic society of Qatar.

MATERIALS AND METHODS

We conducted a retrospective analysis of all patients with suspected stroke admitted to stroke services between January 2014 and September 2020.

RESULTS

A total of 11,892 patients were admitted during this period with suspected stroke. Of these, the diagnosis was ischemic stroke (48.8 %), transient ischemic attack (10.3 %), intracerebral hemorrhage (10.9 %), cerebral venous sinus thrombosis (1.3 %), and stroke mimics (28.6 %). The median age was 52 (43-62), with a male-female ratio of 3:1. The study population was predominantly Asian (56.8 %) and Arab (36 %). The majority of the patients were hypertensive (66.8 %), diabetic (47.9 %), and dyslipidemic (45.9 %). A history of prior stroke was observed in 11.7 %, while 0.9 % had prior transient ischemic attack. Among ischemic strokes, 31.7 % arrived within 4.5 h, 12.5 % received thrombolysis, and 4.6 % underwent thrombectomy. Median Door-to-Needle time was 51 (33-72) minutes. The average length of stay was 5.2 ± 9.0 days, with 71.5 % discharged home, 13.8 % transferred to rehabilitation, 9.3 % to other specialties, 3 % to long-term care, and 2.4 % suffered in-hospital mortality.

CONCLUSION

Stroke in Qatar is characterized by a younger, expatriate-dominant cohort, with notable prevalence of ischemic and hemorrhagic stroke and a distinct risk factor profile. Further analysis of epidemiological differences among different population groups can inform targeted policies for prevention and management to reduce the burden of disease.

Larger wind turbines as a solution to reduce environmental impacts

The EU aims for carbon neutrality by 2050, focusing on offshore wind energy. Investments in North Sea wind farms, with optimal wind resources, play a crucial role. We employed a high-resolution regional climate model, which incorporates a wind farm parametrization, to investigate and address potential mitigating impacts of large wind farms on power generation and air-sea fluxes. Specifically, we examined the effects of replacing 5 MW turbines with larger 15 MW turbines while maintaining total capacity. Our study found that substituting 15 MW turbines increases the capacity factor by 2-3%, enhancing efficiency. However, these turbines exhibit a slightly smaller impact on 10 m wind speed (1.2-1.5%) and near-surface kinetic energy (0.1-0.2%), leading to reduced effects on sea surface heat fluxes compared to 5 MW turbines. This was confirmed by a stronger reduction in net heat flux of about 0.6-1.3% in simulations with 5 MW compared to 15 MW wind turbines. Air-sea fluxes influence ocean dynamics and marine ecosystems; therefore, minimizing these impacts is crucial. Overall, deploying 15 MW turbines in offshore wind farms may offer advantages for ocean dynamics and marine ecosystems, supporting the EU's carbon-neutral objectives.

Stroke and high-risk TIA outcomes with reduction of treatment duration when treatment initiated in emergency rooms (SHORTER-study)

BACKGROUND

Following transient ischemic attack (TIA) and minor stroke, the risk of recurrent stroke can be significantly reduced with short-duration dual antiplatelet therapy (DAPT). We wish to investigate whether 10 days of DAPT is as effective as 21 days' treatment.

STUDY DESIGN

This is an open-label, randomized, parallel-group study comparing whether 10 days of DAPT treatment (ASA + clopidogrel) is non-inferior to 21 days of DAPT in patients with acute ischemic stroke (AIS) or high-risk TIA. In both groups, DAPT is started within 24 hours of symptom onset. This study is being conducted in approximately 15 study sites in the Kingdom of Saudi Arabia. The planned sample size is 1932.

OUTCOMES

Non-inferiority of 10 days compared to 21 days of DAPT in the prevention of the composite endpoint of stroke and death at 90 days in AIS/TIA patients. The primary safety outcome is major intra-cranial and systemic hemorrhage.

STUDY PERIOD

Enrolment started in the second quarter of 2023, and the completion of the study is expected in the fourth quarter of 2025.

DISCUSSION

The trial is expected to show that 10 days of DAPT is non-inferior for the prevention of early recurrence of vascular events in patients with high-risk TIAs and minor strokes.

Association between serum triglycerides and stroke type, severity, and prognosis. Analysis in 6558 patients

BACKGROUND AND OBJECTIVES

Hypertriglyceridemia (HT) may increase the risk of stroke. Limited studies have shown that stroke severity and infarction size are smaller in patients with HT. We explored the relationship between triglyceride levels and stroke risk factors, severity and outcome in a large prospective database.

DESIGN

Prospective Cross-sectional study.

SETTING

We retrospectively interrogated the Qatar Stroke Database in all patients admitted between 2014-2022 with acute ischemic stroke and evaluated the relationship between triglyceride, diabetes, stroke severity (measured on NIHSS), stroke type (TOAST classification) and the short- (mRS at 90 days) and long-term outcomes (MACE at 1 year) in patients with HT.

PARTICIPANTS

Six thousand five hundred fifty-eight patients ≥20 years were included in this study RESULTS: Six thousand five hundred fifty-eight patients with ischemic stroke [mean age 54.6 ± 12. 9; male 82.1%) were included. Triglyceride levels upon admission were low-normal (≤1.1 mmol/L) in 2019 patients, high-normal (1.2-1.7 mmol/L) in 2142 patients, borderline-high (1.8-2.2 mmol/L) in 1072 patients and high (≥2.3 mmol/L) in 1325 patients. Higher triglyceride levels were associated with stroke and increased likelihood of having diabetes, obesity, active smoking, and small vessel/lacunar stroke type. An inverse relationship was noted whereby higher triglyceride levels were associated with lower stroke severity and reduced likelihood of poorer outcome (mRS 3-6) at discharge and 90 days. Long-term MACE events were less frequent in patients with higher triglyceride levels. After adjusting age, gender, diabetes, prior stroke, CAD, and obesity, multivariate analysis showed that hypertension and triglyceride levels were higher in mild ischemic strokes patients.

CONCLUSIONS

Increasing triglycerides are associated with higher risk of small vessel disease and requires further prospective cohort studies for confirmation.

Tocopherol succinate-loaded ethosomal gel synthesized by cold method technique: Deeper biophysical characterizations for translational application on human skin

BACKGROUND

Tocopherols are well-known antioxidant and moisturizing agent. Tocopherol succinate (TS) are widely used in many skin products especially used in anti-aging and skin whitening product formulation.

AIM

We previously reported the successful synthesis and preliminary characterizations of stable TS ethosomal gels (TSEG) (DOI: 10.1111/jocd.14907). Herein, we develop and further characterize TSEG to enhance the stability of the developed formulation with increased permeation through skin.

METHODS

Cold method technique was used to prepare TS ethosomes. The developed ethosomal vesicle size was 250 nm, which allowed TS to penetrate through the stratum corneum layer and act on melanocytes. For stability study was assessed by thermogravimetric analysis (TGA) by placing TSEG and unloaded/control ethosomal gel (CEG) at various temperature conditions, that is, 8°C, 25°C, 40°C, and 40°C ± 75% RH for 3 months. Organoleptic evaluation was done in terms of color, odor, and phase separation. Transmission electron microscopy (TEM), Fourier Transform infrared spectroscopy (FTIR), x-ray diffraction spectroscopy (XRD), zeta potential (ZP) and particle size (PS) was used for TSEG physical characterizations. In vitro dissolution and ex-vivo permeation studies (using Franz diffusion cell) were performed for both TSEG and CEG formulations. Human women (N = 34) were used to evaluate in vivo biophysical parameters including erythema, melanin, moisture content, sebum level, and skin elasticity.

RESULTS

Developed formulation was highly thermostable during the 3 months. Erythema, melanin, and sebum level decreased while marked improvement (p < 0.05) in moisture content and elasticity have been observed for the developed TSEG.

CONCLUSION

The developed TSEG formulation was found to be efficient, safe (no adverse effects observed), stable (at least for 3 months), and easy to use for topical application with improved skin complexation and skin integrity.

Incidence, clinical features, and outcomes of posterior circulation ischemic stroke: insights from a large multiethnic stroke database

Background

Posterior cerebral circulation ischemic stroke (PCS) comprises up to 25% of all strokes. It is characterized by variable presentation, leading to misdiagnosis and morbidity and mortality. We aim to describe PCS in large multiethnic cohorts.

Methods

A retrospective review of a large national stroke database from its inception on the 1st of January 2014 till 31 December 2020. Incidence per 100,000 adult population/year, demographics, clinical features, stroke location, and outcomes were retrieved. We divided the cohort into patients from MENA (Middle East and North Africa) and others.

