The incidental episode of ventricular fibrillation: a case report

Polymorphic ventricular tachycardia and ventricular fibrillation (VF) carry important prognostic implications, especially in the post myocardial infarction period. However, artifact on the electrocardiographic tracing can mimic VF particularly on routinely recorded rhythm strips in hospitals. Such misinterpretation can lead to expensive (and potentially risky) diagnostic and therapeutic steps. We report on such a case and highlight the need for careful inspection of the tracing

Prosthetic valve thrombosis despite seemingly-adequate anticoagulation: the dangers of transient lapses in anticoagulation

We report a 19-year-old woman with thrombosis of a prosthetic mitral valve that was most likely due to a short dip in anticoagulation in the days preceding the event. Interestingly, at presentation the Patient was super-therapeutic, most likely a result of hepatic congestion as the heart began to fail, creating an illusion of thrombosis despite adequate anti coagulation

New class of exact solutions to Einstein-Maxwell-dilaton theory on four-dimensional Bianchi type IX geometry

We construct new classes of cosmological solution to the five dimensional Einstein-Maxwell-dilaton theory, that are non-stationary and almost conformally regular everywhere. The base geometry for the solutions is the four-dimensional Bianchi type IX geometry. In the theory, the dilaton field is coupled to the electromagnetic field and the cosmological constant term, with two different coupling constants. We consider all possible solutions with different values of the coupling constants, where the cosmological constant takes any positive, negative or zero values. In the ansatzes for the metric, dilaton and electromagnetic fields, we consider dependence on time and two spatial directions. We also consider a special case of the Bianchi type IX geometry, in which the geometry reduces to that of Eguchi-Hanson type II geometry and find a more general solution to the theory.Comment: 38 pages, 15 figures, two new appendices added, typos correcte

Spherical inhomogeneous solutions of Einstein and scalar-tensor gravity: a map of the land

We review spherical and inhomogeneous analytic solutions of the field equations of Einstein and of scalar-tensor gravity, including Brans-Dicke theory, non-minimally (possibly conformally) coupled scalar fields, Horndeski, and beyond Horndeski/DHOST gravity. The zoo includes both static and dynamic solutions, asymptotically flat, and asymptotically Friedmann-Lema\^itre-Robertson-Walker ones. We minimize overlap with existing books and reviews and we place emphasis on scalar field spacetimes and on geometries that are "general" within certain classes. Relations between various solutions, which have largely emerged during the last decade, are pointed out.Comment: 140 pages, one figure. Explanation text and bibliography expanded, typographical errors corrected. Matches version to appear in Physics Report

Prognosis of hospitalized new-onset systolic heart failure in Indo-Asians--a lethal problem

Background: Systolic heart failure (SHF), particularly when requiring hospital admission carries a poor prognosis. There is a paucity of data in Indo-Asians on outcomes of SHF, among whom the burden of cardiovascular disease is consistently rising. The purpose of this study was to determine the frequency and predictors of mortality and morbidity amongst patients admitted with new-onset SHF at a tertiary care hospital in Pakistan. Methods and Results: Hospital charts of 196 patients with a diagnosis of new or recent onset (!3 months) SHF (ejection fraction [EF] !40%) were reviewed. Patients who died during the admission, those with life-limiting concomitant disease, and those without follow-up were excluded. Survival was calculated according to the Kaplan-Meier method. Hazards ratios (HR) and 95% confidