Expert Opinion on the Use of Novel Oral Anticoagulants for Stroke Prevention in Non-valvular Atrial Fibrillation for the Primary Care Setting in India: A Literature Review.

Atrial fibrillation (AF), the most prevalent cardiac arrhythmia encountered in clinical practice, is linked with substantial morbidity and mortality due to accompanying risk of stroke and thromboembolism. Patients with AF are at a five-fold higher risk of suffering from a stroke. Anticoagulation therapy, with either vitamin K antagonists or novel oral anticoagulants (NOACs), is a standard approach to reduce the risk. Consultant physicians (CPs) in India are the primary point of contact for the majority of patients before they approach a specialist. The CPs may face challenges in screening and diagnosing AF patients. The apprehensions associated with managing AF patients with anticoagulants, further add to the challenges of a CP. This review aimed to identify the key decision points for the CPs to diagnose AF and initiate anticoagulation in patients with non-valvular AF (NVAF) and bring to the table a simplified recommendation supported by expert opinion and guidelines for stroke prevention in NVAF patients.

30-Day and 1-Year Outcomes With HYDRA Self-Expanding Transcatheter Aortic Valve: The Hydra CE Study.

OBJECTIVES: This study sought to evaluate the 30-day and 1-year safety and performance of the Hydra transcatheter aortic valve (THV) (in the treatment of symptomatic severe aortic stenosis in patients at high or extreme surgical risk. BACKGROUND: The Hydra THV is a novel repositionable self-expanding system with supra-annular bovine pericardial leaflets. METHODS: The Hydra CE study was a premarket, prospective, multicenter, single-arm study conducted across 18 study centers in Europe and Asia-Pacific countries. The primary endpoint was all-cause mortality at 30 days. All endpoints were adjudicated by an independent clinical events committee. RESULTS: A total of 157 patients (79.2 ± 7.1 years of age, 58.6% female; Society of Thoracic Surgeons score 4.7 ± 3.4%) were enrolled. Successful implantation was achieved in 94.3% cases. At 30 days, there were 11 (7.0%) deaths, including 9 (5.7%) cardiovascular deaths, of which 5 (3.2%) were device related. At 1 year, there were 23 (14.6%) deaths, including 13 (8.3%) cardiovascular deaths. At 30 days, there were significant improvement of effective orifice area (from 0.7 ± 0.2 cm2 to 1.9 ± 0.6 cm2) and mean aortic valve gradient (from 49.5 ± 18.5 mm Hg to 8.1 ± 3.7 mm Hg), which were sustained up to 1 year. Moderate or severe paravalvular leak was observed in 6.3% of patients at 30 days and 6.9% of patients at 1 year. The rate of new permanent pacemaker implantation was 11.7% at 30 days and 12.4% at 1 year. CONCLUSIONS: The Hydra CE study demonstrated that transcatheter aortic valve replacement with Hydra THV offered favorable efficacy at 1 year, providing large effective orifice area and low transvalvular gradient as well as acceptable complication rates with regard to new permanent pacemaker and paravalvular leak. (A Clinical Evaluation of the HYDRA Self Expanding Transcatheter Aortic Valve; NCT02434263).

Tamarind (Tamarindus indica) fruit shell carbon: A calcium-rich promising adsorbent for fluoride removal from groundwater.

Tamarindus indica fruit shells (TIFSs) are naturally calcium rich compounds. They were impregnated with ammonium carbonate and then carbonized, leading to ammonium carbonate activated ACA-TIFS carbon. The resulting materials and carbon arising from virgin fruit shells V-TIFS were characterized and assayed as adsorbent for the removal of fluoride anions from groundwater. The fluoride scavenging ability of TIFS carbons was due to naturally dispersed calcium compounds. X-ray diffraction (XRD) showed that TIFS carbon contained a mixture of calcium oxalate and calcium carbonate. Batch studies on the fluoride removal efficiency of TIFS carbons with respect to contact time, pH, initial fluoride concentration, and co-ion interference were conducted. Applicability of various kinetic models (viz., pseudo-first-order, pseudo-second-order, intra-particle diffusion and Elovich) and sorption isotherms were tested for batch techniques. The fluoride removal capacity of TIFS carbons was found to be 91% and 83% at a pH of 7.05 for V-TIFS and ACA-TIFS carbons, respectively. The practical applicability of TIFS carbons using groundwater samples was approved. The fluoride removal was greater in groundwater without hydrogen carbonate ions than those containing these ions. The characterizations of fluoride unloaded and loaded TIFS carbons were done by SEM and XRD studies.

