Good Condition Research Articles

Perioperative Myocardial Infarction and Successful Revascularization in Patient With Primary Metasynchronic Rectal, Gastric and Bladder Cancer

The article presents a clinical case of perioperative non-ST-segment elevation myocardial infarction in a patient with primary metasynchronous cancer of the rectum, stomach and bladder, which developed during simultaneous surgical intervention in the volume of proximal gastrectomy and abdominoperineal extirpation of the rectum. Fluctuations in blood pressure and imbalance in the hemostasis system at the stages of anesthesia and surgery in a patient with severe systemic atherosclerosis caused the development of myocardial ischemia in the area of significant coronary stenosis. Emergency coronary angiography detected subtotal stenosis of the anterior descending artery; stenting of the affected area of the coronary artery was performed. Monitoring of hemodynamic parameters and changes in the hemostasis system during the optimal antianginal therapy allowed to bring the patient out of critical condition and discharge him from the hospital on the 18th day.

Effect Of Level 1 Progressive Mobilization On Oxygen Saturation In Patients With Decreased Consciousness

Background: Patients in the intensive care unit are individuals who are in critical condition due to failure of function of one or more organs, with hemodynamic instability. They require special care and intensive monitoring, in the hope that their condition can improve through appropriate medical action (Setiyawan, 2016). The incidence of stroke is increasing every year, there are 11 million stroke cases in the world, especially in low-income countries, especially in South Asian states and it causes 4 million deaths every year, around 30% of them in Southeastern countries. In addition, stroke is one of the leading causes of death and disability in adults in the United States. Every year, nearly 795,000 people in the country experience a stroke, either new or recurrent, and this causes approximately 130,000 deaths annually. (WHO, 2016). Research Objective: To understand the effect of level 1 progressive mobilization on changes in oxygen saturation in patients with decreased consciousness. Methodology: This research uses quantitative methods. The approach is quasi-experimental with a utilitarian design, where the intervention is applied to one group, then observations are made on the independent variables. Research Results and Discussion: Before progressive mobilization measures were carried out, the level 1 oxygen saturation value in patients with impaired consciousness at Grandmed Lubuk Pakam Hospital, of the 24 respondents, 2 respondents had oxygen saturation of 92% (8.3%), 4 respondents 93% (16, 7%), 7 respondents 94% (29.2%), 7 respondents 95% (29.2%), 3 respondents 96% (12.5%) and 7 respondents had oxygen saturation 98% (4.2%) . Conclusion: The average O2 saturation value in patients with decreased consciousness before doing level 1 progressive exercise was 93.33, whereas after it increased it was 95.67.

Deep Learning Approaches for the Assessment of Germinal Matrix Hemorrhage Using Neonatal Head Ultrasound.

Germinal matrix hemorrhage (GMH) is a critical condition affecting premature infants, commonly diagnosed through cranial ultrasound imaging. This study presents an advanced deep learning approach for automated GMH grading using the YOLOv8 model. By analyzing a dataset of 586 infants, we classified ultrasound images into five distinct categories: Normal, Grade 1, Grade 2, Grade 3, and Grade 4. Utilizing transfer learning and data augmentation techniques, the YOLOv8 model achieved exceptional performance, with a mean average precision (mAP50) of 0.979 and a mAP50-95 of 0.724. These results indicate that the YOLOv8 model can significantly enhance the accuracy and efficiency of GMH diagnosis, providing a valuable tool to support radiologists in clinical settings.

Acute Myocardial Infarction in the Context of Diabetic Ketoacidosis: Pathophysiological Interactions, Clinical Manifestations, and Therapeutic Considerations

Acute myocardial infarction (AMI) and diabetic ketoacidosis (DKA) are two critical conditions that can coexist with significant morbidity and mortality. AMI is a leading cause of cardiovascular death, while DKA is a severe complication of uncontrolled diabetes mellitus, characterized by hyperglycemia, metabolic acidosis, and ketonemia. The convergence of these conditions presents unique challenges in diagnosis and management, as the metabolic disturbances of DKA can exacerbate myocardial ischemia and contribute to poor clinical outcomes. This article aims to explore the pathophysiological interplay between AMI and DKA, focusing on their shared risk factors, metabolic derangements, and the impact of hyperglycemia and ketosis on myocardial oxygen supply and demand. Furthermore, we discuss the clinical presentation, diagnostic strategies, and therapeutic approaches tailored to this dual pathology. Early recognition and prompt intervention are crucial to improving prognosis in patients with coexisting AMI and DKA. Multidisciplinary management involving cardiologists, endocrinologists, and intensivists is essential to mitigate the adverse outcomes of this complex clinical scenario.