Results

In total, 1,571 patients were identified. The incidence of PCS was observed to be rising and ranged from 6.3 to 13.2/100,000 adult population over the study period. Men were 82.4% of the total. The mean age was 54.9 ± 12.7 years (median 54 years, IQR 46, 63). MENA patients comprised 616 (39.2%) while others were 954 (60.7%); of these, the majority (80.5%) were from South Asia. Vascular risk factors were prevalent with 1,230 (78.3%) having hypertension, 970 (61.7%) with diabetes, and 872 (55.5%) having dyslipidemia. Weakness (944, 58.8%), dizziness (801, 50.5%), and slurred speech (584, 36.2%) were the most commonly presenting symptoms. The mean National Institute of Health Stroke Score (NIHSS) score was 3.8 ± 4.6 (median 3, IQR 1, 5). The overall most frequent stroke location was the distal location (568, 36.2%). The non-MENA cohort was younger, less vascularly burdened, and had more frequent proximal stroke location (p < 0.05). Dependency or death at discharge was seen in 39.5% and was associated with increasing age, and proximal and multilocation involvement; while at 90 days it was 27.4% and was associated with age, male sex, and having a MENA nationality (p < 0.05).

Conclusion

In a multiethnic cohort of posterior circulation stroke patients from the MENA region and South Asia, we noted a rising incidence over time, high prevalence of vascular risk factors, and poor outcomes in older men from the MENA region. We also uncovered considerable disparities between the MENA and non-MENA groups in stroke location and outcome. These disparities are crucial factors to consider when tailoring individualized patient care plans. Further research is needed to thoroughly investigate the underlying reasons for these variations.

Association between HDL levels and stroke outcomes in the Arab population

Low HDL levels are associated with an increased stroke incidence and worsened long-term outcomes. The aim of this study was to assess the relationship between HDL levels and long-term stroke outcomes in the Arab population. Patients admitted to the Qatar Stroke Database between 2014 and 2022 were included in the study and stratified into sex-specific HDL quartiles. Long-term outcomes included 90-Day modified Rankin Score (mRS), stroke recurrence, and post-stroke cardiovascular complications within 1 year of discharge. Multivariate binary logistic regression analyses were performed to identify the independent effect of HDL levels on short- and long-term outcomes. On multivariate binary logistic regression analyses, 1-year stroke recurrence was 2.24 times higher (p = 0.034) and MACE was 1.99 times higher (p = 0.009) in the low-HDL compared to the high-HDL group. Mortality at 1 year was 2.27-fold in the low-normal HDL group compared to the reference group (p = 0.049). Lower sex-specific HDL levels were independently associated with higher adjusted odds of 1-year post-stroke mortality, stroke recurrence, and MACE (p < 0.05). In patients who suffer a stroke, low HDL levels are associated with a higher risk of subsequent vascular complication.

Brassica oleracea L. (Acephala Group) based zinc oxide nanoparticles and their efficacy as antibacterial agent

Abstract Zinc oxide nanoparticles were synthesized from the leaf extract of Brassica oleracea L. Acephala group (collard green) followed by their characterization using Scanning Electron Microscope (SEM), and Energy Dispersive X-ray (EDX). The antibacterial properties of zinc nanoparticles were tested against Gram-negative bacteria, Pseudomonas aeruginosa (ATCC ® 9027™), Escherichia coli (ATCC ® 8739™), Klebsiella pneumoniae (ATCC® BAA-1705™) and Gram-positive bacteria, Staphylococcus aureus (ATCC ® 6538™) and Listeria monocytogenes (ATCC ® 13932™), at four different concentrations (50.00 µg/ml, 100.00 µg/ml, 500.00 µg/ml and 1 mg/ml) of zinc oxide nanoparticles suspension. Results revealed that the synthesized nanoparticles exhibit strong antibacterial effects against Pseudomonas aeruginosa, Listeria monocytogenes, Klebsiella pneumonia, Staphylococcus aureus and Escherichia coli at 500.00 µg/ml-1 mg/ml concentrations. An increase in efficacy of nanoparticles with the decrease of their size was also evident. This is a first ever report on Brassica oleracea, L. based nanoparticles which demonstrates that 500.00 µg-1 mg/ml conc. of zinc oxide nanoparticles have antibacterial activity against both Gram -ve and Gram +ve bacteria and have the potential to be considered as an antibacterial agent in future.

Tracing probiotic producing bacterial species from gut of buffalo (Bubalus bubalis), South-East-Asia

Abstract Due to extensive application of antibiotics as growth promoters in animal feed, antimicrobial resistance has been increased. To overcome this challenge, rumen microbiologists search for new probiotics to improve the rate of livestock production. The present study was aimed to isolate and evaluate breed-specific lactic acid bacteria (LAB) as potential animal probiotics. The current study was conducted during 10 months from July 2020 to April 2021, in which a total of n=12 strains were isolated from different samples including milk, rumen, and feces of Nilli Ravi Buffaloes. These isolates were evaluated for their antimicrobial potential against common animal pathogens (Bacillus spp., E. coli, Staphylococcus aureus, Salmonella spp., Listeria spp.). All the isolates were identified using 16S rRNA gene sequencing and the phylogenetic analyses inferred that these strains showed close relations to the species of various genera; Enterococcus lactis, Pediococcus pentosaceus, Bacillus subtilis Weissella cibaria, Weissella soli, Bacillus tequilensis, Weissella bombi, Bacillus licheniformis, Lactococcus lactis, Bacillus megaterium, Lactobacillus ruminis, and Lactococcus lactis. NMCC-Ru2 has exhibited the enormous potential of antimicrobial activity, 28 mm, for Salmonella typhimurium;23 mm for Listeria monocytogenes 21 mm for E.coil. Highest resistance was seen in NMCC-Ru2 agasint test antbiotic, like 25.5 mm for Tetracycline. Overall results revesl that the probiotic profile of isolates was achieved using standard criteria, particularly with animal probiotic properties

Quantitative ethnomedicinal study and conservation status of medicinal flora used by the indigenous peoples of Sultan Khail valley, Dir Upper, Pakistan

The present study was conducted to explore the ethnomedicinal uses, quantitative analysis and conservation status of medicinal flora of Sultan Khail valley, Dir Upper, Pakistan. The data was collected during 2017-2019 using a semi-structured questionnaire. Ethnomedicinal uses of plant species were determined and the plant species were classified based on habits, parts used, and method of preparation of remedies. Frequency of citation (FC), relative frequency of citation (RFC) and family importance values (FIV) were calculated. The plant species were assessed for their conservation status as per IUCN standard criteria. The inhabitants of the Sultan Khail valley use 88 plant species belonging to 57 families for the treatment of different human diseases. Lamiaceae was the dominant family represented with 8 medicinal species (9%) followed by Rosaceae (5 species, 6%). The most commonly used plant parts were leaves (33.1%) followed by fruits (16.1%), while the main method of remedy preparation was decoctions (33.3%). The highest RFC value was recorded for Geranium wallichianum (0.47), followed by Berberis lycium (0.44). Lamiaceae was the most cited family (FIV, 231), followed by Polygonaceae (73). Five plant species were found to be endangered, 39 species were vulnerable, 32 species were rare, and 12 species were found to be infrequent. The medicinal flora of the area is under severe biotic pressure and needs proper conservation; otherwise, they will be lost in the near future.

Predicting 90-day prognosis for patients with stroke: a machine learning approach

Background

Stroke is a significant global health burden and ranks as the second leading cause of death worldwide.

Objective

This study aims to develop and evaluate a machine learning-based predictive tool for forecasting the 90-day prognosis of stroke patients after discharge as measured by the modified Rankin Score.

Methods

The study utilized data from a large national multiethnic stroke registry comprising 15,859 adult patients diagnosed with ischemic or hemorrhagic stroke. Of these, 7,452 patients satisfied the study's inclusion criteria. Feature selection was performed using the correlation and permutation importance methods. Six classifiers, including Random Forest (RF), Classification and Regression Tree, Linear Discriminant Analysis, Support Vector Machine, and k-Nearest Neighbors, were employed for prediction.

Results

The RF model demonstrated superior performance, achieving the highest accuracy (0.823) and excellent discrimination power (AUC 0.893). Notably, stroke type, hospital acquired infections, admission location, and hospital length of stay emerged as the top-ranked predictors.

