Characterization of myocardial injury phenotype by thermal liquid biopsy.

Background and aims: With the advent and implementation of high-sensitivity cardiac troponin assays, differentiation of patients with distinct types of myocardial injuries, including acute thrombotic myocardial infarction (TMI), acute non-thrombotic myocardial injury (nTMi), and chronic coronary atherosclerotic disease (cCAD), is of pressing clinical importance. Thermal liquid biopsy (TLB) emerges as a valuable diagnostic tool, relying on identifying thermally induced conformational changes of biomolecules in blood plasma. While TLB has proven useful in detecting and monitoring several cancers and autoimmune diseases, its application in cardiovascular diseases remains unexplored. In this proof-of-concept study, we sought to determine and characterize TLB profiles in patients with TMI, nTMi, and cCAD at multiple acute-phase time points (T 0 h, T 2 h, T 4 h, T 24 h, T 48 h) as well as a follow-up time point (Tfu) when the patient was in a stable state. Methods: TLB profiles were collected for 115 patients (60 with TMI, 35 with nTMi, and 20 with cCAD) who underwent coronary angiography at the event presentation and had subsequent follow-up. Medical history, physical, electrocardiographic, histological, biochemical, and angiographic data were gathered through medical records, standardized patient interviews, and core laboratory measurements. Results: Distinctive signatures were noted in the median TLB profiles across the three patient types. TLB profiles for TMI and nTMi patients exhibited gradual changes from T0 to Tfu, with significant differences during the acute and quiescent phases. During the quiescent phase, all three patient types demonstrated similar TLB signatures. An unsupervised clustering analysis revealed a unique TLB signature for the patients with TMI. TLB metrics generated from specific features of TLB profiles were tested for differences between patient groups. The first moment temperature (TFM) metric distinguished all three groups at time of presentation (T0). In addition, 13 other TLB-derived metrics were shown to have distinct distributions between patients with TMI and those with cCAD. Conclusion: Our findings demonstrated the use of TLB as a sensitive and data-rich technique to be explored in cardiovascular diseases, thus providing valuable insight into acute myocardial injury events.

Monkeypox: A comprehensive review of a multifaceted virus.

In May 2022, the world witnessed the re-emergence of the zoonotic disease monkeypox. While this was not the first epidemic of this disease, what differentiated the outbreak was the rapid global spread and increase of cases, which led the WHO to declare monkeypox a global health emergency. Although the disease spreads mainly through inadequately cooked meat of various rodent species, this virus also shows droplet, respiratory, sexual, and even vertical transmission. Monkeypox further multiplies in lymphoproliferative organs and presents with a classical smallpox-like rash, fever, headache, and muscle aches. Diagnosis is confirmed with a polymerase-chain-reaction test and is managed largely supportively with possible usage of some antivirals and immunoglobulins. Moreover, some pre-exposure and postexposure prophylactic vaccines have been developed. This paper aims to conduct an in-depth review of the historical epidemics, transmission, pathophysiology, clinical presentation, and management of the monkeypox disease.

Knowledge of Alzheimer's disease among the healthcare staff in a medical college hospital of India.

Background: With increasing numbers of people crossing the age threshold of 65 years, there is a strong likelihood that the cases of Alzheimer's disease (AD) cases will increase manifold in the upcoming decades. It is essential for the healthcare professionals to have a reasonable background knowledge about this neurodegenerative condition. This study was done to assess the level of knowledge of AD among the healthcare staff appointed at a tertiary care hospital. Methodology: A cross-sectional survey study was done in a tertiary care hospital with healthcare workers. The knowledge level of AD was investigated using Alzheimer's Disease Knowledge Scale (ADKS) while a self-assessment scale was used by the participants to rate their own knowledge about the disease. The extent of background knowledge was then statistically evaluated on the basis of multiple subject-oriented factors. The impact of any prior dementia-specific training was also assessed. Data were analyzed by using SPSS-23 where P value < 0.05 was considered significant. Results: Out of a total of 124 participants recruited during the study period, the average score on the ADKS scale was 19.2 ± 3.1. Self-rated Alzheimer's scale depicted a mean value of 4.89 ± 1.7. The participants having a positive family history and personal/professional caring experience for AD did not obtain any remarkably better score. The doctors were more likely to score better than nurses and other healthcare staff (p < 0.001). Moreover, dementia-related training had a significantly better outcome in terms of promoting the knowledge base of AD (p < 0.001). Conclusion: There is a below-par knowledge of Alzheimer's dementia among the healthcare staff of the hospital. The staff of the hospital realizes this shortcoming, and there is a need for dementia-specific training to overcome this knowledge gap.

