Role of echocardiography in diagnostic evaluation of patients admitted to observation unit.

BACKGROUND: Syncope is a transient loss of consciousness due to transient decrease in cerebral perfusion. Syncope accounts for a 3-6% of all emergency department visits. Etiology of syncope can be neural, cardiogenic, or vascular. Previous studies have evaluated the types and management of syncope. Echocardiography is a commonly used test in the evaluation of causes of syncope. Whether the benefit compared to financial burden of this diagnostic study is in all subsets of syncope cases remains unclear. AIM: To evaluate the impact of echocardiography in the diagnostic evaluation of syncope and to evaluate the subset of patients that would benefit more from this diagnostic imaging. METHODS: We performed a retrospective chart review of patients \u3e 18 years of age with a primary diagnosis of syncope in a period of January 1st 2015-January 31st 2017. Our inclusion criteria included patients \u3e 18 years of age who were admitted to the observation floor with the primary complaint as syncope, had a normal or abnormal physical examination for syncope, had a normal or abnormal electrocardiogram during admission, had an echocardiography performed at admission. Our exclusion criteria included patients with seizures, hypoglycemia, myocardial infarction, patients who didn\u27t get echocardiography, and patients who had a positive marker of cardiac injury. RESULTS: A total of 369 patients were initially identified with a primary diagnosis of syncope, however only 120 of these patients fulfilled our inclusion and exclusion criteria. A total of n=25 of included patients had either an abnormal physical exam or abnormal echocardiography. Among this high risk group, 24% (n=6) of the patients had an abnormal finding on their transthoracic echocardiography. On the other hand, in the low risk group with a normal physical examination and electrocardiogram (EKG), 14 had a trans-thoracic echocardiography (TTE) positive for cause of syncope, that led to a change in medication, workup, or intervention in 6.7% (n=8) of the patients. CONCLUSION: The analysis of our study suggested that the diagnostic yield of transthoracic echocardiography in syncope is very limited in the absence of an abnormal physical exam or electrocardiogram, and it increase the health care cost burden with no additional benefits

A rare association of Takotsubo cardiomyopathy with neuroleptic malignant syndrome

Neuroleptic malignant syndrome is a potentially fatal neurological condition secondary toantipsychotic medication. It is characterized by distinctive clinical findings and autonomicdisturbances. NMS has not been associated with Takotsubo cardiomyopathy (TCM). TCM is an abnormal response to physiological stressors resulting from the autonomicabnormalities which at times can mimic myocardial infarction (MI). We present a unique caseof a 54-year-old female with bipolar disease presenting with lithium and haloperidol-inducedNMS complicated by TCM. The purpose of this case is to make clinicians aware of this rareassociation

RV lead placement - A forgotten cause of right heart failure.

Introduction: Cardiac implantable electronic devices (CIEDs) have opened new doors, improving the quality, and increasing the duration of life by providing support of heart rate, atrioventricular and interventricular synchrony, thereby preventing sudden cardiac death. Nevertheless, these devices can pose some risks to the patients, including pacemaker-mediated cardiomyopathy and endocarditis. Case presentation: We elucidate the case of a patient who had severe Tricuspid Regurgitation as a result of single chamber Implantable Cardioverter Defibrillator (ICD) placement which led to right heart failure (RHF). His chief complaints were generalized fatigability and difficulty climbing steps at home. He also had orthopnea but denies paroxysmal nocturnal dyspnea. Despite using home diuretic regimen (Torsemide 40 gm daily), his continued to increase. He did not respond well to intravenous diuretics that time so decision was made to start Aquapheresis to which he responded very well. Discussion: TV dysfunction associated with CIED leads can be investigated and diagnosed using different techniques. These pillars of diagnostic tests include two-dimensional (2D), 3D, and Doppler echocardiography. Presence of holosystolic hepatic vein flow reversal is key in diagnosing severe TR, whereas normal antegrade systolic flow excludes the possibility of moderate and severe TR. Conclusion: CIED leads causing tricuspid valve impairment has become increasingly recognized over the recent times; however, the evidence underlying this trend has been derived primarily from retrospective analyses. In order to circumvent these issues, leadless pacemakers and subcutaneous ICD devices should be considered

Left ventricular outflow tract thrombus in a patient with COVID-19-a ticking time bomb: a case report.

