Atypical case of post-partum cardiomyopathy: an overlap syndrome with arrhythmogenic right ventricular cardiomyopathy?

A middle-aged female patient presented with increasing dyspnoea following delivery of her second child. Echocardiography showed left ventricular (LV) dilatation and severe global impairment of systolic function (ejection fraction < 10%) but normal right ventricular (RV) dimensions. Plasma B-type natriuretic peptide level was elevated. Post-partum cardiomyopathy (PPCM) was considered and after initiating appropriate heart failure pharmacotherapy, her symptoms improved significantly. Cardiovascular MR showed RV free wall dyskinesia and aneurysms at the LV apex, RV free wall and RV outflow tract. Genetic analysis showed a C11842T substitution in the titin gene (TTN). This is the first case to propose an overlap syndrome of PPCM and arrhythmogenic RV cardiomyopathy.published_or_final_versio

CMOS integration of inkjet-printed graphene for humidity sensing.

We report on the integration of inkjet-printed graphene with a CMOS micro-electro-mechanical-system (MEMS) microhotplate for humidity sensing. The graphene ink is produced via ultrasonic assisted liquid phase exfoliation in isopropyl alcohol (IPA) using polyvinyl pyrrolidone (PVP) polymer as the stabilizer. We formulate inks with different graphene concentrations, which are then deposited through inkjet printing over predefined interdigitated gold electrodes on a CMOS microhotplate. The graphene flakes form a percolating network to render the resultant graphene-PVP thin film conductive, which varies in presence of humidity due to swelling of the hygroscopic PVP host. When the sensors are exposed to relative humidity ranging from 10-80%, we observe significant changes in resistance with increasing sensitivity from the amount of graphene in the inks. Our sensors show excellent repeatability and stability, over a period of several weeks. The location specific deposition of functional graphene ink onto a low cost CMOS platform has the potential for high volume, economic manufacturing and application as a new generation of miniature, low power humidity sensors for the internet of things.S.S. acknowledges Department of Science and Technology (DST), India for Ramanujan Fellowship to support the work (project no. SR/S2/RJN-104/2011). This work was (partly) supported through the EU FP7 project MSP (611887). T.H. acknowledges support from the Royal Academy of Engineering through a fellowship (Graphlex).This is the final version of the article. It was first available from NPG via http://dx.doi.org/10.1038/srep1737

Difficulties faced by older Rohingya (forcibly displaced Myanmar nationals) adults in accessing medical services amid the COVID-19 pandemic in Bangladesh

Background COVID-19 has seriously disrupted health services in many countries including Bangladesh. This research aimed to explore whether Rohingya (forcefully displaced Myanmar nationals) older adults in Bangladesh faced difficulties accessing medicines and routine medical care services amid this pandemic. Methods This cross-sectional study was conducted among 416 Rohingya older adults aged 60 years and above residing in Rohingya refugee camps situated in the Cox's Bazar district of Bangladesh and was conducted in October 2020. A purposive sampling technique was followed, and participants' perceived difficulties in accessing medicines and routine medical care were noted through face-to-face interviews. Binary logistic regression models determined the association between outcome and explanatory variables. Results Overall, one-third of the participants reported difficulties in accessing medicines and routine medical care. Significant factors associated with facing difficulties accessing medicine included feelings of loneliness (adjusted OR (AOR) 3.54, 95% CI 1.93 to 6.48), perceptions that older adults were at the highest risk of COVID-19 (AOR 3.35, 95% CI 1.61 to 6.97) and required additional care during COVID-19 (AOR 6.89, 95% CI 3.62 to 13.13). Also, the notable factors associated with difficulties in receiving routine medical care included living more than 30 min walking distance from the health centre (AOR 3.57, 95% CI 1.95 to 6.56), feelings of loneliness (AOR 2.20, 95% CI 1.25 to 3.87), perception that older adults were at the highest risk of COVID-19 (AOR 2.85, 95% CI 1.36 to 5.99) and perception that they required additional care during the pandemic (AOR 4.55, 95% CI 2.48 to 8.35). Conclusion Many Rohingya older adults faced difficulties in accessing medicines and routine medical care during this pandemic. This call for policy-makers and relevant stakeholders to re-assess emergency preparedness plans including strategies to provide continuing care

The WHF Roadmap for Reducing CV Morbidity and Mortality Through Prevention and Control of Rheumatic Heart Disease.

