Laboratory Investigations Research Articles

Gender-driven thyroid dysfunction in systemic lupus erythematosus patients: Clinical significance of an overlooked association and global stance

Aim of the workThis study aimed to determine the association of thyroid dysfunction in systemic lupus erythematosus (SLE) patients Patients and methodsOut of a cohort including 312 adult SLE patients those with thyroid dysfunction (n = 53) were further evaluated. The medical history, clinical examination, laboratory investigations and medications received were recorded. The SLICC damage index (SLICC-DI) was assessed. ResultsThyroid dysfunction formed 17 % of the patients and their mean age was 39.5 ± 11.5 years and disease duration 5.6 ± 3.3 years were comparable to those without thyroid disorder, however female gender was predominantly higher (F:M 52:1 vs 6.2:1, p < 0.0001). The frequency of thyroid dysfunction was alike in Saudi (16 %) and non-Saudi (17.9 %) patients (p = 0.66). The majority of cases (96.2 %) had hypothyroidism, one with autoimmune thyroiditis, while only 2 (3.8 %) had hyperthyroidism. There was a significantly increased frequency of associated neuropsychiatric manifestations (64.2 % vs 45.2 %;p = 0.012), and hematological involvement (32.1 % vs 14.3 %; p = 0.011) and less complement (C4) consumption (15.1 % vs 23.6 %; p = 0.048) in those with thyroid dysfunction compared to those without. The frequency of anti-double stranded deoxyribonucleic acid (anti-dsDNA) positivity tended to be higher (71.7 % vs 66.8 %) and its titre significantly lower (316.3 ± 319.8 IU/ml vs 461.3 ± 459.1; p = 0.013). The SLICC-DI and mortality rate were comparable between groups. Only the presence of proteinuria inversely significantly correlated with the level of T4 (r = -0.31, p = 0.007). ConclusionThyroid dysfunction forms a notable percentage of SLE patients with a prominent female gender propensity. The significant relation of thyroid disorders to neuropsychiatric manifestations, hematological involvement, C4 consumption and anti-dsDNA deserves recognition.

Laboratory investigation on inhibition of polyvinyl alcohol used for wireline coring drilling

AbstractTo address the problems of wall collapse, cuttings slurrying, and scaling on the inner wall of the drill pipe, which often occur in small-diameter diamond wireline core drilling, the inhibition properties of polyvinyl alcohol (PVA) was investigated, and the formulation of solids-free drilling fluid with PVA as the inhibitor were completed. PVA has the advantages of fast adsorption and easy regulation of rheological properties Firstly the inhibition effect of PVA was compared with that of common inorganic salts (sodium chloride, NaCl, potassium chloride, KCl) by bentonite dispersion test, linear swelling test, shale rolling recovery test and mud ball immersion test in this study. Then, the inhibition mechanism of PVA was analyzed with potentiometric particle size tests, Fourier transform infrared (FT-IR) and X-ray Diffraction (XRD) measurements. Based on the outstanding inhibition performance of PVA, tackifiers and filtration reducers were preferred through the compatibility test. And finally, the effects of various contaminants on the comprehensive performance of the formulated solids-free drilling fluids were evaluated. The results showed that PVA exhibited better inhibition of clay hydration and dispersion in shale recovery and linear swelling compared to NaCl and KCl, which was particularly evident in the mud ball immersion test. FT-IR and XRD tests revealed that the inorganic salts were used to replace the cations with larger radius and high degree of hydration in the clay layer by ion exchange ti achieve the effect of clay de-watering by reducing the spacing of the clay interlayer and the electrostatic repulsion between the particles. However, PVA is strongly adsorbed on the clay surface in the form of hydrogen bonds due to its unique multi-hydroxyl chain structure, forming a hydrophobic barrier to prevent water molecules from entering the clay layer, thus inhibiting the hydration and swelling of the clay. Using PVA as an inhibitor, compounded with xanthan gum, sulfonated lignite resin and sulfonated gilsonite (FT-1), the solids-free drilling fluid is promising for use in diamond wireline core drilling in complex formations.

