Acute Aortic Dissection Presenting with Massive Hemoptysis and History of TAVR

Aortic dissection is a rare and life-threatening condition that frequently mimics more common causes of chest pain. This often leads to a missed or delayed diagnosis which can have disastrous consequences for the patient. It is imperative that physicians recognize the variable presentations of this life-threatening illness as early diagnosis and treatment are crucial to the outcome of the patient. We present the case of a 77-year-old female with a past medical history of hypertension, aortic stenosis, TAVR, and ESRD, who presented to the ED with chest pain and massive hemoptysis. PE was suspected,and CT PE was performed revealing an aortic dissection involving the ascending aorta and mediastinal hemorrhage with blood compressing the right main pulmonary artery.This case not only demonstrates the variable presentation of this critical diagnosis, but also raises the question of whether undergoing TAVR increases the risk of developing an aortic dissection, and also illustrates the possible utility of CT PE in the diagnosis of this condition.https://scholarlycommons.henryford.com/merf2019caserpt/1111/thumbnail.jp

Growth status and site quality of different seed production areas of teak (Tectona grandis L. f) in Karnataka, India

In the present study 20 SPAs of teak distributed in southern, central and northern parts of Karnataka, India are selected. Phenotypic parameters of standing trees of different SPAs were recorded. Further, seed yield was also recorded and compared with site quality and stand growth parameters. Result showed that there was a greater variation among SPAs for phenotypic growth characters as well as site quality. The overall growth of SPAs of Madikeri zone (Southern region) was found to be superior with respect to tree height, clear bole height and DBH.SPAs belonged to Dandeli (Northern region) recorded more DBH and nearly round stem. SPAs of Yallapur seed zone showed comparatively less growth over Madikeri zone. SPA of Dandeli zone recorded the more tree volume and top height, followed by SPA of Madikeri zone. Considering site quality of different SPAs, all the studied SPAs of Karnataka are growing under relatively poor site conditions. Sixteen out of twenty SPAs, nearly 80% were growing in areas with site quality classes IV and V. Interestingly, none of the studied SPAs belonged to either class I or II. Association study showed that tree height (r=0.403) and clear bole height (r=0.412) showed positive relationship with seed yield. Furthermore, site quality showed a weak positive relationship with seed yield (R2 =0.052) among SPAs indicating poor site quality could be a major factor for low seed yield. It is concluded that SPAs of Madikeri and Dandeli zones performed better in growth and stem form. Therefore, it is suggested to collect quality seeds from these seed zones

Maternity Experiences and Perceptions of Emergency Medicine Physicians

INTRODUCTION: Postpartum employment has been recognized as a significant obstacle to breastfeeding continuation rates in the general population. Multiple additional factors can influence emergency medicine (EM) physician mothers\u27 ability to continue breastfeeding upon return to work. These include the unpredictable nature of emergency room volumes and acuity, absence of protected lactation time or facilities, and varying levels of support from colleagues. This study investigated a sample of female EM physicians\u27 current perceptions and experiences regarding breastfeeding practices and identified modifiable work-place factors affecting their decision to wean. The authors hypothesized that EM physician mothers would have excellent breastfeeding initiation rates but be largely unable to maintain breastfeeding practices upon returning to work. METHODS: A 34-item survey questionnaire evaluated demographics, perceptions, and experiences with breastfeeding with a convenience sample of EM attending and resident physicians from two Michigan academic community hospitals. RESULTS: Thirty-nine surveys were completed, representing a participant response rate of 88.6%. Breastfeeding had been initiated by all respondent mothers, all of whom returned to full-time employment after delivery. Upon return to work, 15 (75%) respondents continued to exclusively breastfeed. The goal of participants was to breastfeed for an average of 7.1 months (± 4.1 months), although the average duration children were exclusively breastfed was 5.8 months (± 4.0 months). CONCLUSIONS: Based on these results, the reasons for decreased breastfeeding after return to work in an EM residency program setting are multifactorial and include some modifiable interpersonal and institutional influences. These findings support the implementation of work-place strategies and policies to promote successful breastfeeding practices among EM resident and attending physician mothers returning to work

