Students' Perception of Online Versus Face-to-Face Learning: What Do the Healthcare Teachers Have to Know?

During the COVID-19 pandemic, educational institutions confronted the possibility of complete closure and took countermeasures by adapting e-learning platforms. The present cross-sectional study quantified the impact of the pandemic on medical education using a validated and reliable tool. The tool was used to explore the perceptions of 270 healthcare students about e-learning in comparison to traditional learning systems. Inferential statistics were employed using Pearson's chi-squared test. It was found that e-learning was advantageous because of its location flexibility (46.1%) and the ease of access to study materials (46.5%). However, in-person learning was found to lead to an increase in knowledge (44.9%), clinical skills (52.7%), and social competencies (52.7%). The study concluded that while e-learning offers flexibility, traditional face-to-face teaching is deemed more effective for skill development and social interaction. Hence, e-learning should complement rather than replace traditional methods due to limitations in replicating clinical environments.

Approximately half of pediatric or adolescent patients undergoing revision anterior cruciate ligament reconstruction return to the same level of sport or higher: A systematic review.

PURPOSE: To summarise the surgical techniques and clinical outcomes in paediatric and adolescent patients undergoing revision anterior cruciate ligament reconstruction (r-ACLR). METHODS: Three databases (MEDLINE, PubMed and EMBASE) were searched from inception to 29 July 2023. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on demographics, surgical details, patient-reported outcome measures (PROMs), rates of instability, rupture and return to sport (RTS) were extracted. RESULTS: Eight studies comprising 706 (711 knees) patients were included (48.7% female). The mean age at r-ACLR was 17.1 years (range: 16.5-18.0). Autografts (67.5%) were more common than allografts (32.2%) in revision, with bone-patellar tendon-bone (BPTB) being the most prevalent autograft source (59.6%). Bone grafts were used in seven patients (4.8% of 146 patients). The most common femoral and tibial fixation techniques were interference screws (37.6% and 38.1%, of 244 patients, respectively). The most common tunnelling strategy was anatomic (69.1% of 236 patients), and meniscus repairs were performed in 39.7% of 256 patients. The re-rupture rate was 13.0% in 293 patients. RTS at the same level or higher was 51.6% in 219 patients. The mean (SD) Lysholm score was 88.1 (12.9) in 78 patients, the mean (SD) Tegner score was 6.0 (1.6) in 78 patients, and the mean (SD) IKDC score was 82.6 (16.0) in 126 patients. CONCLUSION: R-ACLR in paediatric and adolescent patients predominantly uses BPTB autografts and interference screw femoral and tibial fixation with concomitant meniscal procedures. Rates of re-rupture and RTS at the same level or higher were 13.0% and 51.6%, respectively. Information from this review can provide orthopaedic surgeons with a comprehensive understanding of the most commonly used operative techniques and their outcomes for revision ACLR in this population. LEVEL OF EVIDENCE: Level IV.

Differences in ventricular wall composition may explain inter-patient variability in the ECG response to variations in serum potassium and calcium.

Objective: Chronic kidney disease patients have a decreased ability to maintain normal electrolyte concentrations in their blood, which increases the risk for ventricular arrhythmias and sudden cardiac death. Non-invasive monitoring of serum potassium and calcium concentration, [K+] and [Ca2+], can help to prevent arrhythmias in these patients. Electrocardiogram (ECG) markers that significantly correlate with [K+] and [Ca2+] have been proposed, but these relations are highly variable between patients. We hypothesized that inter-individual differences in cell type distribution across the ventricular wall can help to explain this variability. Methods: A population of human heart-torso models were built with different proportions of endocardial, midmyocardial and epicardial cells. Propagation of ventricular electrical activity was described by a reaction-diffusion model, with modified Ten Tusscher-Panfilov dynamics. [K+] and [Ca2+] were varied individually and in combination. Twelve-lead ECGs were simulated and the width, amplitude and morphological variability of T waves and QRS complexes were quantified. Results were compared to measurements from 29 end-stage renal disease (ESRD) patients undergoing hemodialysis (HD). Results: Both simulations and patients data showed that most of the analyzed T wave and QRS complex markers correlated strongly with [K+] (absolute median Pearson correlation coefficients, r, ranging from 0.68 to 0.98) and [Ca2+] (ranging from 0.70 to 0.98). The same sign and similar magnitude of median r was observed in the simulations and the patients. Different cell type distributions in the ventricular wall led to variability in ECG markers that was accentuated at high [K+] and low [Ca2+], in agreement with the larger variability between patients measured at the onset of HD. The simulated ECG variability explained part of the measured inter-patient variability. Conclusion: Changes in ECG markers were similarly related to [K+] and [Ca2+] variations in our models and in the ESRD patients. The high inter-patient ECG variability may be explained by variations in cell type distribution across the ventricular wall, with high sensitivity to variations in the proportion of epicardial cells. Significance: Differences in ventricular wall composition help to explain inter-patient variability in ECG response to [K+] and [Ca2+]. This finding can be used to improve serum electrolyte monitoring in ESRD patients.