Insights into Nephrotic Syndrome in Pediarics: Case Series Analysis

Nephrotic syndrome (NS) is one of the most common childhood kidney diseases. NS can affect children of any age from infancy to adolescence and predominantly occurs in the age group of 1–6 years. It is an illness caused by idiopathic diseases like minimal change nephrotic syndrome (MCNS) and focal segmental glomerulosclerosis (FSGS), membrane proliferative Glomerulonephritis, membranous Glomerulonephritis and is characterized by increased permeability across the glomerular filtration barrier. NS is classified as primary, secondary, and congenital. It consists of four clinical features like severe proteinuria, edema, hyperlipidaemia, hypoalbuminemia. The main cause of nephrotic syndrome are diseases associated with drugs and rarely genetic disorders. The pathogenesis of the disease affects various biological functions linked to loss of proteins negatively, which results in systemic complications which may be disease and drug-associated complications. Using drugs to treat NS leads to several complications which include improper growth, metabolism, behavior change inpatient. Itis a chronic relapsing disease for most of the steroid response drugs for treatment of nephrotic syndrome. Glucocorticoids, immunosuppressants and biological agents are used for the treatment of the diseases. In this case series, we presented a case series of nephrotic syndrome in pediatrics. Total 4 patients were taken into considerations. The patients came with a chief complaints of swelling of face, foamy urine, abdominal pain, dark coloured urine with decreased urine output, joint pains. The laboratory investigations for all the 4 patients showed that there were decrease in albumin levels (hypoalbuminemia), decrease in serum creatinine levels and protein in urine, although kidney biopsy couldn’t be perform but the diagnosis was made based on clinical and laboratory findings. The patients were mainly treated with prednisolone, pantoprazole, enalapril, nifedipine, amoxiclav, and even albumin transfusion were done. NS was successfully managed and fortunately the patients recovered.

Unravelling the clinical heterogeneity of undefined recurrent fever over time in the European registries on Autoinflammation

BackgroundSystemic autoinflammatory disorders (SAIDs) represent a growing spectrum of diseases characterized by dysregulation of the innate immune system. The most common pediatric autoinflammatory fever syndrome, Periodic Fever, Aphthous Stomatitis, Pharyngitis, Adenitis (PFAPA), has well defined clinical diagnostic criteria, but there is a subset of patients who do not meet these criteria and are classified as undefined autoinflammatory diseases (uAID). This project, endorsed by PRES, supported by the EMERGE fellowship program, aimed to analyze the evolution of symptoms in recurrent fevers without molecular diagnosis in the context of undifferentiated AIDs, focusing on PFAPA and syndrome of undifferentiated recurrent fever (SURF), using data from European AID registries.MethodsData of patients with PFAPA, SURF and uSAID were collected from 3 registries including detailed epidemiological, demographic and clinical data, results of the genetic testing and additional laboratory investigations with retrospective application of the modified Marshall and PRINTO/Eurofever classification criteria on the cohort of PFAPA patients and preliminary SURF criteria on uSAID/SURF patients.ResultsClinical presentation of PFAPA is variable and some patients did not fit the conventional PFAPA criteria and exhibit different symptoms. Some patients did not meet the criteria for either PFAPA or SURF, highlighting the heterogeneity within these groups. The study also explored potential overlaps between PFAPA and SURF/uAID, revealing that some patients exhibited symptoms characteristic of both conditions, emphasizing the need for more precise classification criteria.ConclusionsPatients with recurrent fevers without molecular diagnoses represent a clinically heterogeneous group. Improved classification criteria are needed for both PFAPA and SURF/uAID to accurately identify and manage these patients, ultimately improving clinical outcomes.

Identification and Functional Analysis of a de novo IKZF3 Mutation in a Pediatric Patient with Combined Immunodeficiency.

AIOLOS, a vital member of the IKAROS protein family, plays a significant role in lymphocyte development and function through DNA binding and protein-protein interactions. Mutations in the IKZF3 gene, which encodes AIOLOS, lead to a rare combined immunodeficiency often linked with infections and malignancy. In this study, we evaluated a 1-year-4-month-old female patient presenting with recurrent infections, diarrhea, and failure to thrive. Laboratory investigations revealed decreased T lymphocyte and immunoglobulin levels. Through whole-exome and Sanger sequencing, we discovered a de novo mutation in IKZF3 (NM_012481; exon 5 c.571G > C, p.Gly191Arg), corresponding to the third DNA-binding zinc finger region of the encoded protein AIOLOS. Notably, the patient with the AIOLOS G191R mutation showed reduced recent thymic emigrants in naïve CD4+T cells compared to healthy counterparts of the same age, while maintaining normal levels of Th1, Th2, Th17, Treg, and Tfh cells. This mutation also resulted in decreased switched memory B cells and lower CD23 and IgM expression. In vitro studies revealed that AIOLOS G191R does not impact the expression of AIOLOS but compromises its stability, DNA binding and pericentromeric targeting. Furthermore, AIOLOS G191R demonstrated a dominant-negative effect over the wild-type protein. This case represents the first reported instance of a mutation in the third DNA-binding zinc finger region of AIOLOS highlighting its pivotal role in immune cell functionality.

