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Papers by umair khalid

Texas Heart Institute Journal

A 42-year-old man with a history of metastatic primary renal synovial sarcoma (PRSS) presented wi... more A 42-year-old man with a history of metastatic primary renal synovial sarcoma (PRSS) presented with 1-week history of dyspnea, ascites, and lower-extremity edema. He had undergone a radical nephrectomy a year before current presentation without any recurrence on surveillance imaging. Physical examination was notable for a grade II diastolic murmur heard best at the left lower sternal border, jugular venous distention, ascites, and lower-extremity edema. Basic laboratory data and 12-lead electrocardiogram were largely unremarkable. Computed tomography demonstrated a nonenhancing mass in the right atrium (RA) abutting into the right ventricle (RV) measuring 3.8 × 7.5 × 3.4 cm (Fig. 1A). In addition, there was a 1.7 × 4.2 × 2.1-cm soft tissue mass extending over the anterior aspect of the inferior vena cava within the prior nephrectomy bed, which was concerning for recurrence (Fig. 1B). An echocardiogram performed 8 months earlier had shown no evidence of an intracardiac mass. Subsequently, transthoracic echocardiography revealed a new large echogenic mass nearly filling the entire RA, prolapsing through the tricuspid annulus into the RV. It measured 6.9 × 3.2 cm (Fig. 2A). He was a poor candidate surgery and received salvage chemotherapy with doxorubicin and dacarbazine. On subsequent imaging, the mass had decreased in size to 4.8 × 2.8 cm (Fig. 2B, Fig. 3). His volume status also improved over the next few months. Comment A highly aggressive rare tumor, PRSS represents approximately 1% of all soft tissue tumors. 1,2 There has only been 1 reported case of PRSS associated with an intracardiac mass. Although that case had a similar presentation and imaging findings, it described

Screening for atrial fibrillation in the elderly: A network meta-analysis of randomized trials

European Journal of Internal Medicine

Aim: Renin is activated by the start of the beta-1 adrenoreceptor (β1-AR) in the kidney, which is... more Aim: Renin is activated by the start of the beta-1 adrenoreceptor (β1-AR) in the kidney, which is necessary to aid blood pressure. There can also be an improvement in the physiological and therapeutic consequences of β1-AR genetic diversity. We tried to test this speculation for the care of patients with critical hyperaldosteronism (n = 467). Methods: Segment and hemodynamic specifics were measured and a standard immunoassay was used for plasma renin. Our current research was conducted at Mayo Hospital, Lahore from March 2019 to February 2020. Participants were geneticized for Arg389Gly (rs1801253) and Ser49Gly (rs1801252) 2 human nucleotide base polymorphisms and in this context were the four possible β1-AR haplotypes. Results: In patients tested for hyperaldosteronism, in the Gly49 (49SS) allele conveyors (0.309 ± 0.04 vs 0.165 ± 0.05) plasma renin was elevated fundamentally. In these instances, the token pulse or pulse did not become parallels. Then again, in this meeting either the plasma renin or the pulse did not affect the polymorphism of Arg389Gly. In comparison, there was no documentation of the link between the two sites in this patient conference. Conclusion: This information indicates that the variance Ser49 of the polymorphic quality Ser49Gly β1-AR correlates higher renin levels with this information. However, these standard polymorphisms of β1-AR consistency have little effect on the pulse of a related accomplice.

Recommended Citation

in children at a tertiary care hospital of Karachi

Supernumerary, ectopic tooth in the maxillary antrum presenting with recurrent haemoptysis

Recommended Citation

Supernumerary, ectopic tooth in the maxillary antrum presenting with recurrent haemoptysis.

Journal of Accounting and Finance in Emerging Economies, 2021

Purpose: The research aims to analyze the particular quagmire of endogeneity by u panel data with... more Purpose: The research aims to analyze the particular quagmire of endogeneity by u panel data with the renowned challenge of limited periods. Design/Methodology/Approach: This study employed panel data generalized method of moments (GMM) approach. Findings: Results show a presence of a significant and a negative relationship between operational risk and management performance and returns, thereby emphasizing the importance of operational risk management for enhanced performance in light of the theory of performance frontiers introduced by Schmenner and Swink in 1998. Implications/Originality/Value: The results suggest that the focus on operational risk management should be revitalized if the firms seeks an improved performance and a sustainable competitive advantage.

International Journal of Obesity, 2020

Background Limited data exist on the association of obesity with both hospitalization and mortali... more Background Limited data exist on the association of obesity with both hospitalization and mortality in patients with heart failure with preserved ejection fraction (HFpEF), especially in the real-world ambulatory setting. We hypothesized that increasing body-mass index (BMI) in ambulatory heart failure with preserved ejection fraction would have a protective effect on these patients leading to decreased mortality and hospitalizations. Methods We studied the relationship between BMI and the time to all-cause mortality, time to heart failure (HF) hospitalization, and time to all-cause hospitalization over a 2-year follow-up in a national cohort of 2501 ambulatory HFpEF patients at 153 Veterans Affairs medical centers. Results Compared with normal BMI, overweight (HR 0.72; 95% CI 0.57-0.91), obesity class I (HR 0.59; 95% CI 0.45-0.77), obesity class II (HR 0.56; 95% CI 0.40-0.77), and obesity class III (HR 0.53; 95% CI 0.36-0.77) were associated with improved survival after adjustment for demographics and comorbidities. In contrast, the time to HF hospitalization showed an inverse relationship, with shorter time to HF hospitalization with increasing BMI compared with normal BMI; overweight (adjusted HR 1.30; 95% CI 0.88-1.90), obesity class I (HR 1.57; 95% CI 1.05-2.34), obesity class II (HR 1.79; 95% CI 1.15-2.78), and obesity class III (HR 1.96; 95% CI 1.23-3.12). However, time to first all-cause hospitalization was not significantly different by BMI groups. Conclusions In a large, national ambulatory HFpEF cohort, despite the presence of the obesity paradox with respect to survival, increasing BMI was independently associated with an increased risk of HF hospitalization and similar risk of allcause hospitalization. Future longer-term prospective trials evaluating the safety and efficacy of weight loss on morbidity and mortality, in patients with severe obesity and HFpEF are needed.

Racial disparities among Asian Americans with atrial fibrillation: An analysis from the NCDR® PINNACLE Registry

International Journal of Cardiology, 2021

BACKGROUND There is paucity of data on Atrial Fibrillation (AF) management and associated clinica... more BACKGROUND There is paucity of data on Atrial Fibrillation (AF) management and associated clinical outcomes among Asian Americans. This study sought to investigate baseline risk factor profiles, racial disparities in clinical management and adverse clinical outcomes among White and Asian Americans. METHODS We used National Cardiovascular Data Registry (NCDR®) Practice Innovation and Clinical Excellence (PINNACLE) registry and linked Centers of Medicare and Medicaid Services data to identify Asian and White patients with AF between January 1, 2013-June 30, 2018. We compared rates of baseline risk factors, management strategies (rate versus rhythm control), anticoagulation use and rates of adverse events between racial groups. The two race groups were compared using hierarchical multivariable adjusted regression models to account for site and confounders. RESULTS In total, 1,359,827 patients (18,793 Asians and 1,341,034 Whites) were included in our analysis. Compared to White Americans, Asian Americans were more likely to use a rate control strategy (Odds Ratio [OR]: 1.20, 95% Confidence Interval [CI]: 1.15-1.25) and lower odds of rhythm control strategy (atrial ablations, cardioversions, or use of antiarrhythmic drugs) (OR: 0.83, 95% CI: 0.80-0.87) in adjusted analysis. Use of oral anticoagulants and direct oral anticoagulants were similar. There were no significant race-based differences in likelihood of all-cause mortality, stroke, and bleeding requiring hospitalization. Analyses performed using propensity score matching were consistent with the main results. CONCLUSIONS Asian Americans with AF have a lower likelihood of being managed with rhythm control strategies. Overall use of OAC and AF related adverse events remain similar between the two racial groups.

Sensors, 2020

A multitude of smart things and wirelessly connected Sensor Nodes (SNs) have pervasively facilita... more A multitude of smart things and wirelessly connected Sensor Nodes (SNs) have pervasively facilitated the use of smart applications in every domain of life. Along with the bounties of smart things and applications, there are hazards of external and internal attacks. Unfortunately, mitigating internal attacks is quite challenging, where network lifespan (w.r.t. energy consumption at node level), latency, and scalability are the three main factors that influence the efficacy of security measures. Furthermore, most of the security measures provide centralized solutions, ignoring the decentralized nature of SN-powered Internet of Things (IoT) deployments. This paper presents an energy-efficient decentralized trust mechanism using a blockchain-based multi-mobile code-driven solution for detecting internal attacks in sensor node-powered IoT. The results validate the better performance of the proposed solution over existing solutions with 43.94% and 2.67% less message overhead in blackhole ...

American Journal of Preventive Cardiology, 2021

Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

DEBATE ARTICLE Open Access

Citeseer

Le-Niculescu H, Kuczenski R, Niculescu AB: Convergent functional genomics: a Bayesian candidate g... more Le-Niculescu H, Kuczenski R, Niculescu AB: Convergent functional genomics: a Bayesian candidate gene identification approach for complex disorders – Bertsch, CA, et al. ... SM, Salomon DR, Tsuang MT, Nurnberger JI Jr, Niculescu AB: Convergent Functional Genomics of bipolar ...

Journal of the American College of Cardiology, 2017

Background: Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by the presence... more Background: Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by the presence of severe thunderclap headache with diffuse segmental narrowing of cerebral arteries on imaging with or without neurological symptoms. Cardiac involvement is extremely rare, three reported cases of RCVS with concomitant transient cardiomyopathy in patients without CAD. Case: A 50-year-old Hispanic female with a past medical history of hypertension, diabetes mellitus, and multiple prior admissions for chest pain presented with one day of substernal chest pain. Over the course of three years, the patient has had multiple admissions for similar chest pain with an unremarkable cardiac work up including a coronary angiography, 2D transthoracic echocardiogram (TTE), and pharmacological stress test. On this admission, she reported 9/10 substernal chest pain, radiating to left shoulder and neck with diaphoresis, nausea, and dyspnea. Patient's cardiopulmonary and abdominal exam were unremarkable. Electrocardiogram (EKG) showed mild ST-depression in leads V5-V6, and serum troponin was elevated to 3.66 ng/mL. The patient was managed medically with complete resolution of chest pain. Repeat TTE and myocardial perfusion imaging were unremarkable. While preparing for discharge, the patient developed a thunderclap headache, and neurology was consulted. Cerebral angiography revealed diffuse vasoconstriction which resolved with verapamil infusion, consistent with a diagnosis of RCVS. Decision-Making: Given the new diagnosis of RCVS and likely associated coronary vasospasm, the patient was started on a calcium channel blocker to help relieve vasospasms. Diltiazem provided ultimate relief of her headache, and she has remained chest pain free without any additional hospitalizations for similar chest pain since. Conclusions: Although evidence suggesting systemic vascular involvement in RCVS is limited in literature, we hypothesize that our patient also had coronary vascular involvement. Segmental narrowing of coronary vessels similar to cerebral vasculature could explain the mechanism through which our patient developed symptoms of chest pain, EKG changes and troponin elevation.

Modes of failure with fractional flow reserve guidewires: Insights from the manufacturer and user facility device experience database

World Journal of Cardiology, 2021

BACKGROUND Fractional flow reserve (FFR) measurement is commonly used in the cardiac catheterizat... more BACKGROUND Fractional flow reserve (FFR) measurement is commonly used in the cardiac catheterization laboratory to assess the functional significance of coronary arterial plaques. Robust real-world data on complications and modes of failure of FFR guidewires are limited. AIM To characterize these outcomes by analyzing the post-marketing surveillance data from the United States Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database for commonly used FFR guidewires. METHODS The MAUDE database was queried from January 2010 through April 2020 for 3 FFR guidewires [PressureWireTM X (Abbott), CometTM (Boston Scientific), and VerrataTM (Philips)] by searching for the following events: “Injury”, “malfunction”, “death”, and “other”. This yielded 544 reports. After excluding incomplete reports, 486 reports were analyzed. RESULTS Guidewire tip fracture was the most commonly reported mode of failure, in 174 (35.8%) cases followed by guidewire kinking (n =...

Proclivity of E-Reading Versus Printed Among Generation Z

Pakistan Journal of Rehabilitation, 2021

BACKGROUND In present era people use many digital learning resources for education purposes and f... more BACKGROUND In present era people use many digital learning resources for education purposes and for getting extra knowledge, it promote healthy environment and also convenience in contrast to printed material. This growing trend impact on cognition and understanding of the user differently. OBJECTIVE This study aims to determine the frequency of students who prefer reading on printed text or other digital text and its effects on reading approaches. METHODOLOGY This study included a total of 250 samples using a convenient sampling technique. This study was carried out at different Colleges of Rehabilitation Sciences with the age limit of 19-23 year. The data was obtained by self-designed questionnaire based on 15 close ended questions. RESULT 45.2% of the students prefer reading printed text while 17.2% of the students prefer digital text. Majority of the students choose availability 51.6% as the justification for preferring printed or digital text. For learning from gadgets 70.8% of...

Abstract 12042: The "Obesity Paradox" in Ambulatory Patients With Heart Failure With Preserved Ejection Fraction

Circulation, 2013

Background: The “obesity paradox”, wherein obesity is a risk factor for development of heart fail... more Background: The “obesity paradox”, wherein obesity is a risk factor for development of heart failure (HF) but is associated with better survival in HF, is well described in HF with reduced ejection fraction (HFrEF) and partly attributed to cardiac cachexia. However, cachexia is not usually associated with HF with preserved ejection fraction (HFpEF) and little is known about the existence of the paradox in HFpEF. Accordingly, we examined the prognostic significance of body mass index (BMI) on outcomes in HFpEF. Methods: We evaluated 2501 ambulatory patients with HFpEF from 153 VA healthcare facilities with 2-year follow-up. Kaplan Meier survival curves and Cox-proportional hazard models were used to examine the association of BMI with outcomes of mortality, HF hospitalization and all cause hospitalization. Results: In patients with HFpEF (age 71 ± 10 years, 91% males, 89% white), patients with higher BMI were significantly younger, had higher prevalence of hypertension, diabetes, and...

JPMA. The Journal of the Pakistan Medical Association, 2010

Existing standard treatment options for visceral leishmaniasis are less than optimal. We report h... more Existing standard treatment options for visceral leishmaniasis are less than optimal. We report here the use of oral miltefosine in the treatment of two paediatric cases of visceral leishmaniasis at a tertiary care hospital in Karachi, Pakistan. One patient came from Balochistan while the second patient was from Northern Pakistan. Both presented with a prolonged history of fever, massive hepatosplenomegaly, anaemia and thrombocytopenia. Visceral leishmaniasis was diagnosed with bone marrow studies. Amphotericin B was first started in the first patient; however severe hypokalaemia and allergic reaction occurred. Oral miltefosine was then administered. The child showed clinical improvement with regards to signs of leishmania infection but succumbed to a nosocomial infection during the hospital stay. In the second patient, miltefosine was started in the first instance. He showed remarkable clinical improvement. At 2 months follow-up, the child showed adequate weight gain along with suc...

The Journal of Internet Banking and Commerce, 2018

Liquidity risk Management is fundamental to sound banking practice. No doubt today all banking in... more Liquidity risk Management is fundamental to sound banking practice. No doubt today all banking institutions face countless risks such as liquidity risk which can cause failure of a banking system. Therefore, a proper risk management technique is necessary for the existence and the growth of banks. Therefore, the purpose of this study is to examine the effectiveness of risk management practice that is liquidity risk their impact on performance or Profitability of Islamic and conventional banks. Liquidity risk is measured by loan to deposit ratio, cash to total asset ratio. Performance measure proxies were ROE and ROA for both Islamic and Conventional banks. Data are panel from 2011-2015 which is taken from the financial reports of Islamic and conventional banks. Regression analysis has been used to extract the results. The result of this study concluded that how this liquidity risk will affect the bank performance in conventional and Islamic banks.

Under utilization of sick leave by the physicians - jeopardizing health care?

Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2011

Texas Heart Institute Journal

A 42-year-old man with a history of metastatic primary renal synovial sarcoma (PRSS) presented wi... more A 42-year-old man with a history of metastatic primary renal synovial sarcoma (PRSS) presented with 1-week history of dyspnea, ascites, and lower-extremity edema. He had undergone a radical nephrectomy a year before current presentation without any recurrence on surveillance imaging. Physical examination was notable for a grade II diastolic murmur heard best at the left lower sternal border, jugular venous distention, ascites, and lower-extremity edema. Basic laboratory data and 12-lead electrocardiogram were largely unremarkable. Computed tomography demonstrated a nonenhancing mass in the right atrium (RA) abutting into the right ventricle (RV) measuring 3.8 × 7.5 × 3.4 cm (Fig. 1A). In addition, there was a 1.7 × 4.2 × 2.1-cm soft tissue mass extending over the anterior aspect of the inferior vena cava within the prior nephrectomy bed, which was concerning for recurrence (Fig. 1B). An echocardiogram performed 8 months earlier had shown no evidence of an intracardiac mass. Subsequently, transthoracic echocardiography revealed a new large echogenic mass nearly filling the entire RA, prolapsing through the tricuspid annulus into the RV. It measured 6.9 × 3.2 cm (Fig. 2A). He was a poor candidate surgery and received salvage chemotherapy with doxorubicin and dacarbazine. On subsequent imaging, the mass had decreased in size to 4.8 × 2.8 cm (Fig. 2B, Fig. 3). His volume status also improved over the next few months. Comment A highly aggressive rare tumor, PRSS represents approximately 1% of all soft tissue tumors. 1,2 There has only been 1 reported case of PRSS associated with an intracardiac mass. Although that case had a similar presentation and imaging findings, it described

Screening for atrial fibrillation in the elderly: A network meta-analysis of randomized trials

European Journal of Internal Medicine

Aim: Renin is activated by the start of the beta-1 adrenoreceptor (β1-AR) in the kidney, which is... more Aim: Renin is activated by the start of the beta-1 adrenoreceptor (β1-AR) in the kidney, which is necessary to aid blood pressure. There can also be an improvement in the physiological and therapeutic consequences of β1-AR genetic diversity. We tried to test this speculation for the care of patients with critical hyperaldosteronism (n = 467). Methods: Segment and hemodynamic specifics were measured and a standard immunoassay was used for plasma renin. Our current research was conducted at Mayo Hospital, Lahore from March 2019 to February 2020. Participants were geneticized for Arg389Gly (rs1801253) and Ser49Gly (rs1801252) 2 human nucleotide base polymorphisms and in this context were the four possible β1-AR haplotypes. Results: In patients tested for hyperaldosteronism, in the Gly49 (49SS) allele conveyors (0.309 ± 0.04 vs 0.165 ± 0.05) plasma renin was elevated fundamentally. In these instances, the token pulse or pulse did not become parallels. Then again, in this meeting either the plasma renin or the pulse did not affect the polymorphism of Arg389Gly. In comparison, there was no documentation of the link between the two sites in this patient conference. Conclusion: This information indicates that the variance Ser49 of the polymorphic quality Ser49Gly β1-AR correlates higher renin levels with this information. However, these standard polymorphisms of β1-AR consistency have little effect on the pulse of a related accomplice.

Recommended Citation

in children at a tertiary care hospital of Karachi

Supernumerary, ectopic tooth in the maxillary antrum presenting with recurrent haemoptysis

Recommended Citation

Supernumerary, ectopic tooth in the maxillary antrum presenting with recurrent haemoptysis.

Journal of Accounting and Finance in Emerging Economies, 2021

Purpose: The research aims to analyze the particular quagmire of endogeneity by u panel data with... more Purpose: The research aims to analyze the particular quagmire of endogeneity by u panel data with the renowned challenge of limited periods. Design/Methodology/Approach: This study employed panel data generalized method of moments (GMM) approach. Findings: Results show a presence of a significant and a negative relationship between operational risk and management performance and returns, thereby emphasizing the importance of operational risk management for enhanced performance in light of the theory of performance frontiers introduced by Schmenner and Swink in 1998. Implications/Originality/Value: The results suggest that the focus on operational risk management should be revitalized if the firms seeks an improved performance and a sustainable competitive advantage.

