The Role of 24-Hour Holter Electrocardiogram in the Early Detection of Atrial Fibrillation in Newly Diagnosed Acute Ischemic Stroke Patients.

Introduction Stroke is a leading cause of death and disability globally, with atrial fibrillation (AF) recognized as a significant risk factor due to its association with increased stroke recurrence and mortality. Timely detection of AF is crucial to prevent recurrent strokes and improve outcomes. This study primarily aimed to evaluate the utility of 24-hour Holter monitoring for AF detection in acute ischemic stroke patients. Methods This retrospective observational study examined data from 207 patients admitted with acute ischemic stroke to a tertiary-care hospital over a two-year period. Patients with pre-existing AF, transient ischemic attacks, unconfirmed diagnoses, and missing Holter reports were excluded. A total of 140 patients were included in the analysis. The study investigated AF detection rates, the relationship between AF and stroke risk factors, other Holter findings, and the time delay in attaching Holter monitors. Results Of the 140 patients evaluated, AF was detected in nine (6.4%), exclusively in those aged ≥65 years. The most prevalent risk factors among the study participants were hypertension (74.3%) and diabetes (61.4%). No significant correlations were observed between AF and the analyzed stroke risk factors. The median delay for Holter device attachment was 3,503 minutes (approximately two days and 10 hours), with longer delays noted in males (4,084 mins (approximately two days and 20 hours) vs. 2,565 mins (approximately one day and 18 hours), p=0.005). Premature atrial complexes (PACs) were notably associated with the absence of AF, suggesting their potential role as markers for undiagnosed AF. Conclusion The study highlights the limited utility of 24-hour Holter monitoring in detecting AF in acute ischemic stroke patients, advocating for extended monitoring durations, especially in older patients. To improve AF detection, potential strategies include using longer monitoring periods and optimizing hospital workflows to reduce delays in attaching Holter devices. These approaches can minimize the risk of underdiagnosing paroxysmal AF, thereby preventing recurrent strokes and improving patient outcomes. Further investigation into PACs as potential predictive markers for AF is warranted.

Assessing the impact of green finance on sustainable tourism development in China.

The escalating urgency to address environmental degradation and promote sustainable development globally has emphasized the critical role of Green Finance (GF) in fostering responsible practices across industries. The tourism sector has drawn significant attention due to its substantial environmental impact, necessitating the implementation of robust financial mechanisms to mitigate its ecological footprint. China, recognized as a key player in the global tourism arena, the convergence of rapid economic expansion and the imperative for environmental conservation presents a distinctive set of challenges and opportunities. The study employed the Fuzzy Analytic Hierarchy Process (AHP) and Fuzzy Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) methodologies to systematically evaluate the impact of GF. The findings of fuzzy AHP indicate the critical role of environmental sustainability measures (GF2) as the topmost impacting factor. This refers to the practice of utilizing financial mechanisms and instruments to support initiatives that promote environmental conservation, minimize ecological footprints, and foster sustainable development. While financial allocation and effectiveness (GF1) and policy and regulatory framework impact (GF4) also hold significant importance in shaping sustainable tourism development. Moreover, the results of fuzzy TOPSIS identified top strategies such as green bond innovation for ecosystem regeneration (S1) and circular economy integration (S4), which can play a significant role in promoting sustainable tourism practices by facilitating initiatives aimed at ecosystem regeneration and integrating circular economy principles into the tourism industry.

Platypnea-Orthodeoxia Syndrome Caused by Patent Foramen Ovale with Right-To-Left Shunt.

BACKGROUND Patent Foramen Ovale (PFO) is an important part of fetal circulation. It allows the oxygenated blood from the umbilical cord to bypass the lungs. PFOs usually close after birth due to the sudden change of the hemodynamics associated with the expansion of the lungs however they are known to persist in about 25% of the total population. One of their rare manifestations is Platypnea-Orthodeoxia Syndrome (POS) that presents as dyspnea upon assuming an upright position, which improves upon recumbency, accompanied by hypoxemia. CASE REPORT We report a case of a 63-year-old man, known to have systemic lupus erythematosus (SLE) and positive anti-phospholipid antibodies but with no prior thrombotic events, admitted with symptoms of SARS-COV2 infection, and developed symptoms of Platypnea-Orthodeoxia Syndrome during his hospitalization, further evaluation by a transthoracic echocardiography revealed he had PFO with a right-to-left shunt which was treated successfully with percutaneous device closure. CONCLUSIONS Platypnea-Orthodeoxia Syndrome (POS) can be associated with various cardiac defects resulting in right-to-left shunts and other non-cardiac pathologies such as pulmonary AV malformations, lung parenchymal diseases and hepatopulmonary syndrome. In cases of cardiac right-to-left shunts Contrast-enhanced Transthoracic Echocardiography (TTE) can effectively diagnose Platypnea-Orthodeoxia Syndrome, and percutaneous closure has shown to be an efficacious treatment option in alleviating the symptoms. This case report highlights the necessity of actively exploring the possibility of PFOs with right-to-left shunts in patients exhibiting POS symptoms, while considering other potential aetiologies.