Outpouching in the Esophagus: An Uncommon Endoscopic Finding of Esophageal Intramural Pseudodiverticulosis in the Absence of Esophageal Candidiasis.

We present a case of a 51-year-old female with a history of acquired immunodeficiency syndrome (AIDS) and medication non-compliance who experienced progressively worsening dysphagia to both solids and liquids over a three-month period. The patient underwent an esophagogastroduodenoscopy (EGD), which revealed multiple small pseudodiverticula without any other notable abnormalities. Subsequently, a barium esophagogram was performed, confirming the presence of multiple esophageal pseudodiverticula. Biopsies taken during the procedure showed chronic inflammatory changes, with no evidence of viral or fungal elements. In light of the patient's HIV history and the absence of esophageal candidiasis, the diagnosis of esophageal intramural pseudodiverticulosis (EIP) was made. The patient was initiated on highly active antiretroviral therapy (HAART) and received high-dose proton pump inhibitors (PPIs). Remarkably, the patient reported a complete resolution of her dysphagia symptoms during the follow-up visit. Risk factors associated with EIP include HIV infection, diabetes mellitus (DM), and esophageal candidiasis. To confirm the diagnosis, a barium esophagogram is considered the preferred imaging study. The management of EIP focuses on PPI therapy, the dilation of strictures if present, and addressing the underlying etiology. Given the association between EIP and esophageal malignancies, surveillance endoscopy may be recommended in these patients. This case highlights the importance of considering EIP as a potential cause of dysphagia, particularly in individuals with HIV/AIDS, even in the absence of esophageal candidiasis. Prompt diagnosis and appropriate management can lead to symptom resolution and improved quality of life for affected patients.

Women are underrepresented in cardiac resynchronization therapy trials.

INTRODUCTION: Current guidelines for cardiac resynchronization therapy (CRT) device implant are the same across both sexes however women have been traditionally underrepresented in randomized controlled trials (RCTs). We aimed to identify if the number of women included in CRT trials is representative of the real-world burden of heart failure (HF) in women. METHODS: RCTs evaluating the benefit of CRT in HF patients referenced in the 2012 EHRA/HRS expert consensus statement on CRT in HF were included. Studies were evaluated for gender representation, baseline variables, and gender-based analysis of outcomes. RESULTS: A total of 10 CRT trials including 8107 patients were studied. Of the total patient population in these RCTs, only 23% were women. Analysis of outcomes based on sex was reported only in 5 out of 10 trials. Of these five trials reporting sex-based outcomes, multicenter automatic defibrillator implantation trial with cardiac resynchronization therapy (MADIT-CRT) and resynchronization-defibrillation for ambulatory heart failure trial (RAFT) showed a greater benefit in women compared to men. Both MADIT and RAFT trials had a lower ejection fraction (EF) cut-off in the inclusion criteria (EF ≤ 30%) compared to the studies that did not find gender-based differences in the outcome (inclusion criteria: EF ≤ 35% or 40%). Additionally, women had less ischemic cardiomyopathy and more left bundle branch block (LBBB) compared to men in these two trials. CONCLUSION: Women are underrepresented in CRT trials; however, they have been shown to derive a greater benefit from CRT compared to men. Appropriate measures should be taken in future studies to enhance the participation of women in clinical trials for more generalizable evidence.

Vocal fold paralysis following first dose of Oxford-AstraZeneca coronavirus disease 2019 vaccine.