Conclusion

The RF model shows promise in predicting stroke prognosis, enabling personalized care plans and enhanced preventive measures for stroke patients. Prospective validation is essential to assess its real-world clinical performance and ensure successful implementation across diverse healthcare settings.

Formulation, characterization of Quercus infectoria (Olivier) emulsions, and in vitro, in vivo evaluation as cosmeceutical formulation

BACKGROUND

Pharmacological properties of Quercus infectoria Olivier (galls) have been determined to be astringent, antidiabetic, antipyretic, anti-tremor, local anesthetic, and anti-parkinsonism. The galls of Quercus infectoria have been used for millennia in traditional oriental medicine in Asian nations to treat inflammatory illnesses.

AIMS

The study's objective was to create a Quercus infectoria Olivier gall extract in stable water in oil (w/o) emulsion and to check its effects on the mechanical properties of skin and antiaging effects.

METHOD

The galls were macerated in absolute methanol. Quercus infectoria Olivier gall extract's antioxidant property was evaluated using the 2, 2-diphenyl-1-picrylhydrazyl (DPPH) technique. Stearic acid, cetyl alcohol, KOH, glycerin, and distilled water were used to create the emulsion. The test (with extract) and control (without extract) emulsions were made, respectively, using the same process. Stability tests (color, liquefaction, microscopy, phase separation, and pH) are performed in in vitro, lasted 72 days at four distinct storage temperatures that is 8°C, 25°C, 40°C, and 40°C + 75% RH for both the control and test formulations. By using spectrophotometry, the (SPF) sun protection factors of the two formulations were calculated at various concentrations. Extract from Quercus infectoria underwent phytochemical investigation as well.

RESULTS

The results showed that Quercus infectoria Olivier has antioxidant and (SPF) sun protection properties, reduce sebum, increases elasticity and stable emulsion containing 04% Quercus infectoria gall extract which might be used as topical antiaging formulation.

Gauging Quince Phytonutrients and Its 4% Emulgel Effect on Amplifying Facial Skin Moisturizing Potential

BACKGROUND

The aim of this study was to evaluate the moisturizing efficacy of quince fruit, used in folk medicine. For this purpose, the phytoconstituents of Cydonia oblonga fruit extract, like phenolics and flavonoids, were determined. A stable cosmetic emulgel containing 4% Cydonia oblonga fresh fruit extract was formulated and subjected to in vivo evaluation compared with a control.

MATERIALS AND METHODS

Cydonia oblonga fresh fruit extract was evaluated for tyrosinase activity and phenolic and flavonoid content. A stable emulgel containing 4% Cydonia oblonga fresh fruit extract was formulated and tested in a skin irritation test. After this, in vivo tests of erythema, moisture, sebum, and skin elasticity were conducted. The in vivo evaluation was a randomized and single-blind study. Thirteen healthy female volunteers were selected for a three-month study period.

RESULTS

Cydonia oblonga fruit extract showed good phenolic and flavonoid content, which was associated with its good antioxidant and tyrosinase-inhibiting activity. Cydonia oblonga containing the emulgel showed a reduction in sebum and erythema, while the elasticity and moisture content showed increments in their levels after the three-month application of the formulation. The fruit contains chlorogenic acid and many sugars, which might account for its anti-inflammatory and sebum reduction effects; it is also capable of enhancing the skin's hydration level and decreasing skin sagging by enhancing its elasticity.

CONCLUSION

The emulgel loaded with Cydonia oblonga fresh fruit extract is verified regarding its folklore status as a moisturizing agent that enhances the facial skin cells' resilience potential.

Screening of hepatitis B and C viral infection, recognition of risk factors, and immunization of patients against hepatitis B virus: a module developed for effective hepatitis control

Introduction

The continually increasing incidence of hepatitis, a worldwide health issue, in Pakistan, has highlighted the need to investigate the epidemiology factors and implement preventive measures accordingly. The purpose of this study was to scrutinize the prevalent and significantly associated risk factors of hepatitis in students and employees, screening them for hepatitis B and C virus and vaccinating them against HBV to make IUB hepatitis free.

Methodology

A total of 12,912 participants including students (n = 10,948) and employees (n = 1964) were screened for HBV and HCV via immunochromatographic test. Hepatitis- positive participants' blood samples were further tested and viral load was estimated by quantitative PCR. All the hepatitis-negative participants were vaccinated against HBV. The demographic and risk factors-related data were collected using the questionnaire. Statistical analysis (Chi-square test and bivariate regression analysis) was performed using SPSS software to explore any association between risk factors and hepatitis.

Results

Results indicated that 662/12912 participants (students = 478/10,948, employees = 184/1,964) tested positive for hepatitis. Among them, HCV was observed to be more prevalent than HBV among the study participants, employees, and students, and viral count was low in both HBV and HCV-infected participants. However, men were more affected than women. The studied risk factors represented higher frequency among hepatitis-positive participants relative to the hepatitis-negative participants. The Chi-square test revealed that students' gender, history of hepatitis in the family and relatives, dental treatment, sharing cosmetics and shaving blades were significant (p > 0.005) risk factors of hepatitis while in the employees group surgery and age were significant. Moreover, the reused of syringes was found to be associated with hepatitis in both groups. The bivariate analysis helped to identify various new risk factors which were independently, either positively or negatively, associated with hepatitis.

Discussion

Our study enabled us to recognize different risk factors of hepatitis among the target population. The information thus generated can be usefully applied in planning hepatitis awareness, targeted screening, and effective control programs for other target populations. In general, this module can be further utilized for any other disease.

Appropriate use of antiplatelet medications following transient ischemic attacks and stroke: a 9-year study from the Middle East

Background and purpose

Guidelines recommend that patients with high-risk TIAs and minor strokes presenting within 1-3 days from onset should be offered dual antiplatelet therapy (DAPT). There are little data on real-world adherence to these recommendations. We evaluated the appropriateness of DAPT use in TIA and stroke patients in a prospective database.

Methods

The Qatar Stroke Database began the enrollment of patients with TIAs and acute stroke in 2014 and currently has ~16,000 patients. For this study, we evaluated the rates of guideline-adherent use of antiplatelet treatment at the time of discharge in patients with TIAs and stroke. TIAs were considered high-risk with an ABCD2 score of 4, and a minor stroke was defined as an NIHSS of 3. Patient demographics, clinical features, risk factors, previous medications, imaging and laboratory investigations, final diagnosis, discharge medications, and discharge and 90-day modified Rankin Scale (mRS) were analyzed.

Results

After excluding patients with ICH, mimics, and rare secondary causes, 8,082 patients were available for final analysis (TIAs: 1,357 and stroke: 6,725). In high-risk TIAs, 282 of 666 (42.3%) patients were discharged on DAPT. In patients with minor strokes, 1,207 of 3,572 (33.8%) patients were discharged on DAPT. DAPT was inappropriately offered to 238 of 691 (34.4%) low-risk TIAs and 809 of 3,153 (25.7%) non-minor stroke patients.

Conclusion

This large database of prospectively collected patients with TIAs and stroke shows that, unfortunately, despite several guidelines, a large majority of patients with TIAs and stroke are receiving inappropriate antiplatelet treatment at discharge from the hospital. This requires urgent attention and further investigation.

Predicting 90-Day Prognosis in Ischemic Stroke Patients Post Thrombolysis Using Machine Learning

(1) Objective: This study aimed to construct a machine learning model for predicting the prognosis of ischemic stroke patients who underwent thrombolysis, assessed through the modified Rankin Scale (mRS) score 90 days after discharge. (2) Methods: Data were sourced from Qatar's stroke registry covering January 2014 to June 2022. A total of 723 patients with ischemic stroke who had received thrombolysis were included. Clinical variables were examined, encompassing demographics, stroke severity indices, comorbidities, laboratory results, admission vital signs, and hospital-acquired complications. The predictive capabilities of five distinct machine learning models were rigorously evaluated using a comprehensive set of metrics. The SHAP analysis was deployed to uncover the most influential predictors. (3) Results: The Support Vector Machine (SVM) model emerged as the standout performer, achieving an area under the curve (AUC) of 0.72. Key determinants of patient outcomes included stroke severity at admission; admission systolic and diastolic blood pressure; baseline comorbidities, notably hypertension (HTN) and coronary artery disease (CAD); stroke subtype, particularly strokes of undetermined origin (SUO); and hospital-acquired urinary tract infections (UTIs). (4) Conclusions: Machine learning can improve early prognosis prediction in ischemic stroke, especially after thrombolysis. The SVM model is a promising tool for empowering clinicians to create individualized treatment plans. Despite limitations, this study contributes to our knowledge and encourages future research to integrate more comprehensive data. Ultimately, it offers a pathway to improve personalized stroke care and enhance the quality of life for stroke survivors.