International Journal of Obesity, 2020

Background Limited data exist on the association of obesity with both hospitalization and mortali... more Background Limited data exist on the association of obesity with both hospitalization and mortality in patients with heart failure with preserved ejection fraction (HFpEF), especially in the real-world ambulatory setting. We hypothesized that increasing body-mass index (BMI) in ambulatory heart failure with preserved ejection fraction would have a protective effect on these patients leading to decreased mortality and hospitalizations. Methods We studied the relationship between BMI and the time to all-cause mortality, time to heart failure (HF) hospitalization, and time to all-cause hospitalization over a 2-year follow-up in a national cohort of 2501 ambulatory HFpEF patients at 153 Veterans Affairs medical centers. Results Compared with normal BMI, overweight (HR 0.72; 95% CI 0.57-0.91), obesity class I (HR 0.59; 95% CI 0.45-0.77), obesity class II (HR 0.56; 95% CI 0.40-0.77), and obesity class III (HR 0.53; 95% CI 0.36-0.77) were associated with improved survival after adjustment for demographics and comorbidities. In contrast, the time to HF hospitalization showed an inverse relationship, with shorter time to HF hospitalization with increasing BMI compared with normal BMI; overweight (adjusted HR 1.30; 95% CI 0.88-1.90), obesity class I (HR 1.57; 95% CI 1.05-2.34), obesity class II (HR 1.79; 95% CI 1.15-2.78), and obesity class III (HR 1.96; 95% CI 1.23-3.12). However, time to first all-cause hospitalization was not significantly different by BMI groups. Conclusions In a large, national ambulatory HFpEF cohort, despite the presence of the obesity paradox with respect to survival, increasing BMI was independently associated with an increased risk of HF hospitalization and similar risk of allcause hospitalization. Future longer-term prospective trials evaluating the safety and efficacy of weight loss on morbidity and mortality, in patients with severe obesity and HFpEF are needed.

Racial disparities among Asian Americans with atrial fibrillation: An analysis from the NCDR® PINNACLE Registry

International Journal of Cardiology, 2021

BACKGROUND There is paucity of data on Atrial Fibrillation (AF) management and associated clinica... more BACKGROUND There is paucity of data on Atrial Fibrillation (AF) management and associated clinical outcomes among Asian Americans. This study sought to investigate baseline risk factor profiles, racial disparities in clinical management and adverse clinical outcomes among White and Asian Americans. METHODS We used National Cardiovascular Data Registry (NCDR®) Practice Innovation and Clinical Excellence (PINNACLE) registry and linked Centers of Medicare and Medicaid Services data to identify Asian and White patients with AF between January 1, 2013-June 30, 2018. We compared rates of baseline risk factors, management strategies (rate versus rhythm control), anticoagulation use and rates of adverse events between racial groups. The two race groups were compared using hierarchical multivariable adjusted regression models to account for site and confounders. RESULTS In total, 1,359,827 patients (18,793 Asians and 1,341,034 Whites) were included in our analysis. Compared to White Americans, Asian Americans were more likely to use a rate control strategy (Odds Ratio [OR]: 1.20, 95% Confidence Interval [CI]: 1.15-1.25) and lower odds of rhythm control strategy (atrial ablations, cardioversions, or use of antiarrhythmic drugs) (OR: 0.83, 95% CI: 0.80-0.87) in adjusted analysis. Use of oral anticoagulants and direct oral anticoagulants were similar. There were no significant race-based differences in likelihood of all-cause mortality, stroke, and bleeding requiring hospitalization. Analyses performed using propensity score matching were consistent with the main results. CONCLUSIONS Asian Americans with AF have a lower likelihood of being managed with rhythm control strategies. Overall use of OAC and AF related adverse events remain similar between the two racial groups.

