A case of a prominent coumadin ridge poses a diagnostic dilemma

Introduction: Coumadin ridge, also known as warfarin ridge, is an embryological remnant in the form of a muscular ridge in the left atrium. We present a case of a middle-aged gentleman with prominent Coumadin ridge. Case: 49 year old male with history of pulmonary embolism (PE) (on Xarelto), attention deficit hyperactivity disorder (ADHD), prior polysubstance use, currently everyday smoker presented to the emergency department with history of shortness of breath and productive cough for 8 weeks. Initially he was treated with doxycycline for bronchitis and later with azithromycin for pneumonia as outpatient. He did not have chest pain, palpitations or limb swelling. On examination, heart sounds were distant and pulsus paradoxus was noted. He underwent computed tomography angiography (CTA) of the chest which revealed moderate left pleural effusion and a large pericardial effusion. Xarelto was held. He underwent pericardial window and thoracocentesis and chest tube placement for left pleural effusion. Intraoperative transesophageal echocardiography (TEE) showed likely thrombus or mass in the left atrial appendage (LAA). Thought to be xarelto failure, he was started on heparin for anticoagulation. He was also suspected to have malignancy given his extensive tobacco smoking history and family history of lung cancer. CT chest and fluid analysis was negative for malignancy. Cardiac magnetic resonance imaging (MRI) showed features suggestive of effusive constrictive pericarditis, left atrium was normal. Repeat TEE showed prominent Coumadin ridge with prominent LAA trabeculation with no mass or thrombus. Xarelto was restarted. Pericardial and pleural fluid analysis was negative for infectious workup including tuberculosis and autoimmune workup was also negative. He was started on colchicine and tapering dose of steroids for constrictive pericarditis. He improved and was discharged home to follow up with cardiology outpatient. Discussion: In our case, the echogenic hyperdensity on intraoperative transesophageal echocardiography raised suspicion of mass or thrombus. Our patient was already on Xarelto for pulmonary embolism. Direct oral anticoagulants (DOACs) failure has been reported in only approximately 2.1% of patients in large clinical trials. It is really interesting how coumadin ridge can almost be missed and how our patient was almost deemed to have xarelto failure, highlighting about the importance of being mindful about how the presence of prominent coumadin ridge could be easily mistaken for a pathology when it is not

Biosorption of Zinc on Immobilized Green Algae: Equilibrium and Dynamics Studies

The efficacy of using blank alginate beads and immobilized dead algal cells for the removal of zinc ions from aqueous solutions was investigated. It was found that the sorption capacities were significantly affected by solution pH; with higher pH favoring higher zinc ion uptake. Dynamics and isotherm experiments were carried out at the optimal pH 5.0. Zinc uptake on either sorbent was found to be rapid where approximately 90% of the maximum zinc uptake occurred within the first 30 min in both cases of blank alginate and immobilized algal cells. The equilibrium data for the biosorption of zinc ions onto both sorbents were fitted to the Langmuir, Freundlich, and Dubinin-Radushkevich (D-R) isotherm equations. The presence of copper and nickel in aqueous solutions was found to suppress the sorption process. The results of the dynamics studies revealed that the biosorption of zinc on immobilized dead algal cells followed pseudo-second order kinetics with little intraparticle diffusion mechanism contribution

Synthesis and in vivo anti-hyperlipidemic activity of novel n-benzoylphenyl-2-furamide derivatives in Wistar rats

Purpose: To synthesize and evaluate the anti-hyperlipidemic activity of a novel series of N- (benzoylphenyl)-2-furamides (3a, 3b, 4a, 4b and 4c).Methods: Compounds (3a, 3b, 4a, 4b and 4c) were successfully synthesized by reacting activated furan-2-carbonyl-chloride derivatives with aminobenzophenones at 60 °C for 36 h. Hyperlipidemia was induced in overnight fasted rats by intraperitoneal administration of Triton WR-1339 (300 mg/kg). to overnight fasted rats. The rats were divided into six groups: control, hyperlipidemic, hyperlipidemic plus compounds 3b, 4b, 4c, and hyperlipidemic plus bezafibrate-treated. Eighteen hours later, blood samples were collected and plasma lipid profile determined using enzymatic methods.Results: At a dose of 15 mg/kg body weight, the elevated plasma triglyceride (TG) levels, total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) levels were significantly reduced by compounds 4b (p < 0.001) and 4c (p < 0.0001) 18 h later, compared to the hyperlipidemic group. Furthermore, compounds 4b and 4c significantly increased high density lipoprotein cholesterol (HDL-C) levels by 29 and 34 %, respectively.Conclusion: The findings indicate the high potency of N-(benzolphenyl)-2-furamides (4b and 4c) as lipid-lowering agents. Thus, these compounds 4b and 4c may used as lead compounds for the development of new derivatives and agents for targeting dyslipidemia and cardiovascular diseases.Keywords: Triton WR-1339-induced hyperlipidemic rats, N-(benzoylphenyl)-2-furamides, Lipid-lowering activity, Cardiovascular disease, Synthesi