Corneal immune cells as a biomarker of inflammation in multiple sclerosis: a longitudinal study

Background

Corneal immune cells (ICs) are antigen-presenting cells that are known to increase ocular and systemic inflammatory conditions.

Objective

We aimed to assess longitudinal changes in corneal IC in patients with multiple sclerosis (MS) and relation to disability and ongoing treatment.

Design

Prospective observational study conducted between September 2016 and February 2020.

Methods

Patients with relapsing-remitting MS (RRMS) (n = 45) or secondary progressive MS (SPMS) (n = 15) underwent corneal confocal microscopy (CCM) at baseline and 2-year follow-up for estimation of corneal IC density [dendritic cells with (DCF) (cells/mm2) or without nerve fiber contact (DCP); and non-dendritic cells with (NCF) or without nerve fiber contact (NCP)]. Optical coherence tomography, neuroimaging, and disability assessments were additionally performed. Healthy controls (n = 20) were assessed at baseline.

Results

In both RRMS and SPMS compared to controls, DCP (p < 0.001 and p < 0.001, respectively) and DCF (p < 0.001 and p = 0.005) were higher and NCF (p = 0.007 and p = 0.02) was lower at baseline. DCP showed excellent performance in identifying patients with MS (sensitivity/specificity = 0.88/0.90) followed by DCF (0.80/0.75) and NCF (0.80/0.85). At follow-up compared to baseline, DCP (p = 0.01) was significantly reduced, and NCP (p = 0.004) and NCF (p = 0.04) were increased. Subgroup analysis showed that baseline NCP and NCF were significantly higher (p = 0.04-0.05) in patients who switched disease-modifying treatment, and baseline NCP (p = 0.05) was higher in patients on interferon.

Conclusion

Baseline and change in corneal IC were related to axonal degeneration and treatment status. Evaluation of corneal IC using CCM may allow an assessment of ongoing inflammation, disease progression, and the effect of treatment in MS.

Rescue Stent Placement for Acute Ischemic Stroke with Large Vessel Occlusion Refractory to Mechanical Thrombectomy: A Multiethnic Middle Eastern/African/Asian Cohort

PURPOSE

To investigate the safety and effectiveness of rescue stent placement in patients who experienced acute stroke in whom mechanical thrombectomy failed.

METHODS

This was a retrospective review of a multiethnic stroke database. After stent placement, an aggressive antiplatelet protocol was followed with glycoprotein IIb/IIIa infusion. The primary outcomes were incidence of intracerebral hemorrhage (ICH), recanalization score, and favorable prognosis (modified Rankin score ≤ 2) at 90 days. A comparison was made between patients from the Middle East and North Africa (MENA) region and those from other regions.

RESULTS

Fifty-five patients were included, with 87% being men. The mean age was 51.3 years (SD ±11.8); 32 patients (58%) were from South Asia, 12 (22%) from MENA, 9 (16%) from Southeast Asia, and 2 (4%) from elsewhere. Successful recanalization (modified Thrombolysis in Cerebral Infarction score = 2b/3) was achieved in 43 patients (78%), and symptomatic ICH occurred in 2 patients (4%). A favorable outcome at 90 days was seen in 26 of the 55 patients (47%). Apart from significantly older age-mean, 62.8 years (SD ±13; median, 69 years) versus 48.1 years (SD ±9.3; median, 49 years)-and coronary artery disease burden-4 (33%) versus 1 (2%) (P < .05), patients from MENA had risk factors, stroke severity, recanalization rates, ICH rates, and 90-day outcomes similar to those from South and Southeast Asia.

CONCLUSION

Rescue stent placement showed good outcomes and a low risk of clinically significant bleeding in a multiethnic cohort of patients from MENA and South and Southeast Asia, similar to that in published literature.

A survey in the West Midlands of the United Kingdom of current practice in managing hypotension in lower segment caesarean section under spinal anaesthesia

BACKGROUND

Spinal anaesthesia, the most common form of anaesthesia for caesarean section, leads to sympathetic blockade and profound maternal hypotension resulting in adverse maternal and neonatal outcomes. Hypotension, nausea and vomiting remain common but until the publication of the National Institute of Health and Care Excellence (NICE) 2021 guidance, no national guideline existed on how best to manage maternal hypotension following spinal anaesthesia for caesarean section. A 2017 international consensus statement recommended prophylactic vasopressor administration to maintain a systolic blood pressure of >90% of an accurate pre-spinal value, and to avoid a drop to <80% of this value. This survey aimed to assess regional adherence to these recommendations, the presence of local guidelines for management of hypotension during caesarean section under spinal anaesthesia, and the individual clinician's treatment thresholds for maternal hypotension and tachycardia.

METHODS

The West Midlands Trainee-led Research in Anaesthesia and Intensive Care Network co-ordinated surveys of obstetric anaesthetic departments and consultant obstetric anaesthetists across 11 National Health Service Trusts in the Midlands, England.

RESULTS

One-hundred-and-two consultant obstetric anaesthetists returned the survey and 73% of sites had a policy for vasopressor use; 91% used phenylephrine as the first-line drug but a wide range of recommended delivery methods was noted and target blood pressure was only listed in 50% of policies. Significant variation existed in both vasopressor delivery methods and target blood pressures.

CONCLUSIONS

Although NICE has since recommended prophylactic phenylephrine infusion and a target blood pressure, the previous international consensus statement was not adhered to routinely.

Stroke services in MENA: What is there and what is needed

OBJECTIVES

Stroke represents a health care challenge to most parts of the world including the Middle East and North Africa (MENA) region. The MENA represents 6% of the world population with an age-standardized stroke rate of 87.7 (78.2-97.6) per 100,000 population. This number is subject to increase given that the cause of morbidity has recently shifted from infectious diseases to non-communicable diseases. Thus, in the coming years, treatment of stroke will pose a major burden on MENA countries which mostly lie in the low to middle income economies. Accordingly, we need to study the state of MENA stroke services in order to recognize and further inform policy makers about any gaps that need to be bridged in this domain.

METHODS AND RESULTS

Stroke specialists representing 16 countries filled an online survey that included: screening for risk factors, acute management, diagnostics, medications, post-discharge services, and stroke registries. Results showed that 11 countries screen for risk factors, 16 have neuroimaging studies, 15 provide intravenous thrombolysis (IVT), 13 mechanical thrombectomy (MT) while medications for secondary prevention are available in all countries. However, stroke units are not equally available and even absent in 4 countries, and despite the availability of IVT yet, the rate of administration is still low in 6 countries (<5%), and ranges from 5-20% in 7 countries. Stroke registries and training still need to be implemented in most countries.

CONCLUSION

Although imaging, revascularization therapies and medications for secondary prevention are available in most MENA countries, yet the rate of revascularization is low, so is the number of stroke units insufficient in some countries. Additionally, registries and structured training are still defective. Further field studies are required for more accurate determination of the status of stroke services in the MENA region.

Mesh Convolution With Continuous Filters for 3-D Surface Parsing

Geometric feature learning for 3-D surfaces is critical for many applications in computer graphics and 3-D vision. However, deep learning currently lags in hierarchical modeling of 3-D surfaces due to the lack of required operations and/or their efficient implementations. In this article, we propose a series of modular operations for effective geometric feature learning from 3-D triangle meshes. These operations include novel mesh convolutions, efficient mesh decimation, and associated mesh (un)poolings. Our mesh convolutions exploit spherical harmonics as orthonormal bases to create continuous convolutional filters. The mesh decimation module is graphics processing unit (GPU)-accelerated and able to process batched meshes on-the-fly, while the (un)pooling operations compute features for upsampled/downsampled meshes. We provide an open-source implementation of these operations, collectively termed Picasso. Picasso supports heterogeneous mesh batching and processing. Leveraging its modular operations, we further contribute a novel hierarchical neural network for perceptual parsing of 3-D surfaces, named PicassoNet ++ . It achieves highly competitive performance for shape analysis and scene segmentation on prominent 3-D benchmarks. The code, data, and trained models are available at https://github.com/EnyaHermite/Picasso.