Effect of Oral Bisphosphonates on Vertebral Fractures in Males Living with HIV: A Seven Year Study.

Background: Osteoporosis and vertebral fractures (VFs) are frequently observed in males living with HIV (MLWH). While bisphosphonates seem effective on bone mineral density (BMD) in MLWH, data on VFs are lacking. In this real-life longitudinal study performed on 118 MLWH (median age 53) who were followed-up for a median of 7 years, we aimed to evaluate the long-term efficacy of oral bisphosphonates on VFs in MLWH. Methods: The inclusion criteria were age >18, stable HIV infection, bisphosphonate-naïve, blood samples from the same laboratory, and three densitometries and morphometries performed with the same densitometer. Results: At baseline, VFs were detected in 29/118 patients (24.6%). Patients with VFs were older (p. 0.042), had longer HIV infection duration (p. 0.046) and antiretroviral exposure (p. 0.025), and demonstrated higher luteinizing hormone levels (LH, p. 0.044). Of the 29 patients with VFs at inclusion, 11 developed new VFs, of which 8 were under oral bisphosphonates (p. 0.018). Among the 89 without basal VFs, 11 developed VFs, of which 2 were under oral bisphosphonates. Patients with a worsened bone condition (regarding BMD and/or new VFs, n. 32) had more frequently high LH levels (>9.4 mIU/mL, p. 0.046) and higher HCV co-infection compared to patients with a stable bone condition (p. 0.045). It should be noted that 38.6% of patients discontinued oral bisphosphonates due to medical indication or personal choice, and 14.0% never started them. Conclusions: In conclusion, we found that oral bisphosphonates were not completely effective in preventing VFs, especially in patients with VFs at baseline; this is probably due to the multifactorial pathogenesis of fragility fractures in this population. A poor adherence to treatment and attention to gonadal function are also important issues in this population.

Urban Cemeteries as Biodiversity Refuges: A Comparative Study of Plant Ecobiomorphs in Central Kazakhstan

Cemeteries are often overlooked in ecological studies, yet they represent unique urban microhabitats that contribute to the preservation of diverse plant species, including those adapted to various ecological niches. This study aimed to assess the species composition, ecological classifications, and abundance of vascular plants in the cemetery and surrounding areas to explore cemeteries’ role in conserving plant ecobiomorph diversity in arid climates. This study identified 79 plant species from 23 families within the cemetery compared with 31 species from 11 families in the surrounding area. The plant community in the cemetery was dominated by mesophytes, suggesting favorable and stable conditions for plant growth, while xerophytes were more common in the surrounding areas, indicating harsher, drier conditions. The diversity of plant life forms, including perennial herbs, shrubs, and trees, was significantly higher within the cemetery, indicating a more complex and resilient ecosystem. Our study demonstrates that cemeteries act as vital refuges for plant biodiversity. They offer significantly higher species diversity and more complex ecosystem structures compared with the surrounding areas. These findings emphasize the critical role cemeteries play in urban biodiversity conservation, particularly in increasingly arid environments.

Astragaloside IV Inhibits the Pyroptosis in the Acute Kidney Injury through Targeting the SIRT1/FOXO3a Axis.

Acute kidney injury (AKI) is a commonly encountered critical condition in clinical settings, often resulting from sepsis, infections or ischemia. Astragaloside IV (AS-IV) is the primary active component of Astragalus. The functions of Astragalus are mainly related to AS-IV, showing remarkable therapeutic effects in anti-inflammatory, antioxidant, immune-enhancing, and anti-tumor aspects. This study aimed to explore the role of AS-IV in AKI development. Lipopolysaccharide (LPS) was used to stimulate the HK-2 cells and rats to establish the AKI model in vivo and in vitro. After AS-IV treatment, the cell viability, pyroptosis rate, lactate dehydrogenase (LDH) activity, interleukin (IL)-18 and IL-1β contents, and cleaved-caspase-1, GSDMD-N, SIRT, FOXO3a protein levels were detected. Caspase-1 levels were analyzed by immunofluorescence staining. Additionallly, the acetylation levels of FOXO3a were detected by immunoprecipitation and Western blot assays. AS-IV treatment promoted the cell viability, and inhibited the pyroptosis, LDH activity, caspase-1 levels in the LPS stimulated HK-2 cells. AS-IV treatment decreased the IL-18 and IL-1β contents, cleaved-caspase-1 and GSDMD-N protein levels in both LPS stimulated HK-2 cells and rats. Furthermore, after EX527 treatment, a Sirtuin 1 (SIRT1) inhibitor, the role of AS-IV in the LPS stimulated HK-2 cells were reversed. AS-IV treatment increased the protein levels and decreased the acetylation levels of FOXO3a, which was reversed after EX527 treatment. Co-immunoprecipitation (CO-IP) assay and immunofluorescence staining confirmed that SIRT1 interacted with FOXO3a. In conclusion, this research demonstrated that AS-IV treatment inhibited the pyroptosis occurrence in LPS stimulated HK-2 cells and rats. This may be related to the SIRT1 mediated deacetylation of FOXO3a.

Formulation and evaluation of herbal shampoo

The main objective of these study is to evaluate and formulate herbal shampoo. Shampoo are one of the cosmetic products used in daily life. Synthetic preservatives and detergents have sometimes been the cause of adverse effects among consumers. A more radical approach in reducing the synthetic ingredients is by incorporating natural ingredients whose functionality is comparable with their synthetic ingredients. The ingredients used in formulation of Herbal Shampoo are Ficus Religiosa leaves (Powder), Hibiscus Leaves (Powder), Reetha (Powder), Shikakai (Powder), Aloevera, then prepared by mixing with each other and evaluated for its organoleptic and physio-chemical characteristics and performance tests in terms of wetting time test, pH, solid contents, surface tension, dirt dispersion, foam Stability, and Viscosity was performed. The combination of several such ingredient of herbal origin has made it possible to secure highly effective dry powder shampoo. The formulation at laboratory scale was done and evaluated for number of parameters to ensure its safety and efficacy The Formulated Herbal Shampoo was clear and good appealing. It demonstrated good froth stability, detergency, good cleansing, small bubble size, low surface strain, and execution of good conditioning property. The physicochemical evaluation of the formulated shampoo showed ideal results. However, to improve its quality, product performance, and safety, further development was required.

Challenges of high-fidelity air quality modeling in urban environments – PALM sensitivity study during stable conditions

Abstract. Urban air quality is an important part of human well-being, and its detailed and precise modeling is important for efficient urban planning. In this study the potential sources of errors in large eddy simulation (LES) runs of the PALM model in stable conditions for a high-traffic residential area in Prague, Czech Republic, with a focus on street canyon ventilation, are investigated. The evaluation of the PALM model simulations against observations obtained during a dedicated campaign revealed unrealistically high concentrations of modeled air pollutants for a short period during a winter inversion episode. To identify potential reasons, the sensitivities of the model to changes in meteorological boundary conditions and adjustments of model parameters were tested. The model adaptations included adding the anthropogenic heat from cars, setting a bottom limit of the subgrid-scale turbulent kinetic energy (TKE), adjusting the profiles of parameters of the synthetic turbulence generator in PALM, and limiting the model time step. The study confirmed the crucial role of the correct meteorological boundary conditions for realistic air quality modeling during stable conditions. Besides this, the studied adjustments of the model parameters proved to have a significant impact in these stable conditions, resulting in a decrease in concentration overestimation in the range 30 %–66 % while exhibiting a negligible influence on model results during the rest of the episode. This suggested that the inclusion or improvement of these processes in PALM is desirable despite their negligible impact in most other conditions. Moreover, the time step limitation test revealed numerical inaccuracies caused by discretization errors which occurred during such extremely stable conditions.

Examining the Stability of Public Opinion in an Era of Polarization: A Review of Stable Condition

Examining the Stability of Public Opinion in an Era of Polarization: A Review of <i>Stable Condition</i>

Hemodynamic monitoring- (NOT) anursing task?!

Ensuring adequate and stable hemodynamic conditions is an essential component of patient care in emergency and intensive care units. The assessment of circulatory status is complex and influenced by patient-specific characteristics, medical staff experience, and available equipment. Hemodynamic monitoring encompasses both invasive and noninvasive methods to monitor circulatory parameters. It supports patient management and ensures therapeutic success by alerting healthcare providers to deviations, including critical values. In practice, numerical data often receive more emphasis than comprehensive patient observation, potentially leading to misinterpretation. Advanced practice nurses (APNs) are highly qualified nursing professionals who work largely autonomously due to their advanced training. However, there is currently no uniform legal regulation for these professions in Germany. Clear definitions and nationwide regulations for related academic programs are necessary. Interprofessional collaboration, as well as the qualifications and numbers of nursing staff, significantly impact therapeutic outcomes. Hemodynamics involves the physical principles of blood flow and the assessment of vital parameters to ensure organ perfusion and oxygenation. The competence and knowledge of nursing staff are crucial for safe patient care. Local standard operating procedures (SOPs) should consider interprofessional collaboration and the qualifications of team members.

Analysis of groundwater and surface water quality using modelled water index and multivariate statistics in Kampala and Mbarara Districts, Uganda

The demand for domestic, public and industrial use of water increases with population growth. However, activities from humans and natural environment have resulted into decline in water quality. The aim of this study was to evaluate the quality of groundwater and surface water collected from Kampala and Mbarara districts of Uganda using water quality index and multivariate statistics. A total of 10 physicochemical parameters (pH, water temperature, chloride, sulphate, nitrate, electrical conductivity, total dissolved solids, total suspended solids, total solids, and phosphate) were measured monthly to evaluate the quality of water in the study districts. Results showed that sulphate, electrical conductivity and total dissolved solids were observed with significantly high values in surface water than the groundwater for both seasons. Among all the parameters measured, electrical conductivity was observed with the highest value (2129.67 ± 1.41 µS/cm) while nitrate concentration (0.57 ± 0.02 mg/L) was observed with the lowest during the wet season in surface water. In addition, the mean values of nitrate, electrical conductivity, total dissolved solids and sulphate detected in the groundwater and surface water were within the recommended limits, while phosphate and chloride were observed with mean concentrations above the regulatory limits in 50% of the samples. The correlation analysis revealed strong and positive association between electrical conductivity and total dissolved solids in groundwater and surface water for both seasons. Also, the chemical make-up of groundwater and surface water within the study districts revealed that the determination of water quality rests on two major indices (conductivity and anthropogenic-pollutants) based on the factor analysis. The two indices accounted for 0.619% in groundwater and over 0.70% in surface water, indicating more pollution in surface water. Moreover, the water quality index (WQI) values obtained ranged from 14.81 to 115.73 in dry season and 7.77 to 108.24 during the wet season. According to WQI classification, 42% of the samples collected fell within the “excellent” and “good” categories while others fell within “poor” and “unfit” categories (58%) during the dry season. Based on these findings, appropriate treatment methods, proper sanitation and waste management should be implemented in locations with critical water conditions. Also, frequent monitoring of groundwater and surface water quality by environmental protection agency is highly recommended.

Transforming Subdural Hematoma Treatment in the Elderly: Insights from an Endoscopic Case Series.

Subdural hematoma (SDH), a critical brain condition, significantly affects the elderly, making traditional surgeries risky due to their length and potential for blood loss. Endoscope-assisted evacuation offers a safer, less invasive alternative by reducing operation time and minimizing damage, providing an effective solution for older patients. This study evaluated six patients treated with endoscopic evacuation for different stages of SDH from August 2019 to July 2023. Selection criteria were based on altered consciousness, lack of severe brain contusion, SDH thickness over 1 cm, or midline shift over 0.5 cm. The technique used a burr hole and rigid lens endoscope for hematoma removal, focusing on shorter surgery times and better outcomes. Patients aged between 63 to 84 years showed no surgical fatalities, with all recovering well by discharge. Hematoma clearance rates were 76.9% at three days, improving to 96.8% after one month. Endoscope-assisted evacuation is a safe, efficient treatment for elderly patients with various stages of SDH, offering a less invasive option with potential for better outcomes. It supports the trend towards minimally invasive neurosurgery, with further research needed to optimize patient selection and understand long-term benefits.

Numerical Verification of a Polarization-Insensitive Electrically Tunable Far Infrared Band-Stop Meta-Surface Filter

Tunable filters have many potential applications in diverse fields, including high-capacity communications, dynamic beam shaping and spectral imaging. Although providing a high-performance solution for actively tunable devices, metasurface combined with tunable materials faces the great challenges of limited tuning range and modulation depth. Here, we propose a far-infrared tunable band-stop filter based on Fabry-Perot (FP) resonators and graphene surface plasmons. By switching the wavelength of the critical coupling condition of the filter via the gate voltage applied on graphene, achieving the dynamically tunable band-stop filtering at the central wavelengths from 12.4 μm to 14.1 μm with a modulation depth of more than 99%. Due to the symmetry of the proposed meta-atoms, the filter is insensitive to the polarization direction of the incident light. And it can realize more than 85% filtering efficiency within 60° angle of incidence around the vertical direction. By adjusting the geometry of the meta-atoms structure, it is feasible to move the operational range from the near-infrared to terahertz bands.

