Cardiac Remodeling and Functional Changes in Patients With Hypertrophic Cardiomyopathy: A Longitudinal Observational Study.

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is a hereditary cardiac disorder characterized by abnormal thickening of the left ventricular myocardium. This can lead to various clinical manifestations, including sudden death. AIM: To investigate the cardiac remodeling and functional changes in patients with HCM over a specific time period and explore the impact of different treatment regimens on disease progression. METHODS: We conducted a prospective longitudinal observational study involving 100 patients diagnosed with HCM. Baseline clinical data, including demographics, medical history, and echocardiographic measurements, were collected. Follow-up assessments were performed at regular intervals over 24 months to track changes in cardiac structure, function, and clinical status. Statistical analysis, including paired t-tests and subgroup analysis, was conducted to identify significant associations and differences between treatment groups. RESULTS: A total of 100 patients (mean age = 55 years, 50% male) were enrolled in the study. At baseline, echocardiography revealed increased left ventricular wall thickness (mean = 18.5 mm), left atrial dimensions (mean = 39 mm), and ventricular mass (mean = 230 g). During the follow-up period, there was a progressive increase in left ventricular wall thickness (mean change = 1.0 mm/year, p < 0.001), left atrial dimensions (mean change = 3.0 mm/year, p < 0.001), and ventricular mass (mean change = 8 g/year, p = 0.003). Additionally, alterations in diastolic and systolic function parameters were noted, with a decline in E/A ratio (mean change = -0.1 units/year, p = 0.008) and a reduction in ejection fraction (mean change = -2.0% per year, p = 0.001). CONCLUSION: Our longitudinal observational study provides important insights into the cardiac remodeling and functional changes in patients with HCM over time. The progressive increase in cardiac parameters indicates ongoing disease progression. Additionally, beta-blocker therapy was associated with a slower rate of left ventricular wall thickening. These findings contribute to a better understanding of HCM's natural history and may guide targeted therapeutic approaches to improve patient outcomes.

Impact of oral conditions on oral health-related quality of life among Indians- a systematic review and Meta-analysis.

OBJECTIVE: This review assessed the impact of oral conditions on Oral Health Related Quality of Life among Indians. METHODS: Databases, including PubMed and Scopus, CINAHL, Web of Science, PsycInfo were systematically searched for English Language studies conducted among Indians up to July 2022. Two independent reviewers assessed studies selected for retrieval for methodological quality using standardised quality assessment instruments for analytical cross-sectional studies in JBI SUMARI. RESULTS: Fourty one publications were included in this review (N = 23,090). Studies includes both cross sectional study and Randomized Controlled Trials. Based on the JBI critical appraisal tools, the quality of the included studies was low to high. Twenty-six studies were considered for the meta-analysis. Individuals with dental caries [OR: 3.54 (95% CI 2.24- 5.60), ten studies, 4945 participants] and malocclusion [ OR: 5.44 (95% CI 1.61, 18.39), six studies, 3720 participants] had poor OHRQoL compared to individuals without oral conditions. CONCLUSIONS: Despite the various definitions of the exposures and instruments used to assess Oral Health-Related Quality of Life, our review found that people with dental caries and malocclusion have a significantly higher experience of poor quality of life. PROSPERO SYSTEMATIC REVIEW REGISTRATION NO: CRD42021277874.

Molecular and morphometric analyses reveal host-specific cryptic speciation in a mite species, Tetranychus neocaledonicus (Andre, 1933) (Acari: Tetranychidae).

Host- and habitat-induced morphological shape and size variations are common in phytophagous and parasitic taxa. Several integrated morphological and molecular techniques have been commonly used to understand host-induced morpho-cryptic species forms. Compared to other arthropods, cryptic speciation was more common in Acari. This study focused on the host-specific morphological cryptic shape and size variations of Tetranychus neocaledonicus, collected from moringa and cassava hosts. We used geometric morphometric analysis to uncover the shape and size of inter-and intra-spider mite populations, and discovered that host-specific shape and size variations existed in spider mites regardless of sex. Interestingly, there was no phylogenetic signal in spider mites, implying that the morpho-cryptic speciation of T. neocaledonicus is solely based on the host-induced selection. The molecular clock hypothesis was accepted in our CO1 and 18s rRNA phylogeny analyses, and spider mites collected from both hosts were genetically less diverse. We conclude that T. neocaledonicus exhibited morphologically detectable cryptic population diversity in each host but that these populations are evolutionarily young form. Apart from these host-induced variations, we also monitored the impact of the clearing agent (lactic acid) on the shape and size of T. neocaledonicus; from this study, we proved that the clearing agent significantly alters the taxonomically important morphological traits of spider mites irrespective of the mites' sex, as confirmed by multivariate statistical analysis. This is the first study report to investigated the host-induced morphological variations of spider mites and the impact of a clearing agent.