Women and stroke: disparities in clinical presentation, severity, and short- and long-term outcomes

Objectives

There are limited data from the Middle East on sex-related differences in short- and long-term stroke outcomes. We present 8 years of experience based on the Qatar stroke database.

Setting

The Qatar stroke database prospectively collects data on all stroke patients admitted to Hamad General Hospital. For this study, we compared female and male acute ischemic stroke patients on their characteristics at admission, short-term outcomes [modified Rankin Scale (mRS) score], and long-term outcomes [incidence of major adverse cardiovascular events (MACEs)].

Participants

A total of 7,300 patients [F: 1,406 (19.3%), M: 5,894 (80.7%); mean age 55.1 ± 13.3 (F: 61.6 ± 15.1, M: 53.5 ± 12.3; p < 0.001)] were admitted with acute ischemic stroke.

Results

Significantly fewer women presented within 4.5 h of onset (F: 29% vs. M: 32.8%; p = 0.01). Although women were more likely to experience severe stroke (NIHSS >10; F: 19.9% vs. M: 14.5%; p < 0.001), fewer were treated with thrombolysis (F: 9.8% vs. M: 12.1%; p = 0.02). Women experienced more medical complications (F: 11.7% vs. M: 7.4%; p < 0.001) and tended to have a more prolonged length of stay in the hospital (F: 6.4 ± 7.6 days vs. M: 5.5 ± 6.8 days; p < 0.001).

Primary and secondary outcome measures

Good outcomes at 90 days (mRS score of 0-2) were less frequent in women (F: 53.3% vs. M: 71.2%; p < 0.001). Fewer female patients were taking antiplatelets (F: 78% vs. M: 84.8%; p < 0.001) or statins (F: 81.2% vs. M: 85.7%; p < 0.001). Significantly more female patients experienced a MACE (F: 12.6% vs. M: 6.5%; p < 0.001).

Conclusion

Older age at presentation contributes to poor outcomes following acute stroke in women. Other contributing factors include delays in admission to the hospital, lower rates of thrombolysis, and lower rates of provision of preventative treatments.

Corneal axonal loss as an imaging biomarker of neurodegeneration in multiple sclerosis: a longitudinal study

Background

Resourceful endpoints of axonal loss are needed to predict the course of multiple sclerosis (MS). Corneal confocal microscopy (CCM) can detect axonal loss in patients with clinically isolated syndrome and established MS, which relates to neurological disability.

Objective

To assess corneal axonal loss over time in relation to retinal atrophy, and neurological and radiological abnormalities in MS.

Methods

Patients with relapsing-remitting (RRMS) (n = 68) or secondary progressive MS (SPMS) (n = 15) underwent CCM and optical coherence tomography. Corneal nerve fibre density (CNFD-fibres/mm²), corneal nerve branch density (CNBD-branches/mm²), corneal nerve fibre length (CNFL-mm/mm²) and retinal nerve fibre layer (RNFL-μm) thickness were quantified along with neurological and radiological assessments at baseline and after 2 years of follow-up. Age-matched, healthy controls (n = 20) were also assessed.

Results

In patients with RRMS compared with controls at baseline, CNFD (p = 0.004) and RNFL thickness (p < 0.001) were lower, and CNBD (p = 0.003) was higher. In patients with SPMS compared with controls, CNFD (p < 0.001), CNFL (p = 0.04) and RNFL thickness (p < 0.001) were lower. For identifying RRMS, CNBD had the highest area under the receiver operating characteristic (AUROC) curve (0.99); and for SPMS, CNFD had the highest AUROC (0.95). At follow-up, there was a further significant decrease in CNFD (p = 0.04), CNBD (p = 0.001), CNFL (p = 0.008) and RNFL (p = 0.002) in RRMS; in CNFD (p = 0.04) and CNBD (p = 0.002) in SPMS; and in CNBD (p = 0.01) in SPMS compared with RRMS. Follow-up corneal nerve loss was greater in patients with new enhancing lesions and optic neuritis history.

Conclusion

Progressive corneal and retinal axonal loss was identified in patients with MS, especially those with more active disease. CCM may serve as an imaging biomarker of axonal loss in MS.

Abstract TP192: Compared To Men, Women Have Worse Outcome In Acute Stroke: An Eight-years Prospective Study From Qatar

Hypothesis: There is considerable evidence that women have poor outcome following acute stroke when compared to men. We report our experience from a large prospective stroke database from Qatar.

Methods: The Qatar stroke database is a prospective study, which began enrolling patients in 2014. We collected data on the demographics, clinical presentation, investigations, treatments, hospital complications and outcome (measured as 90-days modified Rankin Score [mRS]) on all patients admitted with acute stroke to the Hamad General Hospital where ~95% of stroke patients in Qatar are admitted. Multivariate analysis of risk factors, stroke type and severity, and in-hospital complications were compared to determine 90-days and one-year outcome in men and women.

Results: There were 7300 stroke patients (women:1406 [19.3%], men:5894 [80.7%] admitted between 2014-2021. Multivariate analysis revealed significantly higher rates of obesity (OR 2.51), increasing age (age>65 years [OR 3.79]) and atrial fibrillation (OR 1.26) in women, p<0.001. In women, thrombolysis was less frequent and poor outcome (mRS 3-6) was more frequent (OR 1.62, p< 0.001) after adjustment for risk factors, stroke severity and in-hospital complications. The one-year mortality was significantly higher in women (11.7% versus men: 5.1%, p<0.001).

Conclusions: In this large series of prospectively collected acute stroke patients from Qatar, our study reveals that women are more likely to have a poor outcome when compared to men. Although there was a higher incidence of obesity and previous CAD in women, we were unable to explain the reasons for the poor outcome at 90 days and one year.

Abstract TP174: The Impact Of Serum Triglycerides On Stroke Severity And Prognosis. Analysis In 6558 Patients (2014-2022)

Hypothesis: Hypertriglyceridemia (HT) may increase the risk of stroke. Limited studies have shown that stroke severity and infarction size are smaller with HT. We explored the relationship between triglyceride and stroke risk factors, severity and outcome in a large prospective database.

Methods: We interrogated the Qatar Stroke Database in all patients admitted between 2014-2022 with acute ischemic stroke and evaluated the relationship between vascular risk factors, stroke severity (measured on NIHSS), stroke type (TOAST classification) and the short- (mRS at 90 days) and long-term outcomes (MACE at 1 year) in patients with and without HT.

Results: 6558 patients with ischemic stroke [mean age 54.6 ± 12. 9; male 82.1%) with normal (<1.7 mmol/L) in 4161 (63.4%) and high (≥1.7 mmol/L) in 2397 (36.6%) were analyzed. Patients with HT were younger (53.1 ±11.4 versus 55.4 ±13.6, p <0.001), and had more diabetes, obesity, and active smoking. Stroke severity was higher with normal triglycerides (NIHSS: <1.7 mmol/l - 5.5 ±5.6 vs. >1.7 mmol/l - 4.4 ±4.6; p<0.001). Lacunar stroke was more common with HT (53.4% vs. 45.7%, p<0.001). mRS of 3-6 was more common with normal triglycerides (i.e. poorer outcome) at discharge (42% vs 35.5 p<0.001) and 90-days (31.7% vs 25.5%, p<0.001). Multivariate analysis showed that age, hypertension, HT, obesity, active smoking, and diabetes were independently associated with stroke severity.

Conclusion: Onset of stroke occurs earlier in HT. The lower severity of symptoms and better prognosis evident with HT may in part be related to higher rates of lacunar stroke. Long-term MACE are however more frequently seen in HT subjects.

Profiling of phytochemicals using LC-ESI-MS2 , in vitro, in vivo characterization and cosmeceutical effects of Alpinia galanga (wild) extract loaded emulgel

BACKGROUND

The potential as a depigmenting agent, sun protection, and healthy benefits is indicated by the sun protection factor, radical scavenging, and tyrosinase inhibitory activities of Alpinia galanga (wild).

AIMS

A stable emulgel containing A .galanga (wild) extract is prepared. This emulgel is then characterized by in vitro evaluation and identification of contents by LC-ESI-MS² . In vivo performance is counted in terms of moisturizing, melanin level, erythema, sebum, skin fine pores and large pores analysis, and other related physiological skin parameters.

