Background: Selective anthelmintic treatment, advocated due to evolving anthelmintic resistance, has been associated with an increase in Strongylus vulgaris prevalence. Reverting to routine interval anthelmintic treatments is not viable and therefore, identifying other management factors correlated with S. vulgaris infection is vital. Objectives: To investigate possible risk factors associated with the presence of S. vulgaris infection in residing horses on Swedish horse establishments. Study design: Internet-based questionnaire survey. Methods: A questionnaire, created using the internet-based survey platform Netigate, was distributed to owners of equine establishments throughout Sweden via established equine platforms and social media channels. The survey was available for response from May 21 until September 1 2022. Questions were closed ended with branching logic paths. Results: Four factors were significantly associated with S. vulgaris infection, with an increased odds of infection seen in livery yards (OR 1.67, 95% CI 1.18-2.36, p = 0.004) and premises with more than ten residing horses (OR 2.42, 95% CI 1.64-3.56, p < 0.001). A lower odds of infection was seen in establishments using quarantine routines (OR 0.69, 95% CI 0.50-0.96, p = 0.03) and anthelmintic treatment of new horses prior to arrival at the premise (OR 0.37, 95% CI 0.18-0.74, p = 0.005). Main limitation: Due to the presence of S. vulgaris infection in the present study being based on S. vulgaris diagnostics performed at the farm level, any association between faecal diagnostic use and risk of infection could not be investigated. Conclusions: Although the use of diagnostics for S. vulgaris can keep infection rates low, large farms or livery yards with many different horse owners, and those with low use of biosecurity measures as regards to new horses arriving at the premise, are associated with a higher risk of infection.

Background There are limited data on outcomes and complications of conjunctival pedicle grafts in horses. Objective Document the indications, complications and outcomes of conjunctival pedicle grafts in horses. Study Design Retrospective case series. Methods Review of case records of horses with corneal diseases managed using conjunctival pedicle grafts. History, clinical findings, treatments, complications, and outcomes were recorded. Results 26 horses were treated by conjunctival pedicle grafts over a 16 years period. The indications were deep corneal ulceration (n=9), non-healing superficial corneal ulceration (n=6), corneal stromal abscessation (n=5), corneal laceration (n=3) and keratomalacia (n=3). Short term complications occurred in 12 horses (46%), the commonest being necrosis of the graft (n=6); in 3 cases, the corneal lesion healed following debridement, but in 2 the affected eye required enucleation and one was euthanased. Keratomalacia and ulceration extending beyond the graft occurred in 3 horses, all of which were enucleated. Uveitis occurred in 6 horses (4 cases prior to discharge and 2 after discharge); enucleation was required in 5 of these horses. Phthisis bulbi occurred prior to discharge in one horse and after discharge in another. Two horses had decreased faecal output after surgery (one had caecal impaction). In 6/26 cases (23%) enucleation was required prior to hospital discharge. One horse was euthanased due to post-operative caecal impaction. The short-term success rate was 69%. Two horses (8%) required enucleation after discharge from the hospital and the long-term success rate was 58%. Main Limitations Small number of cases with variety of different diseases of varying severities. Conclusions Conjunctival pedicle grafts were successfully employed to treat several corneal diseases including chronic superficial corneal ulceration, deep corneal ulceration, corneal stromal abscesses, corneal lacerations and keratomalacia. The short-term success rate was 69%. Long-term follow-up indicated a good prognosis for most horses that had a successful short-term outcome.

Pollution from toxic spores has caused us a lot of problems, because spores are extremely resistant and can survive most disinfectants. Therefore, the detection of spore response to disinfectant is of great significance for the development of effective decontamination strategies. In this work, we investigated the effect of 0.5% sodium hypochlorite on the molecular and morphological properties of single spores of Bacillus subtilis using single-cell techniques. Laser tweezers Raman spectroscopy showed that sodium hypochlorite resulted in Ca 2+-dipicolinic acid release and nucleic acid denaturation. Atomic force microscopy showed that the surface of treated spores changed from rough to smooth, protein shells were degraded at 10 min, and the permeability barrier was destroyed at 15 min. The spore volume decreased gradually over time. Live-cell imaging showed that the germination and growth rates decreased with increasing treatment time. These results provide new insight into the response of spores to sodium hypochlorite.