A CASE REPORT OF AN ASYMPTOMATIC PATIENT WITH TYPE 2 WELLENS’ SYNDROME AND RENAL CARCINOMA

Abstract A 65–year–old male with renal cell carcinoma, previously treated with nephrectomy and recently diagnosed with lung metastases, presented to the cardiology clinic for investigations before starting chemotherapy. He reported a history of ischemic heart disease, a non–ST–elevation myocardial infarction for which he refused coronary angiography in 2005, and a negative maximal stress test for ischemia in 2017. Additionally, the patient reported insulin–dependent type 2 diabetes mellitus and well–controlled arterial hypertension. The patient was referred for a cardiological evaluation due to a reported short–term rhythmic heartbeat without other cardiological symptoms. Cardiological parameters were stable (blood pressure: 140/95 mmHg; heart rate: 42 bpm, and oxygen saturation without oxygen supplementation: 98%). Physical examination was normal. Laboratory investigations did not show elevated levels of high–sensitivity troponin I, and only signs of mild chronic kidney disease were observed. The initial ECG showed sinus bradycardia with deeply inverted T–waves in the extended anterior area (Fig. 1), which were not present in an ECG performed one month earlier. There was no reported chest pain. An echocardiogram examination demonstrated hypertensive heart disease with marked hypokinesia of the mid–apical portion of the anterior wall and anterior interventricular septum, together with a moderate reduction in global systolic function (LV ejection fraction: 40%). The patient was hospitalized, and underwent coronary angiography the following day. He had a low–risk score (GRACE: 95 pts) As shown in Fig. 2, there was evidence of long sub–occlusive stenosis of the proximal part of the anterior descending coronary artery that was treated with angioplasty and a single drug–eluted stent placement, resulting in a good angiographic result. After the procedure, there was a rapid recovery of regional kinetics but a slower normalization of the electrocardiographic morphology (Fig. 3). Comment Wellens‘ syndrome identifies a particular subtype of unstable angina characterized by the appearance of ischemic changes on the ECG,. The clinical risk assessment of this subgroup of patients with ACS, apparently having a more benign prognosis due to their definition as unstable angina with a low GRACE risk score, potentially has an evolution toward a large myocardial infarction if not promptly diagnosed.

The role of color doppler in high risk pregnancies: A prospective comparative study

Pregnancy can be considered as the most beautiful period of a woman’s life. The recent medical advances are helpful in taking very good care of the female throughout her pregnancy. The pregnancy is constantly observed by clinical examination, laboratory investigations, and radiographic examinations at specific intervals throughout its course.To study the role of doppler ultrasound in high-risk pregnancies.This is a prospective comparative study was conducted in department of Obstetrics and Gynaecology at Government medical college, Nagpur. The study period was 12 months. 232 patients were included in this study.In our study, 2 patients had Chronic hypertension, 2 patients had GDM, 1 patient had Gestational hypertension, 3 patients had Anaemia, 6 patients had Heart Disease, 5 patients had HIV positive,15 patients had Hypothyroidism, 2 patients had Increased BP, 1 patient had Overt DM,6 patients had Pre-eclampsia,1 patient had previous abortion, 4 patients had Rh negative, 5 patients had Sickle Cell Disease(SS) and 15 patients had Sickle Cell trait(AS). Distribution of normal doppler changes in cases according to high risk factor was statistically significant (p&amp;#60;0.0001).In our study, NICU Admission with doppler changes was statistically significant and Association of Baby weight in cases according to doppler changes in uterine artery and Baby weight in cases according to doppler changes in umbilical artery was not statistically significant.