METHODS

DPPH radical scavenging activity, total phenolic and flavonoid counts were used to measure the free radical scavenging and tyrosinase inhibitory capability of A .galanga (wild) extract, respectively. LC-ESI-MS² used for phytochemical analysis. Emulgels synthesize, and their globule size, Ultracentrifugation, pH, and conductivity were all evaluated. Among the developed formulations, the optimal emulgels formulation underwent 90-day stability tests for organoleptic characteristics and rheology at 8°C, 25°C, 40°C, and 40°C + 75% RH (relative humidity). Using sebumeter®, mexameter®, and corneometer®, changes in skin physiological parameters were assessed over the course of 12 weeks in 13 healthy male, Asian volunteers. VisioFace® is used for computational analysis of high-resolution pictures to determine the % area, fine pore counts, and large pore counts of the skin.

RESULTS

The antioxidant, tyrosinase inhibitory potential and counts of total phenolic and flavonoids of A .galanga (wild) extract were impressive (85%, 75%, and 48.0 mg GAE/g and 14.37 mg quercetin/g, respectively). In terms of stability evaluation, globule size (0.7528 ± 0.192 μm). Optimized A .galanga (wild) ethanol aqueous (AGEA) extract loaded emulgel was stable in terms of organoleptic and in vitro evaluation. The AGEA formulation significantly reduced the amount of sebum, erythema, fine pore counts, large pore counts, fine pore % area and large pores area percentage while significantly improved the moisture and elasticity of the skin.

CONCLUSION

A stable A .galanga (wild) extract loaded emulgel was successfully produced that improved the skin physiological parameters in terms of skin's sebum, erythema, moisturizing, melanin, and pores.

1146 SLEEP DEPRIVATION INDUCES AGEING-LIKE CHANGES IN ANTIGRAVITY MUSCLES OF YOUNG ADULT MALE WISTAR RATS

Introduction

Poor muscle health is associated with a series of chronic and metabolic conditions that are prevalent in individuals who chronically experience poor-quality sleep. But there is no study deciphering the role of sleep deprivation on muscle ageing. Therefore, in the present study we have measured the ultrastructure, histopathology, and oxidative stressors in soleus muscle of wistar rat after sleep deprivation and recovery sleep.

Material and Methods

The experiments were conducted in 18 rats of three groups. Group I rats had normal sleep wake cycle, Group II rats were subjected to 24 h sleep deprivation (SD) by gentle handling method1 and Group III rats had recovery sleep after 24 h SD. At the end of the sleep, sleep deprivation and recovery period, soleus muscle tissue was collected for ultrastructural, histological and oxidative stress markers. Oxidative damage was assessed by lipid peroxidation, catalase activity, reduced glutathione and nuclear labelling of 8-OHdG. The study was conducted as per the guidelines of the Institutional Animal Ethics Committee (960/IAEC/16).

Results

The data demonstrated that SD leads to ultrastructural changes in soleus muscle which includes sarcolemmal and mitochondrial alterations. In case of histopathological and histomorphological changes there was signs of tissue degeneration, inflammatory infiltrate in type I fibres and muscle atrophy was observed in soleus muscles. There was significant increase in level of 8-OHdG (p=0.02) and malondialdehyde in 24h SD (p=0.02) than control and recovery sleep groups. Moreover, the catalase activity and reduced glutathione level was significantly decreased in 24h SD group (p≤0.02) than control and recovery sleep.

Conclusion

24hr sleep deprivation leads to an ageing like state in the skeletal muscle, which was recovered after sleep rebound.

Successful Pregnancy with SLE-associated Antiphospholipid Syndrome: A Case Report

Pregnancy in women with systemic lupus erythematosus (SLE) is associated with an increased risk of adverse maternal and fetal outcomes. Risk is significantly increased when SLE pregnancy is complicated by anti-phospholipid syndrome (APS). Here, we present a case of a 21 year-old multi-gravid lady with SLE- associated APS who was diagnosed as such when she presented with multisystem flare at her 16 weeks of gestation. At presentation she had fever, multiple joint pain in both upper and lower limbs, loss of hair, history of recurrent oral ulcer, skin rash over hand and feet. Physical examination and laboratory evaluation were consistent with an active SLE flare. A diagnosis of antiphospholipid syndrome (APS) was made based on her clinical presentation and laboratory findings. The reported patient had APS secondary to SLE. She had all the risk factors that would confer a remarkably high risk of pregnancy morbidity: positive anti-SSA(RO) antibody and lupus anticoagulant, history of one neonatal death due to congenital heart block and two consecutive first trimester pregnancy loss. Multidisciplinary management approach with appropriate intervention and close monitoring can bring a successful outcome.

Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry

AIMS

The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation.

METHODS AND RESULTS

Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin.

CONCLUSION

The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.

Increase in repulsive guidance molecule-a (RGMa) in lacunar and cortical stroke patients is related to the severity of the insult

Repulsive guidance molecule-a (RGMa) inhibits angiogenesis and increases inflammation. Animal models of cerebral ischemia have shown that an increased expression of RGMa leads to larger infarction and its inhibition attenuates effects of ischemia. We report on the relationship of RGMa to stroke types and severity. This is a prospective study in patients admitted to the stroke service in Qatar. We collected the clinical determinants, including NIHSS at admission, imaging and outcome at discharge and 90-days. RGMa levels were determined by measuring mRNA levels extracted from peripheral blood mononuclear cells (PBMCs) within 24 h of onset and at 5 days. There were 90 patients (lacunar: 64, cortical: 26) and 35 age-matched controls. RGMa mRNA levels were significantly higher in the stroke patients: day 1: 1.007 ± 0.13 versus 2.152 ± 0.19 [p < 0.001] and day-5: 3.939 ± 0.36 [p < 0.0001]) and significantly higher in patients with severe stroke (NIHSS ≥ 8) compared to milder symptoms (NIHSS < 8) at day 1 (NIHSS ≥ 8: 2.563 ± 0.36; NIHSS < 8: 1.947 ± 0.2) and day 5 (NIHSS ≥ 8: 5.25 ± 0.62; NIHSS < 8: 3.259 ± 0.419). Cortical stroke patients had marginally higher RGMa mRNA levels compared to lacunar stroke at day 1 (cortical stroke: 2.621 ± 0.46 vs lacunar stroke: 1.961 ± 0.19) and day 5 (cortical stroke: 4.295 ± 0.76 vs lacunar stroke: 3.774 ± 0.39). In conclusion, there is an increase in the level of RGMa mRNA in patients with acute stroke and seen in patients with lacunar and cortical stroke. The increase in RGMa mRNA levels is related to the severity of the stroke and increases over the initial 5 days. Further studies are required to determine the effects of the increase in RGMa on stroke recovery.

Assessment of Brassica oleraceae L. (Brassicaceae) extract loaded ethosomal gel as a versatile vesicular carrier system for dermocosmetic application: A noninvasive split-faced study

BACKGROUND

Plant extracts with rich ascorbic acid contents have greater antioxidant capability; extensively employed in skin beautifying products and protect skin from detrimental photodamaging environmental effects. Brassica oleraceae is having a substantial prospective toward cosmeceuticals owed by its profound activity against oxidation.

AIM

To develop an effective topical ethosomal gel loaded with Brassica oleraceae leaves extract with significant antioxidant activity.

METHODOLOGY

Valuation of antioxidant capability of plant leaves extract by 2,2-diphenyl-1-picrylhydrazyl (DPPH), and quantification of ascorbic acid was done through high performance liquid chromatography (HPLC). Ethosomes were prepared by cold method. Optimized suspension containing extract was incorporated in 2% Carbopol gel (test) along with extract solution (control). Noninvasive in vivo studies were performed for final product to assess its effects on skin by measuring melanin and erythema, sebum level, elasticity, moistness level, facial pores count and their area, skin wrinkling, and smoothness.

RESULTS

Brassica oleraceae (red cabbage) leaves extract exhibited significant antioxidant potential (85.64 ± 1.28%) with 14.22 μg/g of ascorbic acid; expressed prominent cosmetic effects in terms of skin melanin, erythema, sebum, elasticity, hydration, facial pores, wrinkles, and smoothness when incorporated in ethosomes. ANOVA test also exhibited positive significant (p ≤ 0.05) effects on skin.

CONCLUSION

Brassica oleraceae extract is a strong antioxidant with remarkable dermocosmetic benefits for skin.

Formulation and characterization of Anacyclus Pyrethrum Emulgels and its in vitro and in vivo evaluation as cosmeceutical product

BACKGROUND

Plants containing high phenolic and flavonoids contents used widely as antioxidant agent by reducing skin photo damaging effects and play important role in skin rejuvenating.