BACKGROUND: In a bid to end the ongoing coronavirus disease 2019 pandemic, many countries, including the UK, have rolled out mass immunisation programmes. While considered generally safe and effective, vaccines against coronavirus disease 2019 have been reported to be associated with rare and potentially adverse reactions and side effects. CASE REPORT: This paper reports an unusual case of a patient who developed a unilateral vocal fold paralysis shortly after receiving the first dose of the Oxford-AstraZeneca ChAdOx1 nCov-19 vaccine. CONCLUSION: To our knowledge, this is the first reported case of vocal fold paralysis following administration of the Oxford-AstraZeneca vaccine. The authors support the position that currently approved coronavirus disease 2019 vaccines remain safe and effective; however, further surveillance and vigilance using real-world data are highly encouraged.

Monitoring of Serum Potassium and Calcium Levels in End-Stage Renal Disease Patients by ECG Depolarization Morphology Analysis.

OBJECTIVE: Non-invasive estimation of serum potassium, [K+], and calcium, [Ca2+], can help to prevent life-threatening ventricular arrhythmias in patients with advanced renal disease, but current methods for estimation of electrolyte levels have limitations. We aimed to develop new markers based on the morphology of the QRS complex of the electrocardiogram (ECG). METHODS: ECG recordings from 29 patients undergoing hemodialysis (HD) were processed. Mean warped QRS complexes were computed in two-minute windows at the start of an HD session, at the end of each HD hour and 48 h after it. We quantified QRS width, amplitude and the proposed QRS morphology-based markers that were computed by warping techniques. Reference [K+] and [Ca2+] were determined from blood samples acquired at the time points where the markers were estimated. Linear regression models were used to estimate electrolyte levels from the QRS markers individually and in combination with T wave morphology markers. Leave-one-out cross-validation was used to assess the performance of the estimators. RESULTS: All markers, except for QRS width, strongly correlated with [K+] (median Pearson correlation coefficients, r, ranging from 0.81 to 0.87) and with [Ca2+] (r ranging from 0.61 to 0.76). QRS morphology markers showed very low sensitivity to heart rate (HR). Actual and estimated serum electrolyte levels differed, on average, by less than 0.035 mM (relative error of 0.018) for [K+] and 0.010 mM (relative error of 0.004) for [Ca2+] when patient-specific multivariable estimators combining QRS and T wave markers were used. CONCLUSION: QRS morphological markers allow non-invasive estimation of [K+] and [Ca2+] with low sensitivity to HR. The estimation performance is improved when multivariable models, including T wave markers, are considered. SIGNIFICANCE: Markers based on the QRS complex of the ECG could contribute to non-invasive monitoring of serum electrolyte levels and arrhythmia risk prediction in patients with renal disease.

Multifunctional Elastic Nanocomposites with Extremely Low Concentrations of Single-Walled Carbon Nanotubes.

Stretchable and flexible electronics has attracted broad attention over the last years. Nanocomposites based on elastomers and carbon nanotubes are a promising material for soft electronic applications. Despite the fact that single-walled carbon nanotube (SWCNT) based nanocomposites often demonstrate superior properties, the vast majority of the studies were devoted to those based on multiwalled carbon nanotubes (MWCNTs) mainly because of their higher availability and easier processing procedures. Moreover, high weight concentrations of MWCNTs are often required for high performance of the nanocomposites in electronic applications. Inspired by the recent drop in the SWCNT price, we have focused on fabrication of elastic nanocomposites with very low concentrations of SWCNTs to reduce the cost of nanocomposites further. In this work, we use a fast method of coagulation (antisolvent) precipitation to fabricate elastic composites based on thermoplastic polyurethane (TPU) and SWCNTs with a homogeneous distribution of SWCNTs in bulk TPU. Applicability of the approach is confirmed by extra low percolation threshold of 0.006 wt % and, as a consequence, by the state-of-the-art performance of fabricated elastic nanocomposites at very low SWCNT concentrations for strain sensing (gauge factor of 82 at 0.05 wt %) and EMI shielding (efficiency of 30 dB mm-1 at 0.01 wt %).

Estimation of potassium levels in hemodialysis patients by T wave nonlinear dynamics and morphology markers.

