Unveiling the Hidden Patterns: Multimodality Cardiac Imaging in Takotsubo Cardiomyopathy Diagnosis.

Takotsubo cardiomyopathy, also known as stress cardiomyopathy, is a reversible form of cardiomyopathy characterized by reduced ejection fraction with regional wall motion abnormalities, elevated cardiac enzyme levels, and signs of ischemia on electrocardiogram despite the absence of obstructive epicardial coronary artery disease. It is often preceded by intense emotional or physical illness stressors. This case describes a 65-year-old female patient who likely developed takotsubo cardiomyopathy precipitated by the stress of diverticulitis.

Distinct Features of Vascular Diseases in COVID-19.

The Coronavirus Disease 2019 (COVID-19) pandemic was declared in early 2020 after several unexplained pneumonia cases were first reported in Wuhan, China, and subsequently in other parts of the world. Commonly, the disease comprises several clinical features, including high temperature, dry cough, shortness of breath, and hypoxia, associated with findings of interstitial pneumonia on chest X-ray and computer tomography. Nevertheless, severe forms of acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) are not limited to the respiratory tract but also may be extended to other systems, including the cardiovascular system. The bi-directional relationship between atherosclerosis and COVID-19 is accompanied by poor prognosis. The immune response hyperactivation due to SARS-CoV-2 infection causes an increased secretion of cytokines, endothelial dysfunction, and arterial stiffness, which promotes the development of atherosclerosis. Also, due to the COVID-19 pandemic, access to healthcare amenities was reduced, resulting in increased morbidity and mortality in patients at risk. Furthermore, as lockdown measures were largely adopted worldwide, the sedentary lifestyle and the increased consumption of processed nutrients or unhealthy food increased, and in the consequence, we might observe even 70% of overweight and obese population. Altogether, with the relatively low ratio of vaccinated people in many countries, and important health debt appeared, which is now and will be for next decade a large healthcare challenge. However, the experience gained in the COVID-19 pandemic and the new methods of patients' approaching have helped the medical system to overcome this crisis and will hopefully help in the case of new possible epidemics.

Pretreatment and Posttreatment Factors Associated with Shunt-Dependent Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis.

BACKGROUND: Hydrocephalus is a common complication after aneurysmal subarachnoid hemorrhage (aSAH). This study aimed to evaluate novel preoperative and postoperative risk factors for shunt-dependent hydrocephalus (SDHC) after aSAH via a systematic review and meta-analysis. METHODS: A systematic search was conducted using PubMed and Embase databases for studies pertaining to aSAH and SDHC. Articles were assessed by meta-analysis if the number of risk factors for SDHC was reported by >4 studies and could be extracted separately for patients who did or did not develop SDHC. RESULTS: Thirty-seven studies were included, comprising 12,667 patients with aSAH (SDHC 2214 vs. non-SDHC 10,453). In a primary analysis of 15 novel potential risk factors, 8 were identified to be significantly associated with increased prevalence of SDHC after aSAH, including high World Federation of Neurological Surgeons grades (odds ratio [OR], 2.43), hypertension (OR, 1.33), anterior cerebral artery (OR, 1.36), middle cerebral artery (OR, 0.65), and vertebrobasilar artery (2.21) involvement, decompressive craniectomy (OR, 3.27), delayed cerebral ischemia (OR, 1.65), and intracerebral hematoma (OR, 3.91). CONCLUSIONS: Several new factors associated with increased odds of developing SDHC after aSAH were found to be significant. By providing evidence-based risk factors for shunt dependency, we describe an identifiable list of preoperative and postoperative prognosticators that may influence how surgeons recognize, treat, and manage patients with aSAH at high risk for developing SDHC.

The Creation of LIFE-M: The Longitudinal, Intergenerational Family Electronic Micro-Database Project.

This paper describes the creation of the Longitudinal, Intergenerational Family Electronic Micro-Database (LIFE-M), a new data resource linking vital records and decennial censuses for millions of individuals and families living in the late 19th and 20th centuries in the United States. This combination of records provides a life-course and intergenerational perspective on the evolution of health and economic outcomes. Vital records also enable the linkage of women, because they contain a crosswalk between women's birth (i.e., "maiden") and married names. We describe (1) the data sources, coverage, and linking sequence; (2) the process and supervised machine-learning methods to linking records longitudinally and across generations; and (3) the resulting linked samples, including linking rates, representativeness, and weights.