AIMS

This study was performed to explore the cosmetic effects of Anacyclus Pyrethrum extract and to develop stable oil in water (O/W) emulsion base gel loaded with Anacyclus Pyrethrum 10% extract.

OBJECTIVE

To explore and quantify phenols and flavonoids present in Anacyclus Pyrethrum extract and determine its cosmetic effects on human skin.

METHOD

Emulgel formulation were developed by mixing o/w emulsion with carbopol gelling agent loaded with Anacyclus Pyrethrum (AP) extract and base gel without AP extract. In vitro study was done for the evaluation of color change, liquefaction, hardness, and pH change at different storage condition for the duration of 12 weeks. For in vivo study, emulgel applied on 13 healthy human volunteer's cheeks to evaluate its cosmetics effects and compared with placebo (base). Facial parameters including skin melanin, redness, sebum, moisture content, and skin elasticity were determined by using mexameter, sebumeter, corneometer, elastometer for the study duration of 12 weeks.

RESULTS

Total phenolic content in Anacyclus Pyrethrum extract was 80.04 ± 0.0043 mg GAE/g, and flavonoids were 54.64 ± 0.0076 mg QE/g. Anacyclus Pyrethrum extract found significantly effective in reducing skin photo-damage effects (p ≤ 0.05) as compared base gel.

CONCLUSION

Anacyclus Pyrethrum extract being rich source of flavonoid and phenolic content, acts as strong antioxidant to protect skin against photo-damaging effect and improve skin conditions.

Whitening effect of kojic acid dipalmitate loaded nanosized ethosomal gel for the treatment of hyperpigmentation: In vitro and in vivo characterization

BACKGROUND

In recent years, the demands of depigmenting agents in cosmetics have been increased to treat skin conditions such as hyperpigmentation and melasma. Tyrosinase is a major enzyme involve in hyperpigmentation. Kojic acid dipalimate (KAD) is an ester derivative of kojic acid and exhibit excellent tyrosinase inhibiting activity on human skin.

OBJECTIVE

To develop and characterize a novel topical delivery system for KAD by using ethosomes and their in vitro, in vivo characterization for the treatment of hyperpigmentation.

METHODS

Different KAD loaded ethosomal suspensions were prepared using soy phosphatidylcholine, ethanol, propylene glycol, and water with cold method. These formulations were evaluated for size, zeta potential, Polydispersity index, entrapment efficiency, FTIR spectroscopy, and scanning electron microscopy (SEM). Afterward, the stability of optimized gel was checked and the in vivo studies were carried out in order to evaluate the skin benefits.

RESULTS

The optimized formulation has zeta potential, size, and entrapment efficiency of -23.4 mV, 148 nm, and 90.0008%, respectively. SEM results showed vesicles were spherical in shape. Ethosomal gel had a good stability at lower temperature (8, 25°C). In addition, ethosomal gel gives significant decrease in skin melanin, erythema, and sebum level while it causes improvement in skin hydration level and elasticity during non-invasive in vivo studies.

CONCLUSION

The overall findings indicated that the prepared KAD loaded ethosomal formulation was stable and provides deep penetration of KAD into the skin. It offers a promising therapeutic approach for use in skin hyperpigmentation as it has skin whitening and moisturizing effects.

Computational Investigation of 1, 3, 4 Oxadiazole Derivatives as Lead Inhibitors of VEGFR 2 in Comparison with EGFR: Density Functional Theory, Molecular Docking and Molecular Dynamics Simulation Studies

Vascular endothelial growth factor (VEGF) is an angiogenic factor involved in tumor growth and metastasis. Gremlin has been proposed as a novel therapeutic pathway for the treatment of renal inflammatory diseases, acting via VEGFR 2 receptor. To date, most FDA-approved tyrosine kinase (TK) inhibitors have been reported as dual inhibitors of EGFR and VEGFR 2. The aim of the present study was to find the potent and selective inhibitor of VEGFR 2 specifically for the treatment of renal cancer. Fourteen previously identified anti-inflammatory compounds i.e., 1, 3, 4 oxadiazoles derivatives by our own group were selected for their anti-cancer potential, targeting the tyrosine kinase (TK) domain of VEGFR2 and EGFR. A detailed virtual screening-based study was designed viz density functional theory (DFT) study to find the compounds' stability and reactivity, molecular docking for estimating binding affinity, SeeSAR analysis and molecular dynamic simulations to confirm protein ligand complex stability and ADMET properties to find the pharmacokinetic profile of all compounds. The DFT results suggested that among all the derivatives, the 7g, 7j, and 7l were chemically reactive and stable derivatives. The optimized structures obtained from the DFTs were further selected for molecular docking, and the results suggested that 7g, 7j and 7l derivatives as the best inhibitors of VEGFR 2 with binding energy values -46.32, -48.89 and -45.01 kJ/mol. The Estimated inhibition constant (IC50) of hit compound 7j (0.009 µM) and simulation studies of its complexes confirms its high potency and best inhibitor of VEGFR2. All the derivatives were also docked with EGFR, where they showed weak binding energies and poor interactions, important compound 7g, 7j and 7i exhibited binding energy of -31.01, -33.23 and -34.19 kJ/mol respectively. Furthermore, the anticancer potential of the derivatives was confirmed by cell viability (MTT) assay using breast cancer and cervical cancer cell lines. At the end, the results of ADMET studies confirmed these derivatives as drug like candidates. Conclusively, the current study suggested substituted oxadiazoles as the potential anticancer compounds which exhibited more selectivity towards VEGFR2 in comparison to EGFR. Therefore, the identified lead molecules can be used for the synthesis of more potent derivatives of VEGFR2, along with extensive in vitro and in vivo experiments, that can be used to treat various cancers, especially renal cancers, and to prevent angiogenesis due to aberrant expression of VEGFR2.

Identification of distinct circulating microRNAs in acute ischemic stroke patients with type 2 diabetes mellitus

Stroke is the second leading cause of global mortality and continued efforts aim to identify predictive, diagnostic, or prognostic biomarkers to reduce the disease burden. Circulating microRNAs (miRNAs) have emerged as potential biomarkers in stroke. We performed comprehensive circulating miRNA profiling of ischemic stroke patients with or without type 2 diabetes mellitus (T2DM), an important risk factor associated with worse clinical outcomes in stroke. Serum samples were collected within 24 h of acute stroke diagnosis and circulating miRNAs profiled using RNA-Seq were compared between stroke patients with T2DM (SWDM; n = 92) and those without T2DM (SWoDM; n = 98). Our analysis workflow involved random allocation of study cohorts into discovery (n = 96) and validation (n = 94) datasets. Five miRNAs were found to be differentially regulated in SWDM compared to SWoDM patients. Hsa-miR-361-3p and -664a-5p were downregulated, whereas miR-423-3p, -140-5p, and -17-3p were upregulated. We also explored the gene targets of these miRNAs and investigated the downstream pathways associated with them to decipher the potential pathways impacted in stroke with diabetes as comorbidity. Overall, our novel findings provide important insights into the differentially regulated miRNAs, their associated pathways and potential utilization for clinical benefits in ischemic stroke patients with diabetes.

Attack to Fool and Explain Deep Networks

Deep visual models are susceptible to adversarial perturbations to inputs. Although these signals are carefully crafted, they still appear noise-like patterns to humans. This observation has led to the argument that deep visual representation is misaligned with human perception. We counter-argue by providing evidence of human-meaningful patterns in adversarial perturbations. We first propose an attack that fools a network to confuse a whole category of objects (source class) with a target label. Our attack also limits the unintended fooling by samples from non-sources classes, thereby circumscribing human-defined semantic notions for network fooling. We show that the proposed attack not only leads to the emergence of regular geometric patterns in the perturbations, but also reveals insightful information about the decision boundaries of deep models. Exploring this phenomenon further, we alter the 'adversarial' objective of our attack to use it as a tool to 'explain' deep visual representation. We show that by careful channeling and projection of the perturbations computed by our method, we can visualize a model's understanding of human-defined semantic notions. Finally, we exploit the explanability properties of our perturbations to perform image generation, inpainting and interactive image manipulation by attacking adversarialy robust 'classifiers'. In all, our major contribution is a novel pragmatic adversarial attack that is subsequently transformed into a tool to interpret the visual models. The article also makes secondary contributions in terms of establishing the utility of our attack beyond the adversarial objective with multiple interesting applications.