Sensors, 2020

A multitude of smart things and wirelessly connected Sensor Nodes (SNs) have pervasively facilita... more A multitude of smart things and wirelessly connected Sensor Nodes (SNs) have pervasively facilitated the use of smart applications in every domain of life. Along with the bounties of smart things and applications, there are hazards of external and internal attacks. Unfortunately, mitigating internal attacks is quite challenging, where network lifespan (w.r.t. energy consumption at node level), latency, and scalability are the three main factors that influence the efficacy of security measures. Furthermore, most of the security measures provide centralized solutions, ignoring the decentralized nature of SN-powered Internet of Things (IoT) deployments. This paper presents an energy-efficient decentralized trust mechanism using a blockchain-based multi-mobile code-driven solution for detecting internal attacks in sensor node-powered IoT. The results validate the better performance of the proposed solution over existing solutions with 43.94% and 2.67% less message overhead in blackhole ...

American Journal of Preventive Cardiology, 2021

Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

DEBATE ARTICLE Open Access

Citeseer

Le-Niculescu H, Kuczenski R, Niculescu AB: Convergent functional genomics: a Bayesian candidate g... more Le-Niculescu H, Kuczenski R, Niculescu AB: Convergent functional genomics: a Bayesian candidate gene identification approach for complex disorders – Bertsch, CA, et al. ... SM, Salomon DR, Tsuang MT, Nurnberger JI Jr, Niculescu AB: Convergent Functional Genomics of bipolar ...

Journal of the American College of Cardiology, 2017

Background: Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by the presence... more Background: Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by the presence of severe thunderclap headache with diffuse segmental narrowing of cerebral arteries on imaging with or without neurological symptoms. Cardiac involvement is extremely rare, three reported cases of RCVS with concomitant transient cardiomyopathy in patients without CAD. Case: A 50-year-old Hispanic female with a past medical history of hypertension, diabetes mellitus, and multiple prior admissions for chest pain presented with one day of substernal chest pain. Over the course of three years, the patient has had multiple admissions for similar chest pain with an unremarkable cardiac work up including a coronary angiography, 2D transthoracic echocardiogram (TTE), and pharmacological stress test. On this admission, she reported 9/10 substernal chest pain, radiating to left shoulder and neck with diaphoresis, nausea, and dyspnea. Patient's cardiopulmonary and abdominal exam were unremarkable. Electrocardiogram (EKG) showed mild ST-depression in leads V5-V6, and serum troponin was elevated to 3.66 ng/mL. The patient was managed medically with complete resolution of chest pain. Repeat TTE and myocardial perfusion imaging were unremarkable. While preparing for discharge, the patient developed a thunderclap headache, and neurology was consulted. Cerebral angiography revealed diffuse vasoconstriction which resolved with verapamil infusion, consistent with a diagnosis of RCVS. Decision-Making: Given the new diagnosis of RCVS and likely associated coronary vasospasm, the patient was started on a calcium channel blocker to help relieve vasospasms. Diltiazem provided ultimate relief of her headache, and she has remained chest pain free without any additional hospitalizations for similar chest pain since. Conclusions: Although evidence suggesting systemic vascular involvement in RCVS is limited in literature, we hypothesize that our patient also had coronary vascular involvement. Segmental narrowing of coronary vessels similar to cerebral vasculature could explain the mechanism through which our patient developed symptoms of chest pain, EKG changes and troponin elevation.

Modes of failure with fractional flow reserve guidewires: Insights from the manufacturer and user facility device experience database

World Journal of Cardiology, 2021

BACKGROUND Fractional flow reserve (FFR) measurement is commonly used in the cardiac catheterizat... more BACKGROUND Fractional flow reserve (FFR) measurement is commonly used in the cardiac catheterization laboratory to assess the functional significance of coronary arterial plaques. Robust real-world data on complications and modes of failure of FFR guidewires are limited. AIM To characterize these outcomes by analyzing the post-marketing surveillance data from the United States Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database for commonly used FFR guidewires. METHODS The MAUDE database was queried from January 2010 through April 2020 for 3 FFR guidewires [PressureWireTM X (Abbott), CometTM (Boston Scientific), and VerrataTM (Philips)] by searching for the following events: “Injury”, “malfunction”, “death”, and “other”. This yielded 544 reports. After excluding incomplete reports, 486 reports were analyzed. RESULTS Guidewire tip fracture was the most commonly reported mode of failure, in 174 (35.8%) cases followed by guidewire kinking (n =...