Surgical Outcomes in Indigenous Peoples Undergoing Cardiac Surgery.

INTRODUCTION: Heart disease is the leading cause of death in indigenous peoples, however cardiac surgical outcomes in this group are rarely studied. We hypothesized that complication rates in indigenous peoples undergoing cardiac surgery would be similar to Caucasians. METHODS: From 2014 to 2020, 1,594 patients underwent cardiac surgery; 36 patients were identified as indigenous peoples. Risk factors, intraoperative, and postoperative variables were abstracted from our institution's database. We used the variables of age, BMI, diabetes, and tobacco use to propensity match the indigenous peoples to a group of Caucasian patients, 1:2, resulting in a total of 107 patients. Logistic regression analysis determined differences in complication rates. RESULTS: Within the propensity-matched group, indigenous peoples were more likely to be in renal failure requiring dialysis (16.7 vs. 2.9 percent, p=0.02). Indigenous peoples had a 30-day mortality of 0 percent while Caucasians had a rate of 4.3 percent (p=0.55). Postoperative complication rates were lower in indigenous peoples (22.2 percent) compared to Caucasians (35.3 percent, p=0.17). Logistic multivariate regression analysis of complication rate did not yield race as a contributing variable (odds ratio 2.05; p=0.21). CONCLUSIONS: Following cardiac surgery, indigenous peoples had a mortality rate of 0 percent and a complication rate of 22 percent. Indigenous peoples had a clinically significant lower complication rate than Caucasians, and race did not play a statistically significant role in complication rates.

Postpartum Psychosis or Something Else?

Psychosis is a psychiatric emergency that affects up to 1 in 500 women postpartum and can result from various etiologies. We present a case vignette and review of the relevant literature to highlight the broad differential diagnosis of postpartum psychosis with atypical features. Recommendations for evaluation, diagnosis, and treatment of patients with complex neuropsychiatric symptoms in the postpartum period are discussed. This case of postpartum psychosis with malignant catatonia highlights the role of immunology in the development and treatment of postpartum psychosis and the need for future research to more accurately define the etiology and best tailor treatment.

A test to study the influence of impaction on mandibular third molar development and forensic age estimation in a sample of south Indian children and young adults.

It has been argued that the impaction of the third molars could result in delayed maturation, which, in turn, could affect age estimations in criminal proceedings. In view of this, the present study was undertaken to determine whether the impaction status could delay the chronological process of third molar mineralization in a sample of south Indian children and young adults. The orthopantomograms (OPGs) of 915 children and young adults of south Indian origin aged between 15 and 22 years were evaluated. Mineralisation stage and impaction status were determined for all lower third molars. Descriptive statistics were performed at stages D to H of Demirjian staging system. The results of independent t-test show that the impaction resulted in statistically significant slower mineralization in impacted lower third molars at stages D to F in both sexes. It was ascertained that the mean ages with the impacted lower third molars at stage G were 0.98-1.38 years higher in males and 0.50-0.80 years higher in females than those with non-impacted lower third molars. For stage H, the mean ages were 0.14-0.21 years higher in males and 0.25-0.44 years higher in females. The probabilities of being 18 years and above is higher for non-impacted lower third molars at stages G and H than those with impacted ones. It is concluded that the impaction could result in delayed maturation in the lower third molars of the studied sample. Further studies are warranted in a more diverse sample.

Toward Development of Neuron Specific Transduction After Systemic Delivery of Viral Vectors.

Widespread transduction of the CNS with a single, non-invasive systemic injection of adeno-associated virus is now possible due to the creation of blood-brain barrier-permeable capsids. However, as these capsids are mutants of AAV9, they do not have specific neuronal tropism. Therefore, it is necessary to use genetic tools to restrict expression of the transgene to neuronal tissues. Here we compare the strength and specificity of two neuron-specific promoters, human synapsin 1 and mouse calmodulin/calcium dependent kinase II, to the ubiquitous CAG promoter. Administration of a high titer of virus is necessary for widespread CNS transduction. We observed the neuron-specific promoters drive comparable overall expression in the brain to the CAG promoter. Furthermore, the neuron-specific promoters confer significantly less transgene expression in peripheral tissues compared with the CAG promoter. Future experiments will utilize these delivery platforms to over-express the Alzheimer-associated pathological proteins amyloid-beta and tau to create mouse models without transgenesis.

Concurrent Use of Mepolizumab and Rituximab for Eosinophilic Granulomatosis With Polyangiitis and Multisystem Involvement.