Fumarate hydratase-deficient renal cell carcinoma in extended remission with bevacizumab and erlotinib.

Hereditary leiomyomatosis and renal cell carcinoma (HLRCC) is an autosomal dominant syndrome associated with fumarate hydratase (FH) gene mutation leading to defective DNA double-strand break repair mechanism. Although these tumours have an aggressive presentation, they respond well to targeted therapy with fewer adverse effects. Here we present a case of a 42-year-old female having isolated renal cell carcinoma, papillary type 2, carrying a mutation in the FH gene without cutaneous and uterine involvement. Her tumour responded well to erlotinib and bevacizumab combination and she was on treatment for 23 months. This report adds to the current literature and can help to define treatment protocols for HLRCC.

Diagnostic Accuracy of Various Biomarkers of Sepsis (Serum Pro-Calcitonin, High-Sensitivity C-reactive Protein, and C-reactive Protein) and Band Cell Percentage in Critically lll Patients: A Prospective, Observational, Cohort Study.

BACKGROUND: Despite the advances in medical sciences, the morbidity and mortality due to sepsis in critically ill medical or surgical patients remains high, hence the need for an early and accurate diagnosis. In the current armamentarium, we have various biomarkers such as procalcitonin (PCT), high-sensitivity C-reactive protein (hs-CRP), CRP, and band cell percentage for an early clue. AIMS: This study explores the accuracy of these markers in distinguishing sepsis from systemic inflammatory response syndrome (SIRS) and their correlation with sequential organ failure assessment (SOFA) scoring in critically ill patients. MATERIALS AND METHODS: After ethical committee approval and written informed consent from guardians, 180 consecutive patients, with clinically suspected infection from any source fulfilling at least two criteria of SIRS, were enrolled and 150 eligible patients were investigated and analyzed prospectively in one cohort, which was later subdivided into two different groups (Group A and Group B) based on microbiology reports, as having SIRS or sepsis, respectively. Samples for cultures (blood, tracheal, or urine as required), biomarkers such as PCT, hs-CRP, and CRP, and band cell percentage were sent from each patient on days 1, 2, 3, and 5 and whenever there were fever spikes. Clinical follow-up was done for 28 days, and demographics, ventilator days, duration of intensive care unit (ICU) stay, and the survival rates were noted. STATISTICAL ANALYSIS: Receiver operating characteristics, area under curve (AUC-ROC) was used for each of the biomarker variables to decide the cutoff values and performance. Correlation coefficient was also seen for each of the biomarkers with SOFA scoring. RESULTS: Attributes of performance for all the biomarkers were satisfactory but was best for PCT (AUC-ROC of 0.987) followed by band cell percentage (0.881). SOFA scoring could also be used with good diagnostic accuracy (AUC-ROC of 0.920). SOFA score correlated best with PCT among the four biomarkers in diagnosing sepsis (Spearman's coefficient of + 0.734). Band cell percentage was significantly higher in the expired group of sepsis patients than survived patients (P = 0.02) and correlated well with ICU stay and 28-day mortality than rest (Spearman's coefficient of - 0.54). CONCLUSIONS: The addition of PCT to the standard workup of critically ill patients with suspected sepsis increases diagnostic certainty and generates improved patient management. Band cell percentage also provides a cost-effective alternative to PCT with an analogous diagnostic performance.