Acute Kidney Injury in Children: Classification, Recognition and Treatment Principles

Acute kidney injury (AKI) in children is a critical medical condition characterized by a sudden decline in kidney function. This article provides a comprehensive overview of AKI in pediatric populations, exploring its pathophysiology, the role of various drugs and the long-term implications for kidney health. Key topics include oliguria, anuria, urine output, hypervolemia and the interactions among them, as well as role of diuretic nephrotoxicity and the glomerular filtration rate. Concepts of electrolytes, acid–base balance and renal perfusion assessment are presented. Basic principles of intensive care unit (ICU) management, renal replacement therapy and the association with multiorgan failure are described. Additionally, the article discusses the potential long-term outcomes of AKI, including the risk of chronic kidney disease, hypertension and proteinuria.

Development of a core outcome set for neonatal septic shock management: a study protocol

BackgroundNeonatal septic shock represents a critical and life-threatening condition that necessitates immediate and personalized interventions. Prior research endeavors have been undertaken to inform the optimization of neonatal septic shock management, yet substantial heterogeneity prevails in the selection, measurement, and reporting of outcomes across relevant studies. The heterogeneity in outcome selections and measures impedes the comparability of results and the synthesis of evidence, thus contributing to suboptimal utilization of research findings. This protocol presents the methodology for identifying and developing a Core Outcome Set for Neonatal Septic Shock Management (COS-NSS), intended for use in both research and routine clinical practice.A rigorous four-stage approach will be employed to develop the COS-NSS. In Stage 1, a scoping review will be conducted to compile a list of currently reported outcomes for neonatal septic shock management. Stage 2 will involve an expert stakeholder meeting using a semi-structured discussion approach to elucidate all identified outcomes and outcome domains, as well as to gather any additional outcomes. Moving to Stage 3, a two-round e-Delphi survey involving a wide variety of stakeholders will be undertaken to elicit diverse perspectives on the level of importance assigned to each proposed outcome. Finally, in Stage 4, the results of the Delphi study will be discussed in a consensus meeting to determine and agree on the final list of outcomes that will constitute the COS-NSS.DiscussionThe stagewise approach integrates research evidence with multi-stakeholder perspectives to establish standardized outcomes that would improve consistency across neonatal septic shock trials. The development and uptake of the COS-NSS will facilitate effective comparison of studies, allowing for study synthesis and generation of high-quality evidence, thus ultimately fostering enhanced medical care for neonates suffering from septic shock.Trial registrationCore Outcome Measures in Effectiveness Trials (COMET) Initiative database registration: 2766. Registered on July 19th, 2023.

Post Mortem Molecular Biomarkers of Asphyxia: A Literature Review.

Asphyxia is a critical condition characterized by inadequate oxygen supply to the body. Post mortem diagnostics of asphyxia present significant challenges in forensic pathology, particularly when there are equivocal signs during autopsy or uncertain circumstantial data. The identification of biochemical biomarkers that indicate asphyxia has emerged as a promising area of research, as these markers can provide vital insights into the physiological changes occurring at the cellular level during asphyxiation. We performed a review of the scientific literature on the search engines Pubmed and Scopus in order to assess the state of the art on this topic. The aim of this study is to analyze which are the most promising markers and methods in the post mortem diagnosis of asphyxia. The literature review highlighted the great potential that molecular investigations can have in the analysis of this type of death, especially considering that hypoxia determines strong biochemical alterations in response to cellular stress. These changes are marked by specific biochemical alterations, which can be detected through various advanced technologies and methodologies, including mass spectrometry, immunohistochemistry, and metabolomic profiling. The review evidenced a combination of markers that can be used for diagnostic purposes in various cases, including mechanical asphyxia, carbon monoxide (CO) poisoning, perinatal asphyxia, and drowning analysis. However, we highlight that, to date, there are still no standard protocols for forensic biochemistry in asphyxia. By scrutinizing the reliability of identified biomarkers and their potential to reshape forensic investigative practices, this research aims to elucidate the critical role that post mortem biochemical analysis can play in diagnosing asphyxia, ultimately contributing to a more nuanced understanding of death-related scenarios and the development of standardized protocols in forensic examinations.