Seed size and its influence on germination, seedling growth and biomass in Saraca asoca (Roxb). De Wilde, critically endangered tree species of Western ghats, India

Saraca asoca (Roxb). De Wilde is one of the high traded medicinal plant species of India. There is a huge demand for bark of this species both in domestic and international markets. There is a demand for quality planting materials for large scale plantation. Forest department and farmers have already initiated captive plantation of this species. Several factors affect the seedling quality in nursery. Seed grading is one among them. The present study aims at understand the influence of seed size on seed germination and seedling vigour in S. asoca. Association study showed that seed length was positively correlated with seed weight (r= 0.887), seed width (r=0.697) and thickness (r=0.621). Therefore, seed length was used to categorize seedlot into small (< 30.0 mm), medium (30.1-40.0 mm) and large (> 40.1 mm) seeds. Result showed that larger seeds produced maximum germination (86.7%) as compared to smaller seeds (45.0%). Moreover, larger seeds attained higher collar diameter (3.34 mm) and dry biomass viz., leaf biomass (0.91 g), shoot biomass (0.31 g), root biomass (0.95 g) and entire seedling biomass (2.17 g) as compared to smaller seeds. Seedlings raised from medium seeds were at par with larger seeds in most of the traits. Therefore, it is suggested to use seedlot having > 30 mm length, preferably larger seeds (> 40 mm) in the nursery for better establishment of quality seedlings

Seed traits, germination pattern and seedling vigour in Antiaris toxicaria (Pers.) Lesch., a rare plant species of Western ghats

Antiaris toxicaria (Pers.) Lesch. is one of the species of ecological importance distributed in Western Ghats and other parts. This species is considered as one of the threatened species and it needs conservation. The information on fruit and seed trait variation and germination attributes are scanty. Such database is useful for afforestation programme as well as for augmentation of rare plant species in their natural habitat. For the present study, 10 open pollinated trees distributed in Devade forest of Sakharpa were marked. April month was the peak fruiting period and healthy fruits were collected from the ground. Fruit and seed traits were found to be varied significantly among trees, where fruit length ranged from 21.50 to 24.71 mm and fruit weight ranged from 3.64 to 4.07 g. Similarly, seeds length (14.01 -15.09 mm), seed thickness (12.15 -13.04 mm) and seed weight (1.20 – 1.57g) also showed significant variation among 10 trees. Field observation showed that there was a poor regeneration in this species at studied site. Therefore, germination study was conducted at nursery condition by imposing several pretreatments. Among eight treatments including control, soaking seeds in water for 24 hrs (T2) resulted in better germination of 38.0% as compared to others. In T2 seed germination started at 16 days after sowing and completed within 42 days. Potting mixture of red soil with saw dust in 30:70 ratio improved seed germination about 20 % as compared to red soil media

Arterial Occlusion and Acute Deep Vein Thrombosis-Induced Acute Limb Ischemia in a COVID-19 Patient

Coronavirus disease 2019 (COVID-19) is a viral illness known to elicit a hypercoagulable state leading to a myriad of vascular pathologies. Over the course of the COVID-19 pandemic, widespread insults to the venous system have been well documented, with an increasing number of arterial events being reported. Despite the rising incidence of both pathological manifestations, these events are rare, but when present, serve as significant life threats to the patient in question. We report and discuss a case of a 69-year-old female with no thromboembolic risk factors or systemic signs of illness who presented with signs and symptoms consistent with acute limb ischemia (ALI). The patient was ultimately found to have occlusion of multiple arterial and venous vessels. She tested positive for COVID-19 despite being otherwise asymptomatic from a viral syndrome standpoint. To our knowledge, there are no reports in the medical literature of ALI - in the setting of arterial occlusion and concomitant deep vein thrombosis (DVT) - as the sole clinical manifestation in an asymptomatic patient without thrombotic risk factors who was only incidentally found to be COVID-19-positive. This case underscores the atypical manifestations and deleterious effects associated with COVID-19 and the need to have a high index of suspicion for a multitude of pathologies when facing this viral illness