Analysis of the immunological response to antiviral therapy in patients with different subtypes of HIV/AIDS: a retrospective cohort study

ObjectiveTo evaluate the effectiveness of standardised antiretroviral therapy (ART) among different HIV subtypes in people living with HIV/AIDS (PLWHA), and to screen the best ART regimen for this patient population.DesignA...

Acute pancreatitis as a manifestation of multisystem inflammatory syndrome among children (MIS-C): A rare case

A multisystem inflammatory syndrome among children (MIS-C) has been linked to COVID-19, and it affects multiple organ systems in the body, including the gastrointestinal system. In present case report, a 14-year-old girl presented with clinico-laboratory and imaging evidence of acute pancreatitis but did not respond to the standard line of management for pancreatitis. Later, the laboratory investigations pointed to the diagnosis of MIS-C. She responded well to a pulse doses of methylprednisolone therapy. Acute pancreatitis as a lone manifestation of MIS-C poses a diagnostic challenge for paediatricians, and one should suspect MIS-C in acute non-responding pancreatitis.

Effect of weight loss program using prebiotics and probiotics on body composition, physique, and metabolic products: longitudinal intervention study

The relationship between gut microbiota and obesity has recently been an important subject for research as the gut microbiota is thought to affect body homeostasis including body weight and composition, intervening with pro and prebiotics is an intelligent possible way for obesity management. To evaluate the effect of hypo caloric adequate fiber regimen with probiotic supplementation and physical exercise, whether it will have a good impact on health, body composition, and physique among obese Egyptian women or has no significant effect. The enrolled 58 women, in this longitudinal follow-up intervention study; followed a weight loss eating regimen (prebiotic), including a low-carbohydrate adequate-fiber adequate-protein dietary pattern with decreased energy intake. They additionally received daily probiotic supplements in the form of yogurt and were instructed to exercise regularly for 3 months. Anthropometric measurements, body composition, laboratory investigations, and microbiota analysis were obtained before and after the 3 months weight loss program. Statistically highly significant differences in the anthropometry, body composition parameters: and obesity-related biomarkers (Leptin, ALT, and AST) between the pre and post-follow-up measurements at the end of the study as they were all decreased. The prebiotic and probiotic supplementation induced statistically highly significant alterations in the composition of the gut microbiota with increased relative abundance of Lactobacillus, Bifidobacteria, and Bacteroidetes and decreased relative abundance of Firmicutes and Firmicutes/Bacteroidetes Ratio. Hypo caloric adequate fiber regimen diet with probiotics positively impacts body composition and is effective for weight loss normalizing serum Leptin and AST.

Improving stormwater infiltration and retention in compacted urban soils at impervious/pervious surface disconnections with biochar

Urban development often results in compacted soils, impairing soil structure and reducing the infiltration and retention of stormwater runoff from impervious features. Biochar is a promising organic soil amendment to improve infiltration and retention of stormwater runoff. Soil at the disconnection between impervious and pervious surfaces represents a critical biochar application point for stormwater management from urban impervious features. This study tested the hypothesis that biochar would significantly improve water retention and transmission at four sites, where varying percentages (0%, 2%, and 4% w/w) of biochar were amended to soils between impervious pavement, and pervious grassed slopes. Field-saturated hydraulic conductivity (Ksat) and easily drainable water storage capacity were monitored at these sites for five months (two sites) and 15 months (two sites). At the end of the monitoring periods, the physical, chemical, and biological properties of each site's soil were assessed to understand the impact of biochar on soil aggregation, which is critical for improved soil structure and water infiltration. Results indicated that the field Ksat, drainable water storage capacity, and plant available water content (AWC) were 7.1 ± 3.6 SE, 2.0 ± 0.3 SE, and 2.1 ± 0.3 SE times higher in soils amended with 4% biochar, respectively, compared to the undisturbed soil. Factor analysis elucidated that biochar amendment increased the organic matter content, aggregate mean weight diameter, organo-mineral content, and fungal hyphal length while decreasing the bulk density. Across the 12 biochar/soil combinations, the multiple linear regression models derived from factor analysis described the changes in Ksat and AWC reasonably well with R2 values of 0.51 and 0.71, respectively. Using soil and biochar properties measured before biochar addition, two recent models, developed from laboratory investigations, were found helpful as screening tools to predict biochar's effect on Ksat and AWC at the four field sites. Overall, the findings illustrate that biochar amendment to compacted urban soils can significantly improve soil structure and hydraulic function at impervious/pervious surface disconnections, and screening models help to predict biochar's effectiveness in this context.