Background: International oral health policy directions led by the World Health Organization call for the inclusion of oral health within universal health coverage. The aim of this study is to perform a budget impact analysis of a policy option for a more cost-efficient oral health workforce skill-mix (dentists and oral health therapists) to provide public oral healthcare in Victoria, Australia. Methods: Two hypothetical standard care pathways were developed. A dynamic population Markov model was generated in TreeAge software, with a time horizon of six years. Two scenarios were modelled to determine: 1) base-case scenario: the threshold the dentist workforce could reduce per year, while achieving the same service delivery outputs, and 2) alternative scenario: the potential cost-savings for utilising an optimally cost-efficient oral health workforce skill-mix. Results: The threshold analysis showed a minimum reduction of 13% of the dentist workforce being replaced with oral health therapists can occur without having any impact on the same service delivery outputs. Under the alternative scenario, the potential cost-savings would be AUD$1,425,037 (SD 58,954). Conclusions: Governments and policy-decision makers should consider strategies in training, attracting, and retaining oral health therapists to achieve an optimally cost-efficient oral health workforce skill-mix when delivering public oral healthcare.

A document by Yanjun Feng. Click on the document to view its contents.

This letter introduces an innovative approach for minimizing energy consumption in multi-UAV (Unmanned Aerial Vehicles) networks using Deep Reinforcement Learning (DRL), with a focus on optimizing the Age of Information (AoI) in disaster environments. We propose a hierarchical UAV deployment strategy that facilitates cooperative trajectory planning, ensuring timely data collection and transmission while minimizing energy consumption. By formulating the inter-UAV network path planning problem as a Markov Decision Process (MDP), we apply a Deep Q-Network (DQN) strategy to enable real-time decision-making that accounts for dynamic environmental changes, obstacles, and UAV battery constraints. Our extensive simulation results, conducted in both rural and urban scenarios, demonstrate the effectiveness of employing a memory access approach within the DQN framework, significantly reducing energy consumption up to 33.25\% in rural settings and 74.20\% in urban environments compared to non-memory approaches. By integrating AoI considerations with energy-efficient UAV control, this work offers a robust solution for maintaining fresh data in critical applications, such as disaster response, where ground-based communication infrastructures are compromised. The use of replay memory approach, particularly the online history approach, proves crucial in adapting to changing conditions and optimizing UAV operations for both data freshness and energy consumption.

A document by Sevil Gaffarzadeh rad . Click on the document to view its contents.

Background: Near-misses are errors that have the potential to cause an adverse event but fail to do so because of chance or because they are intercepted. By 2021, Sri Lanka had only established systems for maternal and blood transfusion services. Methods: A new, holistic near-miss reporting system was developed and piloted at a large tertiary hospital in 2022 to guide subsequent nationwide implementation. During the pre-interventional phase, national-level consultative meetings (n=20), key informant interviews (n=10) and focus groups (n=22) were convened with purposively selected representatives of professional colleges, academia, medical administrators, and senior staff of the participating hospital to identify existing methods of reporting near-misses. A near-miss reporting format and guidelines were designed with input from national-level consultative meetings. Training on the new system for medical and nursing officers, periodic reminders to staff, and dissemination of preventive measures for patient safety incidents were implemented as interventions. A pre-post evaluation was conducted to identify the effect of the new system, and stakeholders’ views on potential for nationwide implementation. Results: Eight near-misses were reported three months following implementation, compared to none prior to implementation. Study participants expressed satisfaction with the new system’s user-friendliness, clarity, non-punitiveness, voluntary nature, and confidentiality protection. The system was perceived to be suitable for national implementation following refinements. Conclusions: This evidence-based near-miss reporting system, combined with the complementary activities implemented in the pilot setting, should now be introduced into additional hospitals before national implementation to further enhance its design, support from stakeholders, and quality and safety impact.