Outcomes in patients of carcinoma cervix Stage IIIB treated with definitive radiotherapy.

BACKGROUND: Cervical cancer is the fourth most common cancer in women. Although cervical cancer screening is available in India, there is lack of awareness and access to screening services. Consequently, most cancers are diagnosed in advanced stagesoften with obstructive uropathy. PATIENTS AND METHODS: This was a retrospective study of stage III B (as per pre-2018 FIGO staging) cervical cancer patients who received radiotherapy at our center between 2012 and 2019. Patients with or without obstructive uropathy, age group between 18 and 85 years, were included. Definitiveradiotherapy (RT) was delivered with 3D CRT to a dose of 50 Gy in 25 fractions over 5weeks given to whole pelvis and boost of 54 Gy was given to para-aortic or retroperitoneal lymph nodes when enlarged. All patients received intracavitary brachytherapy. RESULTS: 3-year overall survival rates for patients who received only RT was 24% versus 71% for those who received chemoradiotherapy (p = 0.0001). 5-year survival for patients who received RT alone was 12% versus 63% for those who received chemoradiotherapy (p = 0.0001). 3-year PFS was 77% versus 83% and those with and without obstructive uropathy respectively. (p = 0.0001). Overall, 37(56%) patients were alive without any evidence of recurrence. CONCLUSION: Early recognition and appropriate intervention for obstructive uropathy can potentially limit the detriment to outcomes in these patients and result is good long-term cure rates in these patients.

Return to work in survivors of Primary Brain Tumours treated with Intensity Modulated Radiotherapy.

MINI: Primary Brain Tumour survivors usually have significant morbidity, especially cognitive and neurological dysfunction. Return to pre-diagnosis work can be an important QoL indicator and outcomes measure in these patients. We did a retrospective study to assess return to work amongst the patients who underwent radiotherapy at our centre. BACKGROUND: Primary brain tumour (PBT) survivors have a high burden of morbidity. Return to work (RTW) is an important survivorship parameter and outcomes measure in these patients, especially in developing countries. This study was done to assess RTW after radiotherapy, reasons for no RTW, and relationship of RTW with treatment and patient factors. PATIENTS AND METHODS: A single centre study was done amongst PBT patients. Baseline and treatment details, education, employment was assessed. RTW assessed as: time to RTW, full/ part-time, reasons for no RTW and RTW at 6 months post-therapy, and last follow up. RESULTS: 67 PBT patients with a median age of 42 years were assessed. Most common diagnosis was low grade glioma. Over 66% patients were illiterate, and 62% had semi-skilled and unskilled jobs, mostly agriculture. About 64.4% patients returned to employment in a median time of 3 months. At 6 months post-treatment 58.2% had a job, with only 42% working full-time. 'Limb weakness' (21.4%), followed by 'loss of job/ no job' (16.7%), 'fatigue'/ 'tiredness' (14.3%), 'poor vision/ diminished vision' (11.9%) were the common reasons for no RTW. The factors found to be significantly associated with return to work were younger age (p = 0.042), male sex (0.013), the absence of complications during radiotherapy (p = 0.049), part time job prior to diagnosis (p = 0.047), and early return to work after RT (p < 0.001). CONCLUSION: Studies are needed to identify the barriers in re- employment and steps to overcome them in cancer patients.

Clinical profile of neural tube defects in Sudanese children: Is malaria a risk factor?