Proclivity of E-Reading Versus Printed Among Generation Z

Pakistan Journal of Rehabilitation, 2021

BACKGROUND In present era people use many digital learning resources for education purposes and f... more BACKGROUND In present era people use many digital learning resources for education purposes and for getting extra knowledge, it promote healthy environment and also convenience in contrast to printed material. This growing trend impact on cognition and understanding of the user differently. OBJECTIVE This study aims to determine the frequency of students who prefer reading on printed text or other digital text and its effects on reading approaches. METHODOLOGY This study included a total of 250 samples using a convenient sampling technique. This study was carried out at different Colleges of Rehabilitation Sciences with the age limit of 19-23 year. The data was obtained by self-designed questionnaire based on 15 close ended questions. RESULT 45.2% of the students prefer reading printed text while 17.2% of the students prefer digital text. Majority of the students choose availability 51.6% as the justification for preferring printed or digital text. For learning from gadgets 70.8% of...

Abstract 12042: The "Obesity Paradox" in Ambulatory Patients With Heart Failure With Preserved Ejection Fraction

Circulation, 2013

Background: The “obesity paradox”, wherein obesity is a risk factor for development of heart fail... more Background: The “obesity paradox”, wherein obesity is a risk factor for development of heart failure (HF) but is associated with better survival in HF, is well described in HF with reduced ejection fraction (HFrEF) and partly attributed to cardiac cachexia. However, cachexia is not usually associated with HF with preserved ejection fraction (HFpEF) and little is known about the existence of the paradox in HFpEF. Accordingly, we examined the prognostic significance of body mass index (BMI) on outcomes in HFpEF. Methods: We evaluated 2501 ambulatory patients with HFpEF from 153 VA healthcare facilities with 2-year follow-up. Kaplan Meier survival curves and Cox-proportional hazard models were used to examine the association of BMI with outcomes of mortality, HF hospitalization and all cause hospitalization. Results: In patients with HFpEF (age 71 ± 10 years, 91% males, 89% white), patients with higher BMI were significantly younger, had higher prevalence of hypertension, diabetes, and...

JPMA. The Journal of the Pakistan Medical Association, 2010

Existing standard treatment options for visceral leishmaniasis are less than optimal. We report h... more Existing standard treatment options for visceral leishmaniasis are less than optimal. We report here the use of oral miltefosine in the treatment of two paediatric cases of visceral leishmaniasis at a tertiary care hospital in Karachi, Pakistan. One patient came from Balochistan while the second patient was from Northern Pakistan. Both presented with a prolonged history of fever, massive hepatosplenomegaly, anaemia and thrombocytopenia. Visceral leishmaniasis was diagnosed with bone marrow studies. Amphotericin B was first started in the first patient; however severe hypokalaemia and allergic reaction occurred. Oral miltefosine was then administered. The child showed clinical improvement with regards to signs of leishmania infection but succumbed to a nosocomial infection during the hospital stay. In the second patient, miltefosine was started in the first instance. He showed remarkable clinical improvement. At 2 months follow-up, the child showed adequate weight gain along with suc...

The Journal of Internet Banking and Commerce, 2018

Liquidity risk Management is fundamental to sound banking practice. No doubt today all banking in... more Liquidity risk Management is fundamental to sound banking practice. No doubt today all banking institutions face countless risks such as liquidity risk which can cause failure of a banking system. Therefore, a proper risk management technique is necessary for the existence and the growth of banks. Therefore, the purpose of this study is to examine the effectiveness of risk management practice that is liquidity risk their impact on performance or Profitability of Islamic and conventional banks. Liquidity risk is measured by loan to deposit ratio, cash to total asset ratio. Performance measure proxies were ROE and ROA for both Islamic and Conventional banks. Data are panel from 2011-2015 which is taken from the financial reports of Islamic and conventional banks. Regression analysis has been used to extract the results. The result of this study concluded that how this liquidity risk will affect the bank performance in conventional and Islamic banks.

Under utilization of sick leave by the physicians - jeopardizing health care?

Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2011