OBJECTIVE: Noninvasive screening of hypo- and hyperkalemia can prevent fatal arrhythmia in end-stage renal disease (ESRD) patients, but current methods for monitoring of serum potassium (K+) have important limitations. We investigated changes in nonlinear dynamics and morphology of the T wave in the electrocardiogram (ECG) of ESRD patients during hemodialysis (HD), assessing their relationship with K+ and designing a K+ estimator. METHODS: ECG recordings from twenty-nine ESRD patients undergoing HD were processed. T waves in 2-min windows were extracted at each hour during an HD session as well as at 48 h after HD start. T wave nonlinear dynamics were characterized by two indices related to the maximum Lyapunov exponent (λt, λwt) and a divergence-related index (η). Morphological variability in the T wave was evaluated by three time warping-based indices (dw, reflecting morphological variability in the time domain, and da and daNL, in the amplitude domain). K+was measured from blood samples extracted during and after HD. Stage-specific and patient-specific K+ estimators were built based on the quantified indices and leave-one-out cross-validation was performed separately for each of the estimators. RESULTS: The analyzed indices showed high inter-individual variability in their relationship with K+. Nevertheless, all of them had higher values at the HD start and 48 h after it, corresponding to the highest K+. The indices η and dw were the most strongly correlated with K+ (median Pearson correlation coefficient of 0.78 and 0.83, respectively) and were used in univariable and multivariable linear K+ estimators. Agreement between actual and estimated K+ was confirmed, with averaged errors over patients and time points being 0.000 ± 0.875 mM and 0.046 ± 0.690 mM for stage-specific and patient-specific multivariable K+ estimators, respectively. CONCLUSION: ECG descriptors of T wave nonlinear dynamics and morphological variability allow noninvasive monitoring of K+ in ESRD patients. SIGNIFICANCE: ECG markers have the potential to be used for hypo- and hyperkalemia screening in ESRD patients.

An Update on the Management of Esophageal Variceal Hemorrhage.

Content available: Author Audio Recording.

Monitoring blood potassium concentration in hemodialysis patients by quantifying T-wave morphology dynamics.

We investigated the ability of time-warping-based ECG-derived markers of T-wave morphology changes in time ([Formula: see text]) and amplitude ([Formula: see text]), as well as their non-linear components ([Formula: see text] and [Formula: see text]), and the heart rate corrected counterpart ([Formula: see text]), to monitor potassium concentration ([Formula: see text]) changes ([Formula: see text]) in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD). We compared the performance of the proposed time-warping markers, together with other previously proposed [Formula: see text] markers, such as T-wave width ([Formula: see text]) and T-wave slope-to-amplitude ratio ([Formula: see text]), when computed from standard ECG leads as well as from principal component analysis (PCA)-based leads. 48-hour ECG recordings and a set of hourly-collected blood samples from 29 ESRD-HD patients were acquired. Values of [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text] and [Formula: see text] were calculated by comparing the morphology of the mean warped T-waves (MWTWs) derived at each hour along the HD with that from a reference MWTW, measured at the end of the HD. From the same MWTWs [Formula: see text] and [Formula: see text] were also extracted. Similarly, [Formula: see text] was calculated as the difference between the [Formula: see text] values at each hour and the [Formula: see text] reference level at the end of the HD session. We found that [Formula: see text] and [Formula: see text] showed higher correlation coefficients with [Formula: see text] than [Formula: see text]-Spearman's ([Formula: see text]) and Pearson's (r)-and [Formula: see text]-Spearman's ([Formula: see text])-in both SL and PCA approaches being the intra-patient median [Formula: see text] and [Formula: see text] in SL and [Formula: see text] and [Formula: see text] in PCA respectively. Our findings would point at [Formula: see text] and [Formula: see text] as the most suitable surrogate of [Formula: see text], suggesting that they could be potentially useful for non-invasive monitoring of ESRD-HD patients in hospital, as well as in ambulatory settings. Therefore, the tracking of T-wave morphology variations by means of time-warping analysis could improve continuous and remote [Formula: see text] monitoring of ESRD-HD patients and flagging risk of [Formula: see text]-related cardiovascular events.

Characterization of T Wave Amplitude, Duration and Morphology Changes During Hemodialysis: Relationship With Serum Electrolyte Levels and Heart Rate.