Kwestia pokojowego rozstrzygania sporów między państwami ma kluczowe znaczenie w prawie międzynarodowym i porządku międzynarodowym. Jak słusznie zauważa Wojciech Stankiewicz, chęć zachowania pokoju zmusza do działań, których istotą jest ograniczenie lub rozwiązanie sporów i uniemożliwienie przekształcenia się ich w konflikt zbrojny. W podpisanej dnia 26 czerwca 1945 r. w San Francisco Karcie Narodów Zjednoczonych. znajduje się rozdział VI "Pokojowe załatwianie sporów" (Chapter on Pacific Settlement of Disputes). Zgodnie z treścią zawartego w rozdziale VI art. 33 ust. 1: "Strony w sporze, którego dalsze trwanie może narazić na niebezpieczeństwo utrzymanie międzynarodowego pokoju i bezpieczeństwa, powinny przede wszystkim dążyć do jego rozstrzygnięcia w drodze rokowań, badań, pośrednictwa, koncyliacji, arbitrażu, postępowania sądowego, odwołania się do organów lub porozumień regionalnych, albo innymi sposobami pokojowymi stosownie do swego wyboru". Art. 33 ust. 1 Karty Narodów Zjednoczonych nie wspomina na temat procedury "dobrych usług", jednak mowa jest w nim o "innych pokojowych sposobach" rozstrzygania sporów. Katalog środków regulowania sporów, który został zawarty w art. 33 Karty Narodów Zjednoczonych, jest jednak otwarty. Celem niniejszego artykułu jest przedstawienie instytucji dobrych usług oraz wskazanie przykładów zastosowania dobrych usług przez państwa w polityce zagranicznej. Poruszona kwestia będzie wymagała analizy normatywnej kluczowych przepisów prawa międzynarodowego, zawartych w dwóch konwencji haskich z 1899 r. i 1907 r., które dotyczą pokojowego załatwiania sporów międzynarodowych. W opracowaniu posłużono się głównie metodami: prawnohistoryczną i formalno-dogmatyczną. (...)

A document by Oliva Henintsoa RAKOTONIRAINY. Click on the document to view its contents.

Aim: The anti-TNF antibody Infliximab (IFX) has therapeutic efficacy in rheumatoid arthritis (RA). However, some patients do not respond. We aimed to identify factors associated with IFX exposure, of clinical response, and of the response at immunologic level. Methods: We performed a prospective observational study of repeated measures in patients with RA treated with IFX from July 2014 to August 2020 at Bellvitge University Hospital. For IFX exposure, we measured IFX trough concentrations (Cmin), and antibodies towards IFX (ATI). For the clinical response we evaluated the Disease Activity Score-28 for Rheumatoid Arthritis using erythrocyte sedimentation rate (ESR) (DAS28-ESR) and C-reactive protein (CRP) (DAS28-CRP). For the immunologic response, we determined total serum concentration of TNF, and IL-6. Finally, we performed a mixed-effects analysis to determine factors associated with IFX Cmin, clinical response and IL-6 and TNF concentrations. Results: We collected a total of 120 samples cor-responding to 22 patients. IFX Cmin were associated with ATI presence and serum IL-6. DAS28-ESR was associated with sex, ESR, CRP, and serum IL-6 influenced DAS28-ESR. Finally, IL-6 concentration was associated with ESR and CRP, and TNF concentration with CRP, IFX Cmin, and IL-6 concentration. Conclusions: IFX Cmin was highly associated with the presence of ATI. IFX Cmin significantly contributed to TNF serum concentrations in patients with undetectable ATI and IL-6 concentration, which in turn was associated with serum TNF and DAS28-ESR score. Additional population pharmacockinetic analysis with rich sampling are warranted to confirm our results.

Background: COVID-19 has imposed significant burden on healthcare systems worldwide. The need for simple, rapid, and affordable diagnostic tests to support the existing costly and demanding polymerase chain reaction (PCR) assay is very necessary. Methods: This study evaluated the performance characteristics of three (3) COVID-19 rapid antigen test kits: DG Rapid, SD Rapid and SS Rapid. They were compared with the gold standard real-time reverse transcriptase- PCR (rRT-PCR) for the detection of SARS-CoV-2 nucleocapsid antigen in 75 archived samples. Results: Of the 75 samples tested, 38 (50.7%) were positive and 37 (49.3%) were negative for SARS-CoV-2 RNA by rRT-PCR assay. No false positive was recorded. The DG Rapid kit detected 30 (78.9%) true positives and 8 (21.1%) false negatives. SD Rapid kit detected 28 (73.7%) true positives and 10 (26.3%) false negatives, while the SS Rapid kit detected 19 (50.0%) true positives and 19 (50.0%) false negatives. Specificity of each test kit was 100% (CI 95%), but the sensitivity of the DG Rapid, SD Rapid, and SS Rapid kits was 79%, 74%, and 50% (CI 95%), respectively. Higher sensitivities among samples with Ct values <29.99 were recorded for each kit. Also, the DG Rapid kit demonstrated 79% excellent agreement with rRT-PCR, while the SD Rapid and SS Rapid kits demonstrated good agreement with rRT-PCR with 73% and 50% Cohen’s kappa values, respectively. Conclusion: The study suggests that DG Rapid and SD Rapid kits are reliable alternatives to rRT-PCR for the detection of SARS-CoV-2 infection, especially in resource-limited settings like Ghana.