Rheumatic heart disease (RHD) is a preventable non-communicable condition that disproportionately affects the world's poorest and most vulnerable. The World Heart Federation Roadmap for improved RHD control is a resource designed to help a variety of stakeholders raise the profile of RHD nationally and globally, and provide a framework to guide and support the strengthening of national, regional and global RHD control efforts. The Roadmap identifies the barriers that limit access to and uptake of proven interventions for the prevention and control of RHD. It also highlights a variety of established and promising solutions that may be used to overcome these barriers. As a general guide, the Roadmap is meant to serve as the foundation for the development of tailored plans of action to improve RHD control in specific contexts

Study of elastic and inelastic scattering of 7^7Be + 12^{12}C at 35 MeV

The elastic and inelastic scattering of $^7$Be from $^{12}$C have been measured at an incident energy of 35 MeV. The inelastic scattering leading to the 4.439 MeV excited state of $^{12}$C has been measured for the first time. The experimental data cover an angular range of $\theta_{cm}$ = 15$^{\circ}$-120$^{\circ}$. Optical model analyses were carried out with Woods-Saxon and double-folding potential using the density dependent M3Y (DDM3Y) effective interaction. The microscopic analysis of the elastic data indicates breakup channel coupling effect. A coupled-channel analysis of the inelastic scattering, based on collective form factors, show that mutual excitation of both $^7$Be and $^{12}$C is significantly smaller than the single excitation of $^{12}$C. The larger deformation length obtained from the DWBA analysis could be explained by including the excitation of $^7$Be in a coupled-channel analysis. The breakup cross section of $^7$Be is estimated to be less than 10$\%$ of the reaction cross section. The intrinsic deformation length obtained for the $^{12}$C$^*$ (4.439 MeV) state is $\delta _2$ = 1.37 fm. The total reaction cross section deduced from the analysis agrees very well with Wong's calculations for similar weakly bound light nuclei on $^{12}$C target.Comment: 8 pages, 5 figure

A review on hierarchical routing protocols for wireless sensor networks

The routing protocol for Wireless Sensor Networks (WSNs) is defined as the manner of data dissemination from the network field (source) to the base station (destination). Based on the network topology, there are two types of routing protocols in WSNs, they are namely flat routing protocols and hierarchical routing protocols. Hierarchical routing protocols (HRPs) are more energy efficient and scalable compared to flat routing protocols. This paper discusses how topology management and network application influence the performance of cluster-based and chain-based hierarchical networks. It reviews the basic features of sensor connectivity issues such as power control in topology set-up, sleep/idle pairing and data transmission control that are used in five common HRPs, and it also examines their impact on the protocol performance. A good picture of their respective performances give an indication how network applications, i.e whether reactive or proactive, and topology management i.e. whether centralized or distributed would determine the network performance. Finally, from the ensuring discussion, it is shown that the chain-based HRPs guarantee a longer network lifetime compared to cluster-based HRPs by three to five times

"Pseudosarcoma" in a pregnant woman

BACKGROUND: Intravascular fasciitis (IVF) is a rare benign condition characterised by reactive myofibroblastic proliferation arising from the superficial or deep fascia and involving arteries and/or veins. It is a distinct variant of the more common condition of nodular fasciitis, which possesses similar clinical and histological features to IVF, but lacks vascular invasion. A thorough review of the literature revealed 26 reported cases of IVF. CASE PRESENTATION: We report a case of IVF in a 16-week pregnant lady affecting the hypothenar eminence of the hand associated with the ulnar artery. CONCLUSION: The characteristic involvement of muscular arteries and veins by reactive myofibroblastic proliferation in IVF suggests a malignant component and often leads to an inappropriate diagnosis for this benign condition. We propose that hormone-related changes associated with pregnancy may play an important role in the aetiopathogenesis of this myofibroblastic lesion

Foregrounds for redshifted 21 cm studies of reionization: GMRT 153 MHz observations

Foreground subtraction is the biggest challenge for future redshifted 21 cm observations to probe reionization. We use a short GMRT observation at 153 MHz to characterize the statistical properties of the background radiation across ~ one degree to sub-arcminutes angular scales, and across a frequency band of 5 MHz with 62.5 kHz resolution. The statistic we use is the visibility correlation function, or equivalently the angular power spectrum C_l. We present the results obtained from using relatively unsophisticated, conventional data calibration procedures. We find that even fairly simple minded calibration allows one to estimate the visibility correlation function at a given frequency V_2(U,0). From our observations we find that V_2(U,0) is consistent with foreground model predictions at all angular scales except the largest ones probed by our observations where the the model predictions are somewhat in excess. On the other hand the visibility correlation between different frequencies kappa(U, Delta nu), seems to be much more sensitive to calibration errors. We find a rapid decline in kappa(U, Delta nu), in contrast with the prediction of less than 1 % variation across 2.5 MHz. In this case however, it seems likely that a substantial part of the discrepancy may be due to limitations of data reduction procedures.Comment: 10 pages, 7 figures, 1 table, Accepted for Publication in MNRA