Acute Kidney Injury in Chronic Liver Disease in Northwest India: Still a Battle to Conquer

Acute Kidney Injury in Chronic Liver Disease in Northwest India: Still a Battle to Conquer

Clinical Profile and In-hospital Outcome of Acute Household Substances Poisoning in a Tertiary Care Hospital

Background: Poisoning is an acute medical emergency. Among the thousands of harmless products available for household, very few are hazardous. Still, self-poisoning with these substances is one of the commonest mode of poisoning. This study was carried out to get information related to clinical profile and inhospital outcome of household substances poisoning in a particular area of Bangladesh. Methods: This cross-sectional type of descriptive study was carried out in the department of Medicine, Sylhet M.A.G. Osmani Medical College Hospital, Sylhet, Bangladesh during the period of June 2022 to November 2022.Purposive convenient sampling was applied to recruit sample from study population. Calculated sample size was 64. Detailed history including nature of poisoning (unintentional/ intentional), route of poisoning, type of poison, symptoms and signs with relevant laboratory findings were documented in a structured data collection sheet through interview from the patient or their guardians after obtaining informed written consent. In-hospital outcome in terms of survival (discharged, discharge without advice/absconded) and mortality were recorded.Results:Among 64 participants majority 65.63% (n=42) were female and most 56.25% (n=36) were of 18-20 years age group.Regarding educational status 96.87 %(n=62) participants were educated. All of the poisoning were intentional and by oral route. Harpic was the most common agents 59.38% (n=38) used by the victims.Vomiting was the most common 81.25% (n=52) symptomand oral ulcer was the commonest 40.63% (n=26) sign. No significant abnormality of vital signs and laboratory investigations were found. Majority of the respondents 43.75 % (n=28) stayed 2 days in hospital for treatment purpose. Total 85.94% (n=55) respondents were discharged with advice and 14.06% (n=9) respondents left hospital without medical advice. No death was documented in this study. Conclusion: Young teenaged female patients were the majority of victims in our study reflecting the degree of powerlessness and hopelessness of young, educated people with unemployment and difficulties in coping with life stressors. Bangladesh J Medicine 2024; 35: 70-75

Autoimmune myelofibrosis revealing a systemic lupus erythematosus

Background: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease, characterised by multi-organ affections. Haematological involvement is a common manifestation of SLE, consisting of autoimmune peripheral cytopenia. Autoimmune myelofibrosis (AIMF) is a rare cause of cytopenia in SLE; it could precede or be concurrent with the diagnosis of SLE. There are few studies that describe this association. Case description: We report a case of AIMF revealing the diagnosis of SLE in a 34-year-old female, presented with episodes of gingival bleeding associated with peripheral inflammatory polyarthralgia, photosensitivity and deterioration of general condition. Clinical examination revealed a soft pitting oedema in the lower limbs. Laboratory investigations showed a pancytopenia, inflammatory biological syndrome, with positive 24-hour proteinuria and anti-native DNA antibodies. A bone marrow biopsy showed diffuse myelofibrosis associated with maturation disorders and no tumour infiltrate. Renal biopsy revealed proliferative glomerulonephritis class III with immune deposits. Conclusion: The association of AIMF with SLE has been rarely reported, and it could be another cause for cytopenia in SLE.

Laboratory investigation and prediction of permeability of fresh to five-year-old municipal solid wastes of low and high food contents

The permeability of municipal solid wastes (MSWs) is important for the design and operation of landfills. This study presented the experimental investigation of the permeability of low food content- (LF-) and high food content- (HF-) MSWs prepared in laboratory-scale bioreactors for up to 5 years. The permeability of MSWs with diverse degrees of decomposition (DOBs), void ratios, and permeation liquids was measured (288 tests). The measured permeability was compared to that predicted from the (modified) Kozeny-Carman (K-C) equations in four different forms. The results indicated that the permeability of both LF- and HF-MSWs decreased significantly (p < 0.05) with decomposition under a given void ratio. The predicted permeability using the original K-C equation fitted well with that of fresh MSWs. The permeability of decomposed MSWs was closer to the predicted results using the modified K-C equation with the effective void ratio. This can be attributed to the increase in the fine fractions due to degradation. The reduction in the effective voids was more significant with HF-MSWs. The parameters required in the (modified) K-C equations showed a good correlation with DOB and effective particle size (d10). The predicted permeability based on the relationship between DOB (or d10) and equation parameters was within 3 times the difference compared to the measured values. The above results indicated that the modified K-C equation can be adopted to predict the permeability of fresh and degraded MSWs while more field-scale experiments should be conducted to further evaluate its feasibility.