Neurogenic Stunned Myocardium Following an Attempt to Pass a Drug Test

Ingestion of a large volume of free water or other hypotonic solution can cause acute hyponatremia, leading to multiorgan dysfunction. Individuals may attempt to generate a false-negative urine drug screen through increased free water consumption leading to acute hyponatremia requiring emergency medical care. We present the case of a 19-year-old male who presented to a community emergency department for altered mental status after an attempt to generate a false-negative urine drug screen. He ingested a large volume of free water and multiple detoxification solutions, causing acute hyponatremia with resultant cerebral edema and neurogenic stunned myocardium. He required extracorporeal membrane oxygenation therapy with complete recovery of neurologic and cardiac function. Acute hyponatremia from excess free water consumption is a well-documented phenomenon that all emergency providers should be aware of. Prompt identification and management of acute hyponatremia are essential to prevent potentially severe, devastating sequelae, including cerebral edema and cardiopulmonary failure.In addition, extracorporeal membrane oxygenation may be considered in patients with cardiopulmonary failure in the setting of reversible cardiomyopathy, as evidenced in our case

Three Lives At Stake: A Case of Acute Myocardial Infarction in a Patient with Twin Pregnancy

An acute myocardial infarction (AMI) is a rare complication of pregnancy. The incidence ranges between 3 to 100 per 100,000 live-births. Risk factors include common comorbidities such as smoking, hypertension, hyperlipidemia, diabetes mellitus, sedentary life-style, and obesity. Pregnancy carries additional unique AMI risk factors including advanced maternal age, preeclampsia, thrombophilia, postpartum infection/sepsis and hemorrhages. We describe the unique case of an acute ST-elevation myocardial infarction (STEMI) in a 37 year old woman at 24 weeks gestation with a dichorionic/diamniotic (DCDA) pregnancy. Through serial EKGs and echocardiography, a diagnosis was able to be made despite an atypical clinical presentation of AMI in a pregnant patient. Using a multidisciplinary approach with OB/Gyn and cardiac specialties, the patient had successful medical management and cardiac catheterization which resulted in a positive outcome as the patient recovered well and ultimately delivered healthy twins. Understanding the subtle differences of specific diagnostic and treatment pathways for AMI in pregnancy is essential to improving outcomes in both mother and fetus.https://scholarlycommons.henryford.com/merf2020caserpt/1083/thumbnail.jp

Growth and productivity of Tectona grandis Linn. f. in plantations and farmlands in coastal zone of Karnataka (India)

The present study was conducted to understand the growth performance and productivity potential of Tectona grandis grown in plantation as well as in the farmlands at coastal zone of Karnataka. The growth of teak tree grown in farmland was significantly higher than tree grown in pure plantation. For instance, the overall height(11.95 m), diameter (23.69 cm), clear bole height (6.20 m), tree volume (0.61 m3) and timber volume (0.33 m3) was higher in farmland than trees grown in pure plantation (11.60 m, 20.33 cm, 4.90 m, 0.42 m3 and 0.18 m3, respectively). However, crown parameters did not show significant difference among trees grown in pure plantations and farmlands. There was a strong influence of age on growth of teak trees grown in both farmland and pure plantation. For instance, tree height (14.72 m) and diameter (30.52 cm) of higher age class (A4: 21-25 years) was maximum as compared lower age class (A1: 5-10 years) with values of 8.29 m and 17.14 cm, respectively. Similar trend was also recorded for volume, clear bole height, crown height, crown length and crown diameter in teak. It was concluded that teak grown in farmland may produce higher growth and volume as compared to pure plantation