OBJECTIVE: Chronic kidney disease affects more than 10% of the world population. Changes in serum ion concentrations increase the risk for ventricular arrhythmias and sudden cardiac death, particularly in end-stage renal disease (ESRD) patients. We characterized how T wave amplitude, duration and morphology descriptors change with variations in serum levels of potassium and calcium and in heart rate, both in ESRD patients and in simulated ventricular fibers. METHODS: Electrocardiogram (ECG) recordings from twenty ESRD patients undergoing hemodialysis (HD) and pseudo-ECGs (pECGs) calculated from twenty-two simulated ventricular fibers at varying transmural heterogeneity levels were processed to quantify T wave width ( Tw), T wave slope-to-amplitude ratio ([Formula: see text]) and four indices of T wave morphological variability based on time warping ( dw, [Formula: see text], da and [Formula: see text]). Serum potassium and calcium levels and heart rate were measured along HD. RESULTS: [Formula: see text] was the marker most strongly correlated with serum potassium, dw with calcium and da with heart rate, after correction for covariates. Median values of partial correlation coefficients were 0.75, -0.74 and -0.90, respectively. For all analyzed T wave descriptors, high inter-patient variability was observed in the pattern of such relationships. This variability, accentuated during the first HD time points, was reproduced in the simulations and shown to be influenced by differences in transmural heterogeneity. CONCLUSION: Changes in serum potassium and calcium levels and in heart rate strongly affect T wave descriptors, particularly those quantifying morphological variability. SIGNIFICANCE: ECG markers have the potential to be used for monitoring serum ion concentrations in ESRD patients.

The 'Digital Twin' to enable the vision of precision cardiology.

Providing therapies tailored to each patient is the vision of precision medicine, enabled by the increasing ability to capture extensive data about individual patients. In this position paper, we argue that the second enabling pillar towards this vision is the increasing power of computers and algorithms to learn, reason, and build the 'digital twin' of a patient. Computational models are boosting the capacity to draw diagnosis and prognosis, and future treatments will be tailored not only to current health status and data, but also to an accurate projection of the pathways to restore health by model predictions. The early steps of the digital twin in the area of cardiovascular medicine are reviewed in this article, together with a discussion of the challenges and opportunities ahead. We emphasize the synergies between mechanistic and statistical models in accelerating cardiovascular research and enabling the vision of precision medicine.

GC-MS and HPLC profiles of phenolic fractions of the leaf of Telfairia occidentalis.

Telfairia occidentalis possesses high antioxidant activity. However, the antioxidant components of the plant have not yet been identified. This study was undertaken to identify the phenolics in the leaf of the plant. Extract and fractions of the leaf of the plant were analysed using the HPLC and GCMS. HPLC analysis revealed the presence of gallic acid (22.19µg/mg), catechin (29.17µg/mg), caffeic acid (9.17µg/mg), ferulic acid (0.94µg/mg), sinapic acid (1.91 µg/mg) and 4-hydroxy benzoic acid (43.86 µg/mg) in the aqueous extract. Phenolics fraction contained gallic acid (0.88 µg/mg), catechin (2.70µg/mg), caffeic acid (7.92µg/mg), ferulic acid (2.72µg/mg), benzoic acid (6.36µg/mg), p-coumaric acid (1.48µg/mg), quercetin (12.00µg/mg). Only caffeic acid (2.50µg/mg), ferulic acid (0.44µg/mg) and quercetin (8.50µg/mg) were detected in the flavonoid fraction. While GCMS analysis showed the presence of methylparaben; ethylparaben; benzoic acid; 4-hydroxy-2-methoxy-3,5,6-trimethyl-, methyl ester; 4-hydroxy-3-methoxy; phenol, 5-methoxy-2-(methoxymethyl)-; phenol, 5-methoxy-2, 3- dimethyl; and phenol, 2-(2-benzothiazolyl)-. This study is the first to reveal the identity of some phenolics components of the leaf of Telfairia occidentalis.

Outpatient clinic numbers: a review of standards and current practice.

This article explores current recommendations for the safe and efficient running of outpatient clinics, why non-adherence exists, the consequences of non-adherence, and what can be done to improve standards. It promotes adherence to recommendations by both clinical and managerial staff.

A CRITICAL REVIEW ON PHARMACOLOGICAL SIGNIFICANCE OF HYDROGEN SULFIDE (H2S) ON NF-κB CONCENTRATION AND ICAM-1 EXPRESSION IN RENAL ISCHEMIA REPERFUSION INJURY.