Clinical profile of adult and pediatric patients with hepatic Wilson's disease.

The clinical profile varies in patients with Wilson's disease (WD). There is paucity of data regarding adult and pediatric patients with hepatic WD. As many as 140 consecutive patients diagnosed with hepatic WD between December 2006andJanuary 2021 were included in the study. Data was collected regarding the demographic parameters, clinical presentation, extrahepatic organ involvement, liver histology and laboratory investigations. Adult and children (0-14years) with hepatic WD were compared regarding thesefeatures. Eighty-eight adults and 52 children were included in the study. The median age of presentation was 17 years (range: 1.1-42years). Male preponderance was seen (adult 68/88, 69%; children 40/52, 77%). Adults as compared to children presented more commonly as cirrhosis (52/88 vs. 15/52, p = 0.0005) and with hepatic decompensation (35/88 vs. 9/52, p = 0.005). Presentation with acute-on-chronic liver failure (ACLF) was more common in children (10/52 vs. 2/88, p = 0.0005). Twenty-eight-day mortality was 50% (5/10) in children and none in adults presenting with ACLF. Nazer's Prognostic Index (≥ 7) and New Wilson Index were more accurate in predicting mortality among children with ACLF with AUROC 1, while AARC (APASL ACLF Research Consortium) was less accurate with AUROC 0.45. Liver histology findings were similar in adults and children. Extrahepatic involvement was also similar. (8/88 in adults vs. 3/52 children, p value 0.48). Most patients with WD present as cirrhosis in adulthood. ACLF is more common in children. Nazer's prognostic index and new Wilson Index score are accurate in predicting mortality in children with ACLF.

Meandering Streamflows across Landscapes and Scales: a Review and Discussion

Abstract The study of meandering patterns created by geophysical flows is important for a number of fundamental and applied research topics, including stream and wetland restoration, land management, infrastructure design, oil exploration and production, carbon sequestration, flood-hazard mitigation, and planetary paleoenvironmental reconstructions. This volume, Meandering Streamflows: Patterns and Processes across Landscapes and Scales , contains 13 papers that present field, laboratory, and numerical investigations of meandering channels found in distinct environmental and geological contexts, and focus on how the interactions of different autogenic and allogenic processes, both in the horizontal and the vertical dimension, affect meander kinematics and the resulting morphology, sedimentology, and stratigraphic architecture. In this introductory chapter, we offer an overview of the evolution of scientific research on meandering streams over time, aiming to review and discuss meandering patterns in both fluvial and non-fluvial settings. Additionally, we present a new compilation of data on meander morphological features, drawn from both existing literature and novel sources, encompassing over 8000 meander bends discovered across a diverse array of environments.

Patients with Steroid Sensitive Nephrotic Syndrome: A Case Series

Nephrotic syndrome (NS) is one of the most common kidney diseases found in childhood. The prevalence of nephrotic syndrome worldwide is approximately 16 cases per 100,000 children with an incidence of two to seven per 100,000 children. Nephrotic syndrome may affect adults and children of both genders and any race. Nephrotic syndrome in children can be classified into three groups; secondary, congenital, infantile, and idiopathic. In first case, a 3-year-old male patient was presented with complaints of fever, cough for 6 days and swelling all over the body, decreased urine output, oral intake for 2 days, edema of face, body and tiredness for 3 days. Laboratory investigations showed elevated ESR, ferritin and lipid profile. Urine routine examination showed elevated urine albumin levels (+++). USG abdomen and pelvis conveyed right basal pleural effusion. In second case, a 4-year-old male patient was presented with complaints of facial puffiness, fever, breathing difficulty, abdominal distension and pain but no edema. He had history of right inguinal hernia and atrial septal defect. Cholesterol level was found to be elevated. Urine routine examination showed elevated urine albumin levels (+++). USG abdomen and pelvis showed mild ascites and right pleural effusion. Presenting third case, a 12-year-old female patient was presented with complaints of edema and decreased urine output. Patient had history of recurrent episodes of edema and decreased urine output for 11 months. Laboratory investigations showed elevated total cholesterol, declined LFT test and RFT test was found to be normal. Urine routine examination showed elevated urine albumin levels (+++), pus cells, RBC, granular cast and bacteria present. USG abdomen and pelvis indicate acute glomerulo nephritis and acute to moderate ascites. Here case series with 3 cases showed the sequence of nephrotic syndrome which is treated with corticosteroid with its side effects and cumulative dose of steroid in children. Keywords: Nephrotic syndrome, Hypocholesteremia, Hypoproteinuria, Hyponatremia, pediatric

EFFICACY AND SAFETY OF NICORANDIL FOR PERIPROCEDURAL MYOCARDIAL INJURY IN PATIENTS UNDERGOING PCI

Coronary artery disease (CAD) remains a leading cause of morbidity and mortality globally, with percutaneous coronary intervention (PCI) being a typical therapeutic approach. Objectives: In this comparative study, we aimed to investigate the efficacy and safety of nicorandil for periprocedural myocardial injury in patients undergoing PCI. Methods: This comparative study was conducted at Ayub Teaching Hospital from September 2023 to December 2023. Data from 90 patients was recruited for the research using inclusion and exclusion screening standards. Our study was performed on 90 patients treated with percutaneous coronary intervention (PCI). Patients from Group 1 were different from those in Group 2. Group A: the critical study parameters will switch between those patients who received nicorandil and Group B: non-nicorandil patients. Baseline demographic data, past medical history, and relevant laboratory values and clinical characteristics were documented for all patients. In addition, an intraoperative laboratory investigation was conducted, including cardiac biomarkers. Results: Research data were drawn from 90 patients whose gender wasn't a factor based on the research protocol. In Group A, the mean age of the patients was 62 years. Players in group A played for 4 ± 8.5 years. In team B, the players had a slightly longer experience and played for 63. Humans on Earth could do the same, and it could significantly impact future generations: ± 7. 9 years. Of 58 men and 32 women in the control group, there were two persons and persons in the experimental group, respectively. Only one stent differed between the two groups; however, the number was similar. 8 ± 0. 6 mmol/l in the tricorandil group and 1. +9 ± 0 in Case 1. Patients in the Nicorandil group displayed the lowest level of heart problem-causing protein (troponin) at the peak (5. There is a statistically significant 1.8-fold (2 ng/mL versus seven ng/mL) decline in serum lysozyme levels in the group administered rhG-CSF. The treatment group exhibited a substantial increase in haemoglobin levels (t(12) = 3. 74, p-value &lt;0.005) with a mean difference of 0. 5 ± 2 ng/mL. 001, 95% CI: 2. 1 to 3. 5). Conclusion: It is concluded that nicorandil shows positive results for the efficacy (the ability of a drug to bring the desired effect) and safety of the drug in reducing myocardial injury and in maintaining the function of myocardial during percutaneous coronary intervention in patients.

Influence of pre-existing crack on rockburst characteristics in coal-rock combination: A laboratory investigation

The existing cracks in the roof rock are critical to stability of the coal-rock combination structure during mining activities, which is vital for safe exploitation in coal mines. However, the physical mechanisms by which pre-existing crack in the roof rock induces rockburst in coal mines are still poorly understood. In this study, to investigate the rockburst characteristics in an underground mine, triaxial compressive experiments on coal-rock combinations containing a pre-existing crack in the roof rock were carried out. Both mechanical and failure behaviours of composite specimen containing a pre-existing crack were analysed. The testing results showed that a pre-existing crack in roof significantly affects mechanical properties of combinations. The average peak stress and average elastic modulus of specimen exhibit an M-shaped change trend when dip angle is in a range of 0°–90°. The average peak strain increases before decreasing with increase in dip angle. In addition, the roof rock is more likely to fail when it contains a pre-existing crack. Both the initial failure location and failure pattern of combinations are highly related to angle of pre-existing crack. A novel rockburst model considering in-situ stress and pre-existing crack was proposed to determine the physical mechanism of rockburst. The findings are useful to understand characteristics and physical mechanism of rockburst in mine engineering.