The stress that the COVID-19 pandemic has placed on health systems internationally has forced difficult decisions concerning the rationing of medical care and has put the bioethical structures that inform those choices under scrutiny. Often, ethical approaches to pandemic circumstances center around utilitarianism, dehumanizing the treatment process and ignoring the plurality of other philosophical doctrines that inform non-Western bioethics, which could be of use in addressing the pandemic. This paper focuses on philosophical Taoism, as developed in the Tao Te Ching and Zhuangzi, in order to suggest an alternative approach to medical care when medical capacity is limited, grounded in the concept of wu-wei, or inaction.

The Kimny guiding catheter is a single universal guiding catheter used for performing percutaneous coronary intervention (PCI) in both the right coronary artery (RCA) and the left coronary artery (LCA). Although this guiding catheter has been shown to yield high procedural success rates in nonemergent conditions, its feasibility for patients with ST-segment elevation myocardial infarction (STEMI) remains unknown and therefore needs to be further investigated.

We retrospectively enrolled 62 consecutive STEMI patients who underwent primary PCI using the Kimny guiding catheter from January 2016 through December 2017. We then evaluated the rates of engagement and procedural success for PCI of the LCA and RCA with the Kimny guiding catheter.

Primary PCI of the infarct-related artery (IRA) by means of the Kimny guiding catheter proved to be successful in 61 of the STEMI patients (98.3%). Besides, the procedural success rate was found to be 100% (44/44) for the LCA and 94.4% (17/18) for the RCA (

= 0.293). With regard to contralateral (non-IRA) angiography, engagement rates of 97.4% (38/39) and 100% (18/18) were obtained for the RCA and LCA, respectively, (

= 1.0). No coronary artery ostial dissection was observed during the procedures. The mean number of total catheters used for each patient turned out to be only 1.035.

Using the Kimny guiding catheter for primary PCI is feasible and results in high procedural success rates, particularly for the treatment of the LCA, with fewer catheters, and at a lower cost.

Using the Kimny guiding catheter for primary PCI is feasible and results in high procedural success rates, particularly for the treatment of the LCA, with fewer catheters, and at a lower cost.

The causes of pancytopenia vary in different populations depending on age, gender, nutrition, geographic location, standard of living, and exposure to certain infections and drugs. As the severity of pancytopenia and its underlying etiology determine the management and prognosis, identifying the correct etiology in a given case is crucial and helps in implementing timely and appropriate treatment. The objectives of this study were to study the clinical profile and hematological parameters of pancytopenic adults and to identify different etiologies of pancytopenia. This observational study was conducted in the Medicine department of a tertiary care teaching hospital.

The study was conducted on 100 adult patients aged 18-65 years presenting with pancytopenia. All the participants were subjected to detailed clinical examination and relevant investigations including bone marrow (BM) examination. Categorical variables were presented in number and percentage (%). Qualitative variables were correlated using the ating timely treatment as a significant number of causes of pancytopenia are potentially curable.

The intima-media thickness (IMT) of the carotid artery can now be detected on a three-dimensional (3D) plane. The 3D vessel wall volume (VWV) more accurately represents vascular conditions. Through 3D ultrasound, we established a standardized method for carotid VWV measurement.

A total of thirty patients without stroke or cardiovascular disease who received carotid duplex sonography were retrospectively reviewed. Gray-scale 3D images from the distal common carotid artery (CCA) to internal carotid artery on both sides were acquired using a single-sweep 3D transducer and analyzed offline by using the vascular plaque quantification function of the Philips QLAB software. Then, the 3D IMT(QLAB intima-media thickness [QIMT]), total plaque volume (TPV), and VWV were measured by a neurologist and a technician, and the interobserver variability was assessed.

The mean two-dimensional (2D) carotid IMT was 0.65 ± 0.12 mm. The mean QIMT, TPV, and VWV measured by observer 1 were 0.68 ± 0.18 mm, 26 ± 12 mm

, and 94 ±ility (ICC = 0.90). The VWV 1 cm from the CCA bifurcation was quantified with a mean value of 94.2 mm3. Further studies on the 3D ultrasound quantification of carotid arteries are warranted.

The bone quantity and quality determine the prosthetic success outcome. This research was performed to evaluate the bone density for insertion of pterygoid implants in edentulous and dentulous participants with cone-beam computed tomography (CBCT).

CBCT evaluation was done for 66 dentate and edentulous patients for pterygoid implants at the pterygomaxillary region. The calculation of joint width, height, and volume of bone was done. Density of the bone was evaluated at the superior and inferior aspects of the pterygomaxillary column.

It was observed that average pterygomaxillary joint height for dentulous (dentate) was -12.7 ± 7.2 mm, edentulous -12.4 ± 7.1 mm, the average pterygomaxillary joint width for dentulous was 8.15 ± 7.3 mm, and 8.13 ± 6.2 mm for edentulous. The average pterygomaxillary joint volume in dentulous participants was 279.4 ± 189.2 mm

and for edentulous was 254.5 ± 176.4 mm

. There was expressively greater density of the bone in dentulous participants over edentulous participants (

< 0.05).

There was better bone density found in dentate participants in comparison to edentulous participants. CBCT is a recent investigative device which measures pterygoid area efficiently. Pterygoid implants may be deliberated as an alternative method for resorbed (atrophic) maxilla.