The Effectiveness of a Training Program Based on Creative Problem Solving Model (CPS) in Developing Mathematical Power for 8th Grade Students in Light of their Mathematics Achievement

This study aimed to reveal the effectiveness of a training program based on a creative problem solving model (CPS) in developing mathematical power for 8th grade students in light of their mathematics achievement. To achieve this goal, a training program was designed to focus on a set of mathematical ideas and skills in an algebra quantities unit using creative problem solving strategies. The researcher designed a test to measure mathematics power. The sample of the study consisted of 135 female eight grade students randomly selected from Dhahra governorate, which was divided into experimental and control groups. For testing the study hypothesis, data were  analyzed by analysis of covariance (ANCOVA 2X3) in which eta squared was obtained. The study revealed a significant difference (α=0.05) in the means between the experimental and control groups in the mathematical power test in favor of the experimental group

Early Diagnosis of Iron Deficiency in School Children: A Qatari Experience

Objective: Iron deficiency still remains the most common nutritional deficiency throughout the world and is the leading cause of anaemia in children. Early recognition of iron deficiency, even before the development of anaemia is crucial to prevent the systemic complications of this disease. Methods: Ninety-seven school children between 5 and 16 years were stratified into prelatent iron deficiency (10 cases), latent iron deficiency (14 cases), overt iron deficiency anemia (13 cases), and controls (60 cases). All hemograms were performed on the same day of collection using the same Sysmex XE-2100 analyzer with reticulocyte indices included. Biochemical markers such serum iron, total iron binding capacity and percent saturation (calculated) in addition to serum ferritin and serum transferrin receptors were simultaneously measured. Data analysis was done using ANOVA test, generalized linear regression, and ROC curve. Results: Our study indicates that a panel based on hematologic parameters including reticulocyte hemoglobin at a cut off of ≤27 and ≤25.6, serum transferrin receptors at a cut off >0.48 and >0.68, red cell distribution width at a cut off >13.8 and >16.8 may provide an alternative to the traditional biochemical panels for the diagnosis of latent iron deficiency and overt iron deficiency anemia respectively. Conclusion: Whenever iron deficiency is thought of, a hemogram including reticulocyte hemoglobin and serum transferrin receptors would be the adequate diagnostic panel obviating the need for a more extensive one. These parameters should always be interpreted in the clinical context involving dietary habits, social standard as well as family history

New derivatives of sulfonylhydrazone as potential antitumor agents: Design, synthesis and cheminformatics evaluation

Phosphoinositide 3-kinase α (PI3Kα) is a propitious target for designing anticancer drugs. A series of new N\u27-(diphenylmethylene)benzenesulfonohydrazide was synthesized and characterized using FT-IR, NMR (1H and 13C), HRMS, and elemental analysis. Target compounds exhibited an antiproliferative effect against the human colon carcinoma (HCT-116) cell line. Our cheminformatics analysis indicated that the para-tailored derivatives [p-NO2 (3) and p-CF3 (7)] have better ionization potentials based on calculated Moran autocorrelations and ionization potentials. Subsequent in vitro cell proliferation assays validated our cheminformatics results by providing experimental evidence that both derivatives 3 and 7 exhibited improved antiproliferative activities against HCT-116. Hence, our results emphasized the importance of electron-withdrawing groups and hydrogen bond-acceptors in the rational design of small-molecule chemical ligands targeting PI3Kα. These results agreed with the induced-fit docking against PI3Kα, highlighting the role of p-substituted aromatic rings in guiding the ligand-PI3Kα complex formation, by targeting a hydrophobic pocket in the ligand-binding site and forming π-stacking interactions with a nearby tryptophan residue

Design , Synthesis and Biological Evaluation Of Sulfonic Acid Esters / Benzene sulfonamides As Potential CETP Inhibitors

Cholesteryl ester transfer protein (CETP) is a glycoprotein involved in transporting lipoprotein particles and neutral lipids between high-density lipoprotein (HDL) and low density lipoproteins (LDL) and therefore it\u3es a proper target for treating dyslipidemia and related disorders, Guided by our previously-reported pharmacophore and QSAR models for CETP inhibition, we synthesized and bio assayed a series of toluene-4-sulfonic acid 4-benzylamino-phcnyl ester (8a-8m)/ N-(4-benzyl-phenyl)-4-methyl- benzene sulfonamide (6a-61) derivatives. The proposed structures for compounds 6a-1 and 8a-m were confirmed via elemental analyses, IR spectroscopy. mass spectroscopy, lH- and 13C-NMR spectra. The most potent synthesized compound 6j illustrated anti-CETP ICSO 0f 3.4 uM