Effect of participatory women's groups facilitated by Accredited Social Health Activists on birth outcomes in rural eastern India: a cluster-randomised controlled trial

BACKGROUND: A quarter of the world's neonatal deaths and 15% of maternal deaths happen in India. Few community-based strategies to improve maternal and newborn health have been tested through the country's government-approved Accredited Social Health Activists (ASHAs). We aimed to test the effect of participatory women's groups facilitated by ASHAs on birth outcomes, including neonatal mortality. METHODS: In this cluster-randomised controlled trial of a community intervention to improve maternal and newborn health, we randomly assigned (1:1) geographical clusters in rural Jharkhand and Odisha, eastern India to intervention (participatory women's groups) or control (no women's groups). Study participants were women of reproductive age (15-49 years) who gave birth between Sept 1, 2009, and Dec 31, 2012. In the intervention group, ASHAs supported women's groups through a participatory learning and action meeting cycle. Groups discussed and prioritised maternal and newborn health problems, identified strategies to address them, implemented the strategies, and assessed their progress. We identified births, stillbirths, and neonatal deaths, and interviewed mothers 6 weeks after delivery. The primary outcome was neonatal mortality over a 2 year follow up. Analyses were by intention to treat. This trial is registered with ISRCTN, number ISRCTN31567106. FINDINGS: Between September, 2009, and December, 2012, we randomly assigned 30 clusters (estimated population 156 519) to intervention (15 clusters, estimated population n=82 702) or control (15 clusters, n=73 817). During the follow-up period (Jan 1, 2011, to Dec 31, 2012), we identified 3700 births in the intervention group and 3519 in the control group. One intervention cluster was lost to follow up. The neonatal mortality rate during this period was 30 per 1000 livebirths in the intervention group and 44 per 1000 livebirths in the control group (odds ratio [OR] 0.69, 95% CI 0·53-0·89). INTERPRETATION: ASHAs can successfully reduce neonatal mortality through participatory meetings with women's groups. This is a scalable community-based approach to improving neonatal survival in rural, underserved areas of India. FUNDING: Big Lottery Fund (UK)

NMR and molecular modelling studies on the interaction of fluconazole with β-cyclodextrin

<p>Abstract</p> <p>Background</p> <p>Fluconazole (FLZ) is a synthetic, bistriazole antifungal agent, effective in treating superficial and systemic infections caused by <it>Candida </it>species. Major challenges in formulating this drug for clinical applications include solubility enhancement and improving stability in biological systems. Cyclodextrins (CDs) are chiral, truncated cone shaped macrocyles, and can easily encapsulate fluconazole inside their hydrophobic cavity. NMR spectroscopy has been recognized as an important tool for the interaction study of cyclodextrin and pharmaceutical compounds in solution state.</p> <p>Results</p> <p>Inclusion complex of fluconazole with β-cyclodextrins (β-CD) were investigated by applying NMR and molecular modelling methods. The 1:1 stoichiometry of FLZ:β-CD complex was determined by continuous variation (Job's plot) method and the overall association constant was determined by using Scott's method. The association constant was determined to be 68.7 M^-1which is consistent with efficient FLZ:β-CD complexation. The shielding of cavity protons of β-CD and deshielding of aromatic protons of FLZ in various¹H-NMR experiments show complexation between β-CD and FLZ. Based on spectral data obtained from 2D ROESY, a reasonable geometry for the complex could be proposed implicating the insertion of the <it>m</it>-difluorophenyl ring of FLZ into the wide end of the torus cavity of β-CD. Molecular modelling studies were conducted to further interpret the NMR data. Indeed the best docked complex in terms of binding free energy supports the model proposed from NMR experiments and the <it>m</it>-difluorophenyl ring of FLZ is observed to enter into the torus cavity of β-CD from the wider end.</p> <p>Conclusion</p> <p>Various NMR spectroscopic studies of FLZ in the presence of β-CD in D₂O at room temperature confirmed the formation of a 1:1 (FLZ:β-CD) inclusion complex in which <it>m</it>-difluorophenyl ring acts as guest. The induced shift changes as well as splitting of most of the signals of FLZ in the presence of β-CD suggest some chiral differentiation of guest by β-CD.</p