A document by Miles Weinberger. Click on the document to view its contents.

Video human action recognition is an important academic issue, and due to the challenges involved in the problem, such as complex scenes, large changes in spatial scale, and irregular deformation of the identified targets, the algorithm generally has some shortcomings such as large parameter quantities and high computational costs. This paper proposes a new computing framework based on lightweight deep learning models, using time-domain Fourier transform to generate motion salience maps to highlight human motion areas in feature extraction in which video intrasegment and inter-segment Feature differences at different time scales are used to obtain action information at different time granularity, to conduct more accurate action model of the human action with varying spatio-temporal scales. Additionally, an action excitation method based on the deformable convolution is proposed to solve problems of irregular deformation, spatial multi-scale changes, and the loss of underlying information as the network depth increases. Data experiments are proposed to verify the effectiveness of the proposed algorithm in terms of computational efficiency and accuracy.

Peach Leaf Curl Disease, caused by the fungus Taphrina deformans, is characterized by reddish hypertrophic and hyperplasic leaf areas. To comprehend the biochemical imbalances caused by the disease an integrated approach including metabolomics, lipidomics, proteomics and complementary biochemical techniques was undertaken. Symptomatic and asymptomatic areas were dissected from leaves with increasing extension of the disease. A differential metabolic behaviour was identified in symptomatic areas with respect to either asymptomatic areas or healthy leaves. Symptomatic areas showed an altered chloroplastic functioning and composition which includes decrease in the photosynthetic machinery, alteration in plastidic lipids, and decreased starch, carotenoid and chlorophyll biosynthesis. In symptomatic areas, decreases in chloroplast redox-homeostasis proteins and in triacylglycerols double bond index were observed. Proteomic data revealed an up-regulation of phenylpropanoid and mevalonate pathways and down-regulation of the plastidic methylerythritol phosphate route. Amino acid pools were affected, with up-regulation of proteins involved in asparagine synthesis. Curled areas exhibited a metabolic shift towards functioning as a sink tissue importing sugars and producing energy through fermentation and respiration and reductive power via the pentose phosphate route. As the disease progresses, reduced asymptomatic areas and healthy leaves diminishes photosynthates production thereby limiting fruit production and ultimately tree survival.

Pediatric secondary Chronic myelogenous leukemia in a patient with Hemophagocytic lymphohistiocytosis carrying UNC13D,LYST and ITK variantChengshuang Huang1, 2, 3 Pei Huang1, 3 Xi Luo1, 3 Zhixu He1, 3 Yan Chen1, 31Department of Pediatrics, Affiliated Hospital of Zunyi Medical University, Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine, Zunyi Medical University, Zunyi, 563000, China2Department of Emergency Medicine, West China Second University Hospital, Sichuan University, Chengdu, 610041, PR China3Department of Pediatrics, Guizhou Children’s Hospital, Zunyi, 563000, ChinaAddress correspondence to: Yan Chen, MD, The Second Department of Pediatrics, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, Guizhou, 563000, China, cyz600@163.com, +86-0851-28608293Short title: Pediatric secondary CML in a patient with HLHKeywords: Hemophagocytic lymphohistiocytosis; Secondary CML; Chemotherapy; Genetic screeningText: 839 wordsNumber of Tables: 1

Spontaneous tumour regression is a well-recognised phenomenon in infantile favourable-biology neuroblastoma. An ‘expectant-observation’ strategy avoids chemotherapy or surgery associated risks but has mostly been limited to small tumours (diameter < 5 cm) and discontinued if significant tumour growth or increasing catecholamine levels. Here we report the successful use of an observation-only strategy in an infant with unresectable neuroblastoma > 5 cm at diagnosis which initially tripled in size with a 10-fold increase in urinary catecholamines. We highlight the need for consensus evidence-based criteria to define the subgroup where a ‘wait-and-see’ approach is appropriate and criteria to begin active treatment.