Angiographic patterns of coronary artery disease in young patients presenting at a tertiary cardiac center.

Objective: To compare the patterns of coronary artery disease (CAD) between young adults ≤35 years of age and patients >35 years of age. Methods: The observational retrospective study was carried out in angiography department of emergency at Punjab Institute of Cardiology, Lahore between January 2020 and October 2020. Patients ≤35 years old were in Group-I whereas patients >35 years who served as controls were in Group-II. Patients with unstable angina, non-ST and ST elevation MI all were included. The patients with previous history of CAD (CABG/PCI) and angiography done for other purposes i.e., before valvular surgery or PPM implantation were excluded. Results: Out of 1268 patients, 552 were in Group-I and 716 were in Group-II. The prevalence of normal coronaries/ mild CAD was higher in Group-I i.e., 224(40.6%) than in Group-II i.e., 64 (8.9%). Single vessel disease (SVD) was comparable in both the groups 185 (33.5%) vs. 216 (30.2%). Double vessel disease and triple vessel disease (TVD) was common in Group-II and left main stem (LMS) involvement was also significantly higher in Group-II i.e., 32 (4.5%) vs. 8 (1.4%). Clot in coronary arteries with or without underlying CAD was seen more frequently in Group-I, 61(11.1%) vs. 34 (4.7%). Presence of clot was seen mostly in those patients who had moderate coronary artery disease. Conclusion: Young patients have different coronary artery disease patterns, so the management strategy must be different in this population. Majority of the young patients have non severe disease. Clot formation is commonly seen in young adults with moderate CAD.

Characteristics and Outcomes of Critically Ill Patients with Raised Cardiac Troponins Admitted in the Intensive Care Unit: A single centre experience from Oman.

Objectives: Critically ill patients have raised troponins. This study aimed to assess the incidence of myocardial injury in the intensive care unit (ICU) at a tertiary care hospital and assess the management and prognosis. Methods: This retrospective study included adult patients who were admitted to the ICU of Sultan Qaboos University Hospital, Muscat, Oman, between January and December 2019 and had undergone a high-sensitive cardiac troponin (hs-cTn) assay. Patients admitted with a primary diagnosis of myocardial infarction were excluded. Results: A total of 264 patients had their hs-cTn measured during the study period. Of these, 128 (64.3 ± 17.1 years; 58.6% male) had elevated levels, giving an incidence rate of approximately 48.5%. Those with raised troponin were older and had more co-morbidities. These patients were also more critically ill with lower blood pressure, higher heart rates and increased hypotensive episodes. Of these, 47 were treated for acute coronary syndrome, 32 underwent coronary angiography and only three required stenting. Patients with raised troponin had a poor outcome with only 45 (35.2%) surviving to discharge compared to 101 (74.3%) with normal troponin. Patients with raised troponin had shorter hospital stays than those with normal troponin (16 versus 19 days; P = 0.017). Conclusion: A high proportion of critically ill patients showed evidence of myocardial injury without significant coronary artery disease, which is associated with a poor prognosis. Further prospective studies are required to ascertain the best course of treatment for these patients.

Energy harvesting based routing protocol for underwater sensor networks.

Underwater sensor networks (UWSNs) are ad-hoc networks which are deployed at rivers, seas and oceans to explore and monitor the phenomena such as pollution control, seismic activities and petroleum mining etc. The sensor nodes of UWSNs have limited charging capabilities. UWSNs networks are generally operated under two deployment mechanisms i.e localization and non-localization based. However, in both the mechanisms, balanced energy utilization is a challenging issue. Inefficient usage of energy significantly affects stability period, packet delivery ratio, end-to-end delay, path loss and throughput of a network. To efficiently utilize and harvest energy, this paper present a novel scheme called EH-ARCUN (Energy Harvesting Analytical approach towards Reliability with Cooperation for UWSNs) based on cooperation with energy harvesting. The scheme employs Amplify-and-Forward (AF) technique at relay nodes for data forwarding and Fixed Combining Ratio (FCR) technique at destination node to select accurate signal. The proposed technique selects relay nodes among its neighbor nodes based on harvested energy level. Most cooperation-based UWSN routing techniques do not exhibit energy harvesting mechanism at the relay nodes. EH-ARCUN deploys piezoelectric energy harvesting at relay nodes to improve the working capabilities of sensors in UWSNs. The proposed scheme is an extension of our previously implemented routing scheme called ARCUN for UWSNs. Performance of the proposed scheme is compared with ARCUN and RACE (Reliability and Adaptive Cooperation for efficient Underwater sensor Networks) schemes in term of stability period, packet delivery ratio, network throughput and path loss. Extensive simulation results show that EH-ARCUN performs better than both previous schemes in terms of the considered parameters.