There was better bone density found in dentate participants in comparison to edentulous participants. CBCT is a recent investigative device which measures pterygoid area efficiently. Pterygoid implants may be deliberated as an alternative method for resorbed (atrophic) maxilla.

Angiopoietin-like protein 3 (ANGPTL3) regulates triglyceride metabolism by reversibly inhibiting the lipoprotein lipase activity. Metabolic syndrome (MetS) is an independent risk factor for further cardiovascular disease. This study evaluated the relationship between the fasting serum ANGPTL3 levels and MetS in patients with coronary artery disease (CAD).

Fasting blood samples were obtained from 90 patients with CAD. Serum ANGPTL3 levels were measured using a commercial enzyme-linked immunosorbent assay kit. MetS and its components were defined using the diagnostic criteria of the International Diabetes Federation.

Fifty-three patients (58.9%) had MetS. The hypertension (

= 0.001), diabetes (

< 0.001), body weight (

= 0.027), body mass index (

= 0.001), waist circumference (

< 0.001), systolic blood pressure (

= 0.001), fasting glucose (

< 0.001), triglycerides (

< 0.001), blood urea nitrogen (

= 0.044), C-reactive protein (

= 0.010), insulin (

= 0.040), homeostasis model assessment of insulin resistance (

= 0.002), and ANGPTL3 level (

= 0.001) of CAD patients who had MetS were higher, and the high-density lipoprotein cholesterol (

= 0.001) and estimated glomerular filtration rate (

= 0.016) were lower. A binary logistic regression analysis of the significant variables also revealed that the ANGPTL3 level (odds ratio 1.023, 95% confidence interval 1.008-1.038,

= 0.002) was an independent predictor of MetS in patients with CAD.

The results of our study indicated that the fasting ANGPTL3 level was positively associated with MetS among patients with CAD.

The results of our study indicated that the fasting ANGPTL3 level was positively associated with MetS among patients with CAD.

Urinary tract infection (UTI) symptoms recurrence is common with estimated rate of 30%-50% within 1 year. The study aimed to evaluate the potential risk factors for symptoms UTI recurrence in women at outpatient clinic in a prospective fashion.

This study was conducted from July 1, 2016, to June 30, 2019. Women who visited urological clinics with symptoms suggestive of UTI were invited to fill the questionnaire including baseline characteristics and Urinary Tract Infection Symptom Assessment questionnaire. Mid-stream urine samples of the participants were collected for urine analysis and urine culture. Phone interviews were done at 12 months’ postclinic visit to inquire if the participants have any episode of UTI symptoms recurrence during the period of time.

Among the 188 eligible patients, 183 patients (age = 50.0 ± 15.3 years old) were included in the analysis. There were 44 (24%) participants had UTI symptoms recurrent episodes during the 12-month follow-up. Further multivariate analysis revealed that menopause (odds ratio [OR] = 4.89, 95% confidence interval [CI] = 1.63-14.68,

= 0.005), history of UTI-related symptoms within 1 year before the episode OR = 3.79, 95% CI = 1.29-11.15,

= 0.016) and

infection (OR = 4.81, 95% CI = 1.51-15.28,

= 0.008) were significant risk factors for UTI symptoms recurrence during the 12 months’ follow-up.

Menopause, history of UTI-related symptoms within 1 year before this episode of UTI and

infection in 12 months were potential risk factors for UTIs symptoms recurrence in women.

Menopause, history of UTI-related symptoms within 1 year before this episode of UTI and E. coli infection in 12 months were potential risk factors for UTIs symptoms recurrence in women.

Myostatin is a myokine predominantly expressed and secreted in skeletal muscle in response to stimulations, including oxidative stress or inflammation. We investigated a potential association between myostatin levels and endothelial function among kidney transplantation (KT) patients.

Fasting blood samples were collected from 64 KT patients. The endothelial function that indicated by vascular reactivity index (VRI) was measured by digital thermal monitoring test. Serum myostatin levels were measured using a commercial enzyme-linked immunosorbent assay kit. All patients were categorized into three groups according to their VRI values poor vascular reactivity was considered if VRI <1.0; 1.0 ≤VRI <2.0 indicated intermediate vascular reactivity, and VRI ≥2.0 was grouped as good vascular reactivity.

Seven KT patients (10.9%) were categorized as poor vascular reactivity, 24 KT patients (37.5%) were grouped as intermediate vascular reactivity, and 33 KT patients had good vascular reactivity. Advanced age (

= -0.372,

= 0.002) and serum alkaline phosphate (ALP) level (

= -0.341,

= 0.006) were negatively correlated with VRI. However, serum myostatin level (

= 0.430,

< 0.001) was positively correlated with VRI. In multivariable forward stepwise linear regression analysis, high serum level of myostatin (β = 0.441, adjusted

change = 0.171;

< 0.001), advanced age (β = -0.317, adjusted

change = 0.138;

= 0.003), and serum ALP level (β = -0.270, adjusted

change = 0.060;

= 0.011) were significantly associated with VRI in KT patients.

Our study showed that fasting myostatin level was positively associated with VRI and endothelial function among KT patients.

Our study showed that fasting myostatin level was positively associated with VRI and endothelial function among KT patients.