Modern vehicles are equipped with hundreds of ECUs deployed across vehicle networks. Each ECU runs a variety of safety and cyber-critical workloads which is facing an increasingly challenging cybersecurity climate, which is being driven by various factors such as vehicle system complexity, software complexity, supply chain complexity and an increase in wireless interfaces. With these challenges, the automotive sector is a perfect domain for the use of Security-by-Design and secure hardware technologies. In this paper, we demonstrate the application of Security-by-Design and the secure hardware Morello, one of the CHERI implementations, in the design and implementation of Telematic Control Units (TCU), a crucial component of modern vehicles. This results in a generic secure TCU design with well-justified security requirements and an understanding of the risks associated with it. As such, this work paves the way for the systematic integration of secure hardware for cyber-physical systems, of which automotive is just one application.

Objective: The most prevalent malignancy that complicates both adult and pediatric solid organ transplantation is post-transplant lymphoproliferative disorder (PTLD). This study aimed to analyze the clinical and pathological characteristics, treatments, and outcomes of EBV viremia and PTLD in pediatric liver transplant recipients. Method: A retrospective chart review was performed on 112 patients less than 18 years of age who underwent isolated orthotopic liver transplantation (OLT) between 2010 and 2022 at Ege University Children’s Hospital. Data gathered for 1-year post-OLT included age at OLT, EBV, immunoglobulin (Ig)M/IgG status of the donor and recipient, indication for OLT, induction regimen, all immunosuppression levels, date and result of EBV polymerase chain reaction (PCR) testing, rejection episodes documented by liver biopsy, and the development of PTLD. Result: Forty-nine patients (43.75%) developed EBV viremia (median interval from surgery: two months, min-max 2-36), of which 43 (87.8%) grafts came from living donors, and 6 (12.2%) came from deceased donors. Nine (18.4%) patients died during follow-up, and eight (16.3%) developed PTLD. Five patients developed EBV-related disease; one child developed hemophagocytic lymphohistiocytosis; one developed aplastic anemia; and one child developed B cell lymphoma. When PTLD patients and without-PTLD patients were compared, pediatric intensive care unit hospitalization, abnormal bone marrow biopsy findings, lymphadenopathy, age at diagnosis of EBV viremia, EBV viral load, tacrolimus (FK 506) pre-infection, and 1-month levels were higher in patients with PTLD (p<0.05). In logistic regression analysis, we showed that the age at diagnosis of EBV viremia was significantly higher in children with PTLD (p=0.045; OR, 1.389; 95% CI, 1.007-1.914). Discussion PTLD is a rare but severe complication associated with EBV after OLT. This study demonstrated that PTLD is associated with older age, higher tacrolimus blood levels before EBV viremia, at one month of EBV viremia, and higher peak EBV viral load.

The clinical presentation of Mpox (monkeypox) resembles that of several other sexually transmitted infections. Although cases of Mpox are thought to be overlooked in the clinical setting, no study has investigated whether this is the case in Japan. In this study, we retrospectively screened suspected cases of syphilis to investigate overlooked cases of Mpox in Japan. We retrospectively analyzed 88 saliva samples and 78 whole blood samples from 88 patients treated in general internal medicine and infectious disease clinics. Molecular diagnostic testing revealed Mpox virus DNA in the saliva and blood samples of 1 patient with suspected primary syphilis in April 2023. This case was retrospectively diagnosed as Mpox. The findings of this study indicate that health care providers should be aware of Mpox as a differential diagnosis in patients with sexually transmitted infections. Improved access to molecular diagnostic testing may reduce the risk of overlooked cases of Mpox. Retrospective screening using saliva samples could help to increase opportunities to intervene against Mpox transmission.