A Paleoenvironmental Reconstruction of Lake Vrana on the Island of Cres (Croatia) Based on the Geochemistry and Mineralogy of the Late Pleistocene and Holocene Sediments

A 7.4 m long sediment core has been retrieved from the central part of Lake Vrana on the island of Cres to reconstruct the paleoenvironmental conditions. Lake Vrana is the deepest freshwater lake in Croatia, located in the karst region of the eastern Adriatic coast. A dated sediment sequence in Lake Vrana of 4.4 m has spanned the past 16.4 kyr, and it featured a dynamic sediment deposition until the beginning of the Holocene, including strong sediment input and supply to the lake by runoff sediments of dolomitic origin from the catchment in the period 16.4–14.4 cal kyr BP. High organic carbon content, which originates from mixed terrestrial and aquatic origins in the periods 14.4–13.3 cal kyr BP and 12.7–11.7 cal kyr BP, indicates fluctuating lake levels in shallow water environments during the Late Glacial to Holocene transition. The Holocene sequence indicates the development of more stable conditions and continuous sediment deposition, characterized by an increasing trend of siliciclastic sediments delivered into the lake during the early Holocene (11.7–10 cal kyr BP) and dominantly from 8 to 4.4 cal kyr BP, indicating enhanced input and erosion, which coincides with the humid and pluvial period recorded in the central Mediterranean region. It is followed by sediments with high organic carbon content between 4.4 and 1.6 cal kyr BP, which points to higher lake productivity. Calcite sedimentation prevailed between 1.6 to 0.4 cal kyr BP, indicating stable deeper-lake conditions. Predominantly, siliciclastic sediments from 0.4 to 0.1 cal kyr BP pointed to erosion during the Little Ice Age (LIA), with enhanced precipitation and sediment discharge from the catchment. The re-establishment of calcite sedimentation has been observed over the last 100 years.

Early coronary revascularization among stable patients with non-ST-segment elevation acute coronary syndromes: the role of diabetes and age

Abstract Background Diabetes mellitus affects 10-30% patients hospitalized with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and two-fold higher mortality risk compared to non-diabetics. Despite higher post-PCI complications in diabetic patients, guidelines advise early invasive NSTE-ACS treatment for all, based expert opinion, and limited evidence. Purpose To investigate the impact of an early coronary revascularization (&amp;lt;24 hours) compared with initial conservative strategy on clinical outcomes in diabetic patients with NSTE-ACS who are in stable condition at hospital admission. Methods The ISACS-TC database was queried for a sample of diabetic and nondiabetic patients with diagnosis of NSTE-ACS. Patients with cardiac arrest, hemodynamic instability, and serious ventricular arrhythmias were excluded. The characteristics between groups were adjusted using logistic regression and inverse probability of treatment weighting models. Primary outcome measure was all cause 30-day mortality. Risk ratios (RRs) and odds ratios (ORs) with their 95% CIs were employed. Results Of the 7,589 NSTE-ACS patients identified, 2,343 were diabetics. The data show a notable reduction in mortality for the elderly undergoing early revascularization compared to those receiving an initial conservative strategy both in the diabetic (3.3% versus 6.7%; RR: 0.48; 95% CI: 0.28-0.80) and nondiabetic patients (2.7% versus 4.7%: RR: 0.57; 95% CI: 0.36-0.90). In multivariate analyses, diabetes was a strong independent predictor of mortality in the elderly (OR: 1.43; 95% CI: 1.03-1.99), but not in the younger patients OR: 1.04; 95% CI: 0.53-2.06). Conclusions Early coronary revascularization does not lead to any survival advantage within 30 days from admission in young NSTE-ACS patients who present to hospital in stable conditions with and without diabetes. An early invasive management strategy may be best reserved for the elderly. Factors beyond revascularization are of considerable importance for outcome in elderly diabetic subjects with NSTE-ACS.

Pyogenic liver abscess due to Burkholderia pseudomallei in immunocompetent patient from Garhwal region of Uttarakhand – A case report

We report a case of liver abscess due to Burkholderia pseudomallei in a 45-year-old, non-diabetic patient from the Garhwal region of Uttarakhand. The patient reported chief complaints of abdominal pain and fever. Ultrasonography and contrast-enhanced computed tomography of the whole abdomen were suggestive of the left liver lobe abscess. Pus was aspirated from the abscess and sent for culture and sensitivity. Growth on the culture plate was identified as B. pseudomallei; the patient was then treated with appropriate antibiotics and discharged in stable condition. Diagnosis of pseudomallei infection requires a high index of suspicion among clinicians as well as laboratory specialists. Early identification of organisms helped clinicians initiate appropriate management in our case.