Eosinophilic granulomatosis with polyangiitis (EGPA), formerly Churg-Strauss, is an anti-neutrophil cytoplasmic antibody (ANCA)-associated autoimmune vasculitis, involving small- and medium-sized arteries, which could involve several organs. This rare syndrome can present with a myriad of symptoms, which may make diagnosis challenging. It has been suggested that there are variants of EGPA, which may respond differently to available modes of treatment. Multiple and different mechanisms may be at play in each case of EGPA. This may influence the decision of clinicians to combine treatment strategies as done in this case. The addition of immunosuppressive agents other than high-dose steroids may mitigate end-organ damage, facilitate faster recovery, and prevent relapse. Rituximab among others has been seen to provide better outcomes, including a lower incidence of relapse. Mepolizumab was approved by the Food and Drug Administration (FDA) in 2017 for the treatment of EGPA. Administered at a higher dose than approved for severe eosinophilic asthma, it has been shown to lengthen remission in EGPA. The optimal dose and duration of therapy with mepolizumab remain unclear. The rarity alone of EGPA creates room for further investigation regarding pathogenesis, outcome over time, and treatment strategies, which may vary depending on how an individual case presents. This case describes the course of a 55-year-old woman who presented with respiratory symptoms, pauci-immune necrotizing granulomatous nephropathy, and neuropathy secondary to P-ANCA-positive EGPA who was successfully treated with rituximab and mepolizumab, in addition to glucocorticoids.

Left ventricular ejection hemodynamics before and after relief of outflow tract obstruction in patients with hypertrophic obstructive cardiomyopathy and valvular aortic stenosis.

OBJECTIVE: There has been debate on the importance and pathophysiologic effects of the dynamic subaortic pressure gradient in hypertrophic obstructive cardiomyopathy. The study was conducted to elucidate the hemodynamic abnormalities associated with the dynamic pressure gradient in hypertrophic obstructive cardiomyopathy. METHODS: Eight patients with hypertrophic obstructive cardiomyopathy and 7 patients with valvular aortic stenosis underwent a detailed hemodynamic study of pressure flow relationships before and after myectomy or aortic valve replacement during operation. RESULTS: In aortic stenosis, the increased gradient after premature ventricular contraction was associated with an increase in peak flow (325 ± 122 mL/s to 428 ± 147 mL/s, P = .002) and stroke volume (75.0 ± 27.3 mL to 88.0 ± 24.0 mL, P = .004), but in hypertrophic obstructive cardiomyopathy peak flow remained unchanged (289 ± 79 mL/s to 299 ± 85 mL/s, P = .334) and stroke volume decreased (45.9 ± 18.7 mL to 38.4 ± 14.4 mL, P = .04) on the postpremature ventricular contraction beat. After myectomy, the capacity to augment stroke volume on the postpremature ventricular contraction beats was restored in patients with hypertrophic obstructive cardiomyopathy (45.6 ± 14.4 mL to 54.4 ± 11.8 mL, P = .002). CONCLUSIONS: The pressure flow relationship in hypertrophic obstructive cardiomyopathy supports the concept of true obstruction to outflow, with a low but continued flow during late systole, when the ventricular-aortic pressure gradient is the highest. Septal myectomy can abolish obstruction and restore the ability to augment stroke volume, which may explain the mechanism of symptomatic improvement after operation.

Regional and Temporal Trends in the Outcomes of Repairs for Acute Type A Aortic Dissections.

BACKGROUND: Little information exists regarding the use of arch operations for repair of acute type A aortic dissections (AADs) despite increasing interest in this strategy and its potential impact on outcomes. We aimed to determine the relationship between extent of aortic repair, US geographic regions, and outcome. METHODS: We queried The Society of Thoracic Surgeons database for patients who underwent AAD repair from January 1, 2004 to December 31, 2016 and grouped patients by ascending-only operations and operations involving the arch. RESULTS: We identified 25,462 patients (mean age, 59.8 ± 14.2; 66.7% men) who underwent AAD repair. Operations involving the ascending aorta only were performed in 54% of patients; 46% had repair additionally involving the arch. The 30-day mortality was 18.9% for patients who underwent ascending-only operations vs 19.8% for patients who underwent arch operations (P = .09). In multivariable analysis older age (P < .001), earlier year of operation (P < .001), diabetes mellitus (P < .001), severe chronic lung disease (P < .001), prior cerebrovascular disease (P < .001), and longer bypass time (P < .001) were independently associated with 30-day mortality. There was regional variation in 30-day mortality (P < .001), and incidence of arch repair varied from 38.6% to 52.6% in 9 geographic regions (P < .001). CONCLUSIONS: In this analysis of cardiac surgical practice in the United States, repair of AADs included a portion of the aortic arch in 46% of patients. Early mortality remained high throughout the current era regardless of extent of aortic resection. Regional variation in perioperative mortality may signal an opportunity for practice improvement.