Case ImageSpontaneous neck hematoma associated with parathyroid adenoma1Mitsumasa Okano, MD, PhD, 2Mitsuko Yui, MD, PhD,2Masanori Teshima, MD, PhD,1Kazuhiko Sakaguchi, MD, PhD1Division of General Internal Medicine, Department of Internal Medicine,2Department of Otolaryngology-Head and Neck Surgery,Kobe University Graduate School of MedicineCorresponding author: Mitsumasa Okano, Division of General Internal Medicine,Department of Internal Medicine, Kobe University Graduate School of Medicine7-5-1, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.Tel:+81-78-382-6596, Fax:+81-78-382-6597E-mail: mokano@med.kobe-u.ac.jpKey words: acute neck pain, neck hematoma, parathyroid bleeding, parathyroid adenoma

This research explores the experience of people living with leprosy at leprosy settlements in Nigeria. This is a concurrent mixed methods design whereby questionnaires, focus groups and interviews are conducted simultaneously. Seven leprosy communities were visited, one from Nigeria’s six geographical zones and the Federal capital area. This study included 35 leprosy patients, 21 family members, seven community leaders, and seven officers in charge of the leprosy settlements. Also questioned were two heads of organisations involved with leprosy control in Nigeria. Majority (93.7%) of the respondents have access to healthcare in the health centres. Majority (95.2%) are interested in learning self-care practices for skin-related neglected diseases. About three-fourths (74.6%) receive free healthcare and accent that PLWL are admitted into the same ward as other patients. Whilst funding is a growing concern for leprosy control, the data from the interview confirmed that there is little support from the government but more from non-governmental organisations and implementing partners in Nigeria for people living with leprosy. Experts demonstrated that leprosy now ranks high among neglected diseases. The Nigerian government must work with partners to ensure the improvement and sustainability of leprosy control programs.

1 IntroductionMalignant ovarian germ cell tumor (MOGCT), a rare form of ovarian malignancy, predominantly affects adolescents and young women of reproductive age [1, 2]. This group of ovarian cancers includes various subtypes, including dysgerminoma, yolk sac tumors, embryonal carcinoma, non-gestational choriocarcinoma, mixed germ cell tumors, and immature teratomas, each with distinct characteristics [3-5]. Dysgerminoma, akin to male seminoma, represents the most prevalent histological variant and immature teratoma and is associated with relatively high bilaterality rates [4, 6, 7].Platinum-based chemotherapy regimens have proven effective in extending survival and preserving fertility [1, 8]. Given the chemosensitivity of these tumor cells, fertility-sparing surgery (FSS) has become a preferred treatment approach, particularly in patients desiring to preserve their reproductive capability. FSS, which involves complete staging and the preservation of at least the uterine corpus and a portion of one ovary, has emerged as the primary treatment modality in patients with early-stage MOGCT [8-10]. However, a couple of studies in which the potential risks of FSS use have been extensively discussed have stated that FSS use can be justifiable in advanced-stage MOGCT patients [10, 11].Menstrual and reproductive outcomes in patients who survived MOGCT are reportedly similar to those of age-matched healthy women [1, 12]. Ovarian function is typically restored following three or four cycles of platinum-based therapy [12]. However, fertility rates vary significantly, including among patients with advanced MOGCT [2, 8, 11].In this context, in this case study, an advanced MOGCT patient who underwent complete staging and was treated with FSS coupled with adjuvant cisplatin-based chemotherapy and still achieved spontaneous pregnancy is presented.

Studies conducted in recent years have demonstrated the positive effects of sacubitril/valsartan and dapagliflozin on cardiac prognosis and performance. These drugs can potentially be abused as doping agents by professional athletes. In our study, we evaluated the effects of sacubitril/valsartan and dapagliflozin on athletic performance. In the study, the swimming performances of three groups of rats were evaluated by dividing them into control, sacubitril/valsartan and dapagliflozin groups. Additionally, echocardiography, weight and rotarod data were evaluated during follow-up. In the comparison of sacubitril/valsartan and control groups, a statistical difference was seen in the 13th, 19th and 20th swimming sessions, and when the total and average swimming times were compared, the p values were 0.115 and 0.015. In the comparison of dapagliflozin and control groups, a statistical difference was observed starting from the 10th swimming session, and when the total and average swimming times were compared, the p values were <0.001 and <0.001. In triple analysis, a statistical difference was seen from the 9th swimming session until the end of the experiment. Furthermore, a statistical difference was observed in rotarod results for sacubitril/valsartan and dapagliflozin compared to baseline. (p value <0.001 and 0.011 respectively) Our study showed a limited positive effect of sacubitril/valsartan on athletic performance. The impact of dapagliflozin on athletic performance was shown to be particularly significant.