Background: Coronavirus disease 2019 (COVID-19) is a manifestation of severe acute respiratory syndrome coronavirus 2, which results in many different complications including left ventricular (LV) thrombi. Case summary: We present a 30-year-old female presenting with chest pain and shortness of breath. Patient had an extensive history including heart failure with an ejection fraction 15-20% and COVID-19 2 months ago. Echocardiogram revealed a 3.3 cm ×  1.7 cm LV thrombus which was not present 4 months ago before her diagnosis of COVID-19. The LV thrombus embolized resulting in an embolus extending from the distal infrarenal abdominal aorta to the common iliac arteries bilaterally. Repeat COVID pre-procedure was positive. She underwent bilateral femoral artery cutdown, bilateral iliac artery embolectomy, superficial femoral artery embolectomy, and bilateral lower extremity fasciotomy. An extensive workup for the aetiology of the LV thrombus turned out to be negative and COVID-19 was deemed to be the aetiology of the thrombus. The patient was bridged from apixaban to warfarin and was successfully discharged within a few weeks. Discussion: Hypercoagulability is a known complication of COVID-19 causing thrombi in various parts of the body including the LV. Early recognition with echocardiography, especially in patients with heart failure, and prompt treatment is key to avoid further complications such as embolization

Great saphenous vein stump: a risk factor for superficial/deep venous thrombosis and an indication for prophylactic anticoagulation? - a retrospective analysis

Background: Great saphenous vein (GSV) grafts are used for coronary artery bypass surgeries, but the remaining stump of the GSV may be the nidus for superficial and deep vein thrombosis. This study aims to determine the risk of thrombosis in the GSV stump in patients who developed lower extremity swelling following coronary artery bypass graft (CABG). Methods: We conducted a single-center retrospective analysis at Abington Jefferson Hospital of 100 patients who underwent CABG with GSV. Patients were monitored via follow-up for seven days for the development of saphenous vein thrombosis without any prophylactic anticoagulation for venous thrombosis. Risk factors including age, diabetes, hypertension, smoking, familial thrombophilia’s, family history of thrombosis, malignancy, and confounding factor-like early mobilization that may potentially alter the results were recorded. Results: The mean age of included patients was 70 years, and 65% of participants were men, 35% were women. Fourteen percent of the patients developed pain, swelling and edema in a leg where the graft was taken. We included patients aged >50 years with coronary artery disease who underwent CABG with SVG and developed lower extremity symptoms concerning for thrombosis. These patients underwent duplex ultrasound for possible GSV stump thrombosis. Any patients with coronary artery disease but no CABG or no lower extremity edema were excluded from the study. We found no saphenous vein thrombosis in the stump of the GSV in patients with clinical symptoms of thrombosis in their lower extremities based on duplex imaging. Conclusion: Based on our findings, the postoperative risk of developing thrombosis at the GSV stump and its extension to the deep veins is low and does not warrant prophylactic anticoagulation for venous thromboembolism. However, we recommend that further prospective studies with larger samples for an extended duration are warranted for better assessment of the risk of venous thrombosis in the GSV stump with minimal confounding factors

A rare association of Takotsubo cardiomyopathy with neuroleptic malignant syndrome

Neuroleptic malignant syndrome is a potentially fatal neurological condition secondary to antipsychotic medication. It is characterized by distinctive clinical findings and autonomic disturbances. NMS has not been associated with Takotsubo cardiomyopathy (TCM). TCM is an abnormal response to physiological stressors resulting from the autonomic abnormalities which at times can mimic myocardial infarction (MI). We present a unique case of a 54-year-old female with bipolar disease presenting with lithium and haloperidol-induced NMS complicated by TCM. The purpose of this case is to make clinicians aware of this rare association

Knowledge, attitudes, and practices regarding Crimean-Congo hemorrhagic fever among general people: A cross-sectional study in Pakistan.

BackgroundCrimean-Congo hemorrhagic fever (CCHF) continues to pose a serious threat to the fragile healthcare system of Pakistan with a continuous increase of morbidity and mortality. The present study aimed to assess the knowledge, attitudes, and practices regarding CCHF among general people who resided in Pakistan.MethodsAn online cross-sectional survey design was applied, and a convenience sampling technique was used to recruit 1039 adult people from Pakistan. Data were collected from September 08 to October 12, 2021. The questionnaire consisted of a total of 32 questions in four parts assessing socio-demographics, as well as knowledge, attitudes, and practices regarding CCHF. All statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS), and logistic regression analyses were performed to determine the factors associated with good knowledge, positive attitudes, and good practices.ResultsAlarmingly, 51.5% of participants heard about CCHF infection before administering the survey. Among these, 20.2%, 33.3%, and 48.2% of the study participants had demonstrated good knowledge, positive attitudes, and good practices, respectively. Binary logistic regression analysis revealed that education and income status had a significant impact on knowledge and attitudes (pConclusionsThe findings reflected inadequate levels of knowledge, attitudes, and practices regarding CCHF among general people in Pakistan which may regard as lower than expected. As CCHF is a highly contagious disease, it's urgent to initiate a comprehensive approach to handle the situation before it spreads further in Pakistan