Until recently hydrogen sulfide (H2S) was the least appreciated of the three gasotransmitters but now recognized as 3Y gaseous mediator after nitric oxide(NO) and carbon monoxide (CO). H2S regulates a number of physiological processes like vasorelaxation, prevention of inflammation, leukocyte adhesion, anti-prolifera- tive effects, anti-thrombotic effects, resistance to oxidative stress and protection against ischemia reperfusion injury (IRI). However, considerable amount of research is still needed to evaluate the mechanisms involved in the therapeutic effects of H2S in IRI such as its effects on nuclear factor-kappa B (NF-KB) concentration and intercellular adhesion molecule-1 (ICAM-1) expression in renal IRI and ARF (acute renal failure). More than a decade of good repute among researchers, H2S research has certain results that need to be clarified more such as whether H2S is pro-inflammatory or anti-inflammatory agent. Moreover, pathways adopted by H2S in the protein modification and its effects on cell signalling specially its effect on NF-KB in the process of inflamma- tion are not fully elucidated. H2S has delighted researchers and a great deal of information is being generated every year.The main purpose of the review is to provide an update on the development in the research of H2S in renal IRI due to uncertainty of the exact role of H2S on ICAM-1 expression and NF-KB concentration whether it inhibits or activates them.

Pancreaticopericardial Fistula: A Case Report and Literature Review.

Purpose. Pancreaticopericardial fistula (PPF) is an extremely rare complication of acute or chronic pancreatitis. This paper presents a rare case of PPF and provides systematic review of existing cases from 1970 to 2014. Methods. A PubMed search using key words was performed for all the cases of PPF from January 1970 to December 2014. Fourteen cases were included in the study. The cases were reviewed for demographic characteristics, diagnostic modalities, and treatment. Descriptive analysis of these variables was performed. Results. Median age was 43 years. 78% were known alcoholics and 73.3% had chronic pancreatitis. Dyspnea was present in 78%. Cardiac tamponade was present in 53%; 75% of patients had known chronic pancreatitis (RR = 0.74). Surgery was associated with best treatment outcomes and 50% of patients who underwent endoscopic treatment survived. Conclusion. PPF is a rare disease. This paper indicates that acute cardiac tamponade in patients with history of alcoholism and chronic pancreatitis could be a sign of an existing pancreaticopericardial fistula and early surgical intervention could be life-saving.

Up Regulation of cystathione γ lyase and Hydrogen Sulphide in the Myocardium Inhibits the Progression of Isoproterenol-Caffeine Induced Left Ventricular Hypertrophy in Wistar Kyoto Rats.

Hydrogen sulphide (H2S) is an emerging molecule in many cardiovascular complications but its role in left ventricular hypertrophy (LVH) is unknown. The present study explored the effect of exogenous H2S administration in the regression of LVH by modulating oxidative stress, arterial stiffness and expression of cystathione γ lyase (CSE) in the myocardium. Animals were divided into four groups: Control, LVH, Control-H2S and LVH-H2S. LVH was induced by administering isoprenaline (5mg/kg, every 72 hours, S/C) and caffeine in drinking water (62mg/L) for 2 weeks. Intraperitoneal NaHS, 56µM/kg/day for 5 weeks, was given as an H2S donor. Myocardial expression of Cystathione γ lyase (CSE) mRNA was quantified using real time polymerase chain reaction (qPCR).There was a 3 fold reduction in the expression of myocardial CSE mRNA in LVH but it was up regulated by 7 and 4 fold in the Control-H2S and LVH-H2S myocardium, respectively. Systolic blood pressure, mean arterial pressure, pulse wave velocity were reduced (all P<0.05) in LVH-H2S when compared to the LVH group. Heart, LV weight, myocardial thickness were reduced while LV internal diameter was increased (all P<0.05) in the LVH-H2S when compared to the LVH group. Exogenous administration of H2S in LVH increased superoxide dismutase, glutathione and total antioxidant capacity but significantly reduced (all P<0.05) plasma malanodialdehyde in the LVH-H2S compared to the LVH group. The renal cortical blood perfusion increased by 40% in LVH-H2S as compared to the LVH group. Exogenous administration of H2S suppressed the progression of LVH which was associated with an up regulation of myocardial CSE mRNA/ H2S and a reduction in pulse wave velocity with a blunting of systemic hemodynamic. This CSE/H2S pathway exhibits an antihypertrophic role by antagonizing the hypertrophic actions of angiotensin II(Ang II) and noradrenaline (NA) but attenuates oxidative stress and improves pulse wave velocity which helps to suppress LVH. Exogenous administration of H2S augmented the reduced renal cortical blood perfusion in the LVH state.