The impact of enteric coating of aspirin on aspirin responsiveness in patients with suspected or newly diagnosed ischemic stroke: prospective cohort study: results from the (ECASIS) study

Background and purpose

Uncertainty remains regarding the impact of enteric-coated aspirin (EC-ASA) on secondary prevention of ischemic stroke compared to plain aspirin (P-ASA). Hence, this study was designed to investigate the effect of EC formulation on ASA response via evaluating thromboxane B2 (TXB2) levels in patients with suspected or newly diagnosed stroke.

Methods

A prospective cohort study on suspected or newly diagnosed ischemic stroke patients who are aspirin-naive was conducted. Patients were received either EC aspirin or plain aspirin for at least 3 days. The primary outcome was the proportion of aspirin non-responsiveness between two groups (level of residual serum TXB2 associated with elevated thrombotic risk (< 99.0% inhibition or TXB2 > 3.1 ng/ml) within 72 h after three daily aspirin doses, while secondary outcomes were the incidence of early gastrointestinal tract (GIT) bleeding with the various aspirin preparations. (Trial registration: Clinicaltrials.gov NCT04330872 registered on 02 April 2020).

Results

Of 42 patients, ischemic strokes were confirmed in both P-ASA (81%) and EC-ASA (67%) arms. ASA non-responsiveness showed no significant difference between the two formulations (P-ASA vs. EC-ASA; 28.6% vs 23.8%; P = 0.726). Univariate and multivariate logistic regression analysis showed that patients treated with EC-ASA were more likely to have a lower rate of non-responders compared to P-ASA (unadjusted OR 0.78; 95% CI 0.20, 3.11); with the risk highest in type 2 diabetic patients with HBA1c > 6.5% (adjusted OR 6; 95% CI 1.02, 35.27; P = 0.047). No incidence of GIT bleeding observed throughout the study.

Conclusion

A significant proportion of ASA non-responsiveness was recorded regardless of ASA formulation administered. The increased risk of ASA non-responsiveness in diabetic patients needs further exploration by larger prospective studies.

Evaluation of Pyrus communis and Cydonia oblonga fruit extract loaded emulgel on skin pliancy by using Cutometer

Current study was designed to determine the skin elasticity potential of tested emulgel formulations. One emulgel containing Pyrus communis fruit extract and the other had Cydonia oblonga fruit extract. For this purpose 26 female subjects were selected and divided into two batches. Each batch has 13 volunteers, who used tested formulations and their base for 90 days. Skin elasticity were observed by using Cutometer MPA 580. From Cutometer skin mechanical parameters were calculated. From the results it was noted that emulgel formulations containing extracts of Pyrus Communis and Cydonia oblonga showed marked effect on the facial skin mechanical properties during 90 days study period. Statistically observed skin mechanical parameters of tested formulations had significant difference from base. After distention from Cutometer both formulations enhance the retraction ability of the skin as compared to base. Moreover it was also noted that Cydonia oblonga had more pronounced results than Pyrus communis loaded emulgel. From the results it has been interpreted that although both formulations has good potential to hydrate the skin resulting in intensification of its elasticity. As both fruits are rich source of phytonutrients like Vitamin C, Sugar, organic acids which might be the reason of their enhancement potential of skin pliancy.

Sodium alginate/N-(Vinylcaprolactam) based supramolecular self-assembled subcutaneously administered in situ formed gels depot of 5-fluorouracil: Rheological analysis, in vitro cytotoxic potential, in vivo bioavailability and safety evaluation

In current study, novel in situ formed injectable self-assembled thermoreversible depot gels based on N-(Vinylcaprolactam) were synthesized with a carbohydrate polymer i.e. sodium alginate in aqueous solution using cold method. The prepared gels preparations were intended to be utilized as 5-FU delivery depot after injectable administration through subcutaneous route. The structural characterization of self-assembled gels samples were studied through FTIR. The thermal properties of newly formed gels complexes were investigated by DSC and TGA. While the morphology of gels were assessed through SEM. The tunable gelation temperatures and phase transition of optimized formulations were confirmed by tube inverting, rheology determination and optical transmittance test. Thermo and pH response was evaluated at different temperatures and in various acidic and basic buffer solutions. In vitro release experiments were conducted using Franz diffusion system to monitor the controlled delivery fashion of gels matrices. Results concluded that depot gels exhibit controlled delivery fashion with maximum release at pH 7.4 and 37 ± 2 °C. The biocompatible nature of blank gels samples was assessed by MTT assay against Vero cell lines and was found safe. While killing ability of 5-FU encapsulated gels was evaluated against HeLa (19 ± 0.22 μg/ml; 23 ± 0.55 μg/ml) and MCF-7 (21 ± 0.06 μg/ml and 22 ± 0.34 μg/ml) cancer cell lines and were found effective to kill cancer cells. Histopathological study showed that gels depot is safe with no harmful effects on major organs. The in vivo bioavailability in rabbits showed controlled release (C_max, 4465.78 ± 1.99 ng/ml) in comparison to free drug (C_max, 4883.73 ± 3.32 ng/ml) administration after subcutaneous injection.

Ischemic stroke in patients that recover from COVID-19: Comparisons to historical stroke prior to COVID-19 or stroke in patients with active COVID-19 infection

Background and purpose

Understanding the relationship of COVID-19 to stroke is important. We compare characteristics of pre-pandemic historical stroke (Pre-C), cases in acute COVID infection (Active-C) and in patients who have recovered from COVID-19 infection (Post-C).

Methods

We interrogated the Qatar stroke database for all stroke admissions between Jan 2019 and Feb 2020 (Pre-C) to Active-C (Feb2020-Feb2021) and Post-C to determine how COVID-19 affected ischemic stroke sub-types, clinical course, and outcomes prior to, during and post-pandemic peak. We used the modified Rankin Scale (mRS) to measure outcome at 90-days (mRS 0–2 good recovery and mRS 3–6 as poor recovery). For the current analysis, we compared the clinical features and prognosis in patients with confirmed acute ischemic stroke.

Results

There were 1413 cases admitted (pre-pandemic: 1324, stroke in COVID-19: 46 and recovered COVID-19 stroke: 43). Patients with Active-C were significantly younger, had more severe symptoms, fever on presentation, more ICU admissions and poor stroke recovery at discharge when compared to Pre-C and Post-C. Large vessel disease and cardioembolic disease was significantly more frequent in Active-C compared to PRE-C or post-C.

Conclusions

Stroke in Post-C has characteristics similar to Pre-C with no evidence of lasting effects of the virus on the short-term. However, Active-C is a more serious disease and tends to be more severe and have a poor prognosis.

Acute ischemic stroke and convexity subarachnoid hemorrhage in large vessel atherosclerotic stenosis: Case series and review of the literature

Atraumatic convexity subarachnoid hemorrhage (cSAH) is a rare non‐aneurysmal SAH, commonly due to ipsilateral internal carotid artery (ICA) stenosis. It is unusual for the cSAH to occur contralaterally to the infarct. We report two cases of acute ischemic stroke associated with contralateral and ipsilateral cSAH that had different presentations.

Comparative Study of Chinese and American Media Reports on the COVID-19 and Expressions of Social Responsibility: A Critical Discourse Analysis

Critical discourse analysis aims to explore the dialectical relationship between discourse and ideology. Based on psycholinguistic research, this paper analyzes the Chinese and American media's news reports and comments on the COVID-19. It aims to expose the hidden psychological messages and ideologies behind the words. The corpus in this paper is mainly from the official media of China Daily and Time from December 2019 to January 2021 in China and the United States. This paper uses Wang Zhenhua's Appraisal Theory and Halliday's Systemic Functional Grammar as tools to make a comparative analysis of the corpus. At the textual level, languages are classified and lexical choices are analyzed followed by the analysis of the reporter's ideology after reviewing the motivation of the reporters of two countries. On the level of social responsibility expression and discourse, the paper analyzes the news reports, which are characterized by the combination of the reporter's views on the news. In the aspect of social practice, the social and cultural factors and background of news reports are analyzed. China calls for strengthening cooperation and exchanges with other countries to jointly fight the epidemic. The Chinese government has actively shared its experience and made corresponding contributions to international economic recovery. However, the US government shirks its responsibility by claiming that the effective implementation of Chinese methods and experience in China does not mean that it can achieve corresponding results in Europe and the US. At the same time, the United States provides medical supplies to other countries. This study hopes to help awaken readers' critical thinking and increase their awareness of the anti-control of mass discourse. At the same time, it is hoped that readers can view the epidemic from a more scientific perspective, understand the facts and reject the unwarranted panic. It will also help reshape Chinese and American discourse.