Development of a Low-Cost Biomass Furnace for Greenhouse Heating

The energy crisis and increasing fossil fuel prices due to increasing demands, controlled supplies, and global political unrest have adversely affected agricultural productivity and farm profitability across the globe and Pakistan is not an exception. To cope with this issue of energy deficiency in agriculture, the best alternate strategy is to take advantage of biomass and solid waste potential. In low-income countries such as Pakistan, the greenhouse heating system mostly relies on fossil fuels such as diesel, gasoline, and LPG. Farmers are reluctant to adopt greenhouse farming due to the continuously rising prices of the fossil fuels. To reduce reliance on fossil fuel energy, the objective of this study was to utilize biomass from crop residues to develop an efficient and economical biomass furnace that could heat greenhouses to protect the crop from seasonal temperature effects. Modifications made to the biomass furnace, such as the incorporation of insulation around the walls of the furnace, providing turbulators in fire tubes, and a secondary heat exchanger (heat recovery system) in the chimney, have increased the thermal efficiency of the biomass furnace by about 21.7%. A drastic reduction in hazardous elements of flue gases was observed due to the addition of a water scrubber smoke filter in the exit line of the flue. The efficiency of the biomass furnace ranged from 50.42% to 54.18%, whereas the heating efficiency of the diesel-fired heater was 71.19%. On the basis of the equal heating value of the fuels, the unit material and operating costs of the biomass furnace for wood, cotton stalks, corn cobs, and cow dung were USD 2.04, 1.86, 1.78, and 2.00 respectively against USD 4.67/h for the diesel heater. The capital and operating costs of the biomass furnace were about 50% and 43.7% of the diesel heater respectively, resulting in a seasonal saving of about 1573 USD. The produced smoke was tested as environmental friendly under the prescribed limits of the National Environmental Quality Standards (NEQS), which shows potential for its large-scale adoption and wider applications

Solar Irrigation Potential, Key Issues and Challenges in Pakistan

Pakistan faces water scarcity and high operational costs for traditional irrigation systems, hindering agricultural productivity. Solar-powered irrigation systems (SPIS) can potentially provide a sustainable and affordable solution, but face technical, financial and policy barriers to adoption. A comprehensive study is needed to examine feasibility and identify barriers. Therefore, a comprehensive review study is conducted to identify the potential for solar irrigation, key issues and challenges related to its implementation in Pakistan. The analysis is based on published studies, technical reports and a survey of solar-powered drip irrigation systems. The use of SPIS in Pakistan is becoming a cost-effective and sustainable option for irrigation, particularly in remote and off-grid areas. However, these systems also have their challenges, such as high initial costs, maintenance and repairs, limited access to spare parts, lack of government policies and regulations, lack of technical expertise, lack of financing options and social acceptance. The most pressing issue is the risk of groundwater exploitation by using SPIS. Based on the analysis of the energy and water situation in Pakistan, it is important to sustainably use both solar energy and groundwater resources, through the implementation of effective management strategies and policies. With the right policies and investment in research and development of SPIS and groundwater, farmers can benefit by increasing crop yields, conserving water resources, reducing the cost of energy, increasing productivity and improving the standard of living and access to electricity in remote and off-grid areas. It is recommended that the adoption of solar energy be promoted to run high efficiency irrigation systems (HEIS) with urgent capacity improvement among farmers, advisors and system installers to sustainably manage water resources in SPIS. This would not only help to reduce the consumption of fossil fuels and associated environmental impacts, but also increase farmers’ income and reduce their operational costs. Moreover, the use of SPIS can improve crop yields, leading to food security and poverty reduction. Thus, the government and policymakers should consider implementing policies and incentives to encourage the large-scale adoption of solar energy in the agricultural sector

Attitude among general people regarding Congo (<i>N</i> = 535).

Attitude among general people regarding Congo (N = 535).</p