Neural tube defects (NTDs) are one of the most common structural malformations in human kind. It is a public health problem with great impact on the child, parents and the community at large. The aim is to study the epidemiological profile and patterns of NTDs in under five-year of age Sudanese children who attended the neurosurgical clinic at the National Centre of Neurological Sciences (NCNS), Khartoum during the period from March 2014 to December 2014. This was a prospective cross-sectional study conducted at the neurosurgery clinic in NCNS, Khartoum. A pre-set structured questionnaire was the research tool. All children under five-year of age with NTDs, who attended the Neurosurgery clinic in NCNS during the period of the study, were recruited. The data were analyzed using statistical package of social sciences (SPSS). The sample size was 71. The majority of cases were less than 6 months of age (57.7%). The female to male ratio was (1.2:1). Spinal defects were noticed to be more common than cranial defects. The spina bifida was the commonest anomaly accounting for (73.2%), whereas, encephaloceles accounted for (26.8%). The lumbo-sacral region was the commonest site (34.6%). Hydrocephalus was the most commonly associated anomaly. NTDs were common in the young mother age group and consanguine parents. Although folic acid was taken by (69.0%) of the mothers, it was not on regular bases in the majority. Infection, particularly, malaria, during pregnancy was reported in 25.4%. Anti-malaria Sulfadoxine/Pyremethamine (Fansidar®) used by most in our cohort is an anti-folate drug and could be implicated in the etiology.

Effect of Biochanin A versus 17ß estradiol in rat submandibular salivary gland.

The epigenetic nature of development mandates the observation of the effect of any exogenous substance, especially those with estrogenic activities, during critical phases of development. The submandibular gland (SMG) presents as a great model due to extensive postnatal development, and is known to be regulated and affected by hormones as well as growth factors. Herein, we observed postnatal development following low doses of Biochanin A (BCA) and 17ß estradiol (E2) in rats. The pups were randomly divided into four groups: control, BCA, E2, and dimethyl sulfoxide (DMSO), and euthanized at the 6th, 15th, 30th, and 60th postnatal days (PND). SMG morphogenesis was assessed. The nuclear expression of estrogen receptor beta (ERß) was evaluated immunohistochemically; ERß expression was up-regulated by BCA and down-regulated by E2. Similarly, caspase three gene expression, assessed by real time polymerase chain reaction was increased in the BCA group but decreased in the E2 group. A significant decrease in epidermal growth factor gene expression was noted at PND 30. The results presented by this study provide evidence that the effect of a postnatal exposure of the SMG to Biochanin A during development could be linked to sex hormone-dependent disorders.

Avicenna's contribution to cardiology.

Ibn Sina, known in the West as Avicenna, was the most famous and influential of all the Islamic philosopher-scientists. His most important medical works are the Canon of Medicine medical encyclopedia and a treatise on cardiac drugs. His Canon of Medicine remained the standard text in both the East and West until the 16(th) century. Avicenna's description of cardiac diseases was logically presented perhaps for the first time in the history of medicine. Avicenna was the first to describe carotid sinus hypersensitivity, which presents with vasovagal syncope. He was a pioneer in pulsology and the first correct explanation of pulsation was given by Avicenna, after he refined Galen's theory of the pulse. Besides, he discussed the action of available drugs on the heart in details and mentioned their indications and contraindications. In conclusion, Avicenna made important contributions to cardiology. This article describes some of his contributions in this field.

Angiotensin-converting enzyme 2 as a therapeutic target for heart failure.

The renin-angiotensin system (RAS) plays a major role in the pathophysiology of cardiovascular disorders. Angiotensin II (Ang-II), the final product of this pathway, is known for its vasoconstrictive and proliferative effects. Angiotensin-converting enzyme 2 (ACE2), a newly discovered homolog of ACE, plays a key role as the central negative regulator of the RAS. It diverts the generation of vasoactive Ang-II into the vasodilatory and growth inhibiting peptide angiotensin(1-7) [Ang(1-7)], thereby providing counter-regulatory responses to neurohormonal activation. There is substantial experimental evidence evaluating the role of ACE2/Ang(1-7) in hypertension, heart failure, and atherosclerosis. In this review, we aim to focus on the conceptual facts of the ACE2-Ang(1-7) axis with regards to clinical implications and therapeutic targets in cardiovascular disorders, with emphasis on the potential therapeutic role in cardiovascular diseases.

Mycobacterium avium Complex-Associated Hemophagocytic Lymphohistiocytosis in a Sickle Cell Patient: An Unusual Fatal Association.