A clinical study of 125 patients with phrynoderma.

BACKGROUND: Phrynoderma is a type of follicular hyperkeratosis. Various nutritional deficiency disorders have been implicated in the etiology of phrynoderma. AIM: To determine clinical features of phrynoderma and its association with nutritional deficiency signs. MATERIALS AND METHODS: A cross-sectional descriptive study of 125 consecutive patients with phrynoderma attending the outpatient department (OPD) of dermatology was conducted in a tertiary care hospital. In all patients, a detailed history was taken and cutaneous examination findings such as distribution, sites of involvement, morphology of the lesions, and signs of nutritional deficiencies were noted. RESULTS: The proportion of patients with phrynoderma attending the OPD was 0.51%. There were 79 males and 46 females. Age of the patients was in the range of 3-26 years with a mean of 10 ± 4.3 years. The lesions were asymptomatic in 114 (91.2%) patients. The distribution of lesions was bilateral and symmetrical in 89 (71.2%) patients. The disease was localized (elbows, knees, extensor extremities, and/or buttocks) in 106 (84.8%) patients. The site of onset was elbows in 106 (84.8%) patients. The lesions were discrete, keratotic, follicular, pigmented or skin colored, acuminate papules in all patients. Signs of vitamin A and vitamin B-complex deficiency were present in 3.2% and 9.6% patients, respectively. Epidermal hyperkeratosis, follicular hyperkeratosis, and follicular plugging were present in the entire biopsy specimen. CONCLUSION: Phrynoderma is a disorder with distinctive clinical features and can be considered as a multifactorial disease involving multiple nutrients, local factors like pressure and friction, and environmental factors in the setting of increased nutritional demand.

Prozone phenomenon in secondary syphilis.

Prozone phenomenon is a false negative response resulting from high antibody titer which interferes with formation of antigen- antibody lattice, necessary to visualize a positive flocculation test. We present a case of secondary syphilis who presented to us with features of contact irritant dermatitis. She initially tested non- reactive for VDRL testing but tested positive with higher dilution. The prozone phenomenon is attaining importance because of increasing prevalence of Acquired immune deficiency syndrome. So one needs to be familiar with the occurrence of prozone phenomenon.

Bifurcation and chaos in spin-valve pillars in a periodic applied magnetic field.

We study the bifurcation and chaos scenario of the macromagnetization vector in a homogeneous nanoscale-ferromagnetic thin film of the type used in spin-valve pillars. The underlying dynamics is described by a generalized Landau-Lifshitz-Gilbert (LLG) equation. The LLG equation has an especially appealing form under a complex stereographic projection, wherein the qualitative equivalence of an applied field and a spin-current induced torque is transparent. Recently, chaotic behavior of such a spin vector has been identified by Li et al. [ Phys. Rev. B 74, 054417 (2006)] using a spin-polarized current passing through the pillar of constant polarization direction and periodically varying magnitude, owing to the spin-transfer torque effect. In this paper, we show that the same dynamical behavior can be achieved using a periodically varying applied magnetic field in the presence of a constant dc magnetic field and constant spin current, which is technically much more feasible, and demonstrate numerically the chaotic dynamics in the system for an infinitely thin film. Further, it is noted that in the presence of a nonzero crystal anisotropy field, chaotic dynamics occurs at much lower magnitudes of the spin current and dc applied field.

Contactants in 'Kum-Kum' dermatitis.

Twenty patients having contact dermatitis on the forehead due to Kum-Kum were patch tested with the commercially available Kum-Kum used by the patient as such, and also the extended European standard series of allergens, as well as brilliant lake red R, sudan I, aminoazobenzene and canaga oil since analysis of the Kum-Kum by thin-layer chromatography showed presence of these constituents. Patch tests were positive in all the patients with the commercial Kum-Kum and brilliant lake red R, sudan I, aminoazobenzene and canaga oil, but not with the extended European standard series of allergens.