Hemophagocytic lymphohistiocytosis (HLH) is a rare hyperinflammatory syndrome, characterized clinically by fever, splenomegaly, cytopenia, and high ferritin. Infectious causes have been associated with secondary HLH, with viruses being the most common. We report a case of Mycobacterium avium complex-associated HLH in a sickle cell anemia patient. To the best of our knowledge, this association has never been reported in sickle cell anemia.

Brugada pattern electrocardiogram unmasked with cocaine ingestion.

Cocaine is considered a leading cause of drug-related deaths. This is usually sudden, unwitnessed, and without prodromal features. It has been reported that in-hospital mortality is close to 2%. Cocaine has powerful central nervous system effects(1) and acute cocaine overdose has been associated with hyperthermia, agitation, paranoid ideation, status epilepticus, ventricular fibrillation, ventricular tachycardia, and myocardial infarction (MI). The mechanisms of cocaine-related death remain poorly understood. We report a patient who survived massive cocaine ingestion with psychomotor agitation and generalized seizures followed by asystolic cardiac arrest and transient Brugada pattern on electrocardiogram (ECG).

Organized intrapericardial haematoma: a rare cause of heart failure after 2 years of trauma.

Intrapericardial organized haematoma secondary to blunt chest trauma is an extremely rare cause of constrictive pericarditis. We report a 30-year-old male who presented with heart failure for 12 months and was found to have an organized intrapericardial haematoma secondary to blunt chest trauma in a road traffic accident 2 years prior. The use of multiple imaging modalities including two-dimensional (transthoracic and transoesophageal) echocardiogram and cardiac magnetic resonance imaging established the diagnosis. Surgical excision of the haematoma and removal of the constricting pericardium relieved his symptoms.

An incidental finding of mitral valve network.

A 63-year-old male presented with a 6-month history of worsening exertional dyspnea and was found to have three-vessel coronary artery disease. Transesophageal echocardiography revealed a filamentous structure attached to the anterior mitral valve leaflet, which was confirmed during surgery as filamentous network. To our knowledge, this is the first report to describe such a network attached to the mitral valve.

Right atrial metastasis mimicking myxoma in advanced hepatocellular carcinoma.

Hepatocellular carcinoma is the most common primary tumor of the liver accounting for 4.6% of all new human cancers. Cardiac metastasis in hepatocellular carcinoma is an uncommon secondary cardiac malignancy. We described two cases of advanced hepatocellular carcinoma with large masses in the right atrium mimicking atrial myxoma. The RA masses were incidentally detected during two-dimensional echocardiographic examination.

Biological control of the red palm weevil, Rhynchophorus ferrugineus (Olivier) (Coleoptera: Curculionidae) by the parasitoid mite, Rhynchopolipus rhynchophori (Ewing) (Acarina: Podapolipidae).

The parasitoid mite, Rhynchopolipus rhynchophori was released against the red palm weevil Rhynchophorus ferrugineus stages. Released of this mite applied at four levels of treatment, A (30 parasitic mites: 1 prey), B (60 parasitic mites: 1 prey), C (90 parasitic mites: 1 prey) and D (120 parasitic mites: 1 prey). The parasitoid mites successfully suppressed population density of the red palm weevil, R. ferrugineus stages within two weeks. The killing of different developmental stages of the red palm is due to sucking their body fluid by the parasitoid mite, Rh. rhynchphori. But, the pupal weight was significantly (P < 0.5) decreased by increasing numbers of parasitoid mites at the different treatment levels.

Imaging of ventricular septal tumor in an asymptomatic adolescent using multiple modalities.

Primary cardiac tumors are rare at all ages, and especially so in childhood, where the most prevalent type of benign cardiac masses are rhabdomyomas followed by fibromas, both of which have a predilection for ventricular septum. We report an unusual case of a tumor involving the ventricular septum in an asymptomatic 17-year-old adolescent who has been known to have this tumor for 10 years. The use of multiple imaging included myocardial contrast two-dimensional echocardiography, real time three-dimensional echocardiography (with and without myocardial contrast), and magnetic resonance imaging supported the diagnosis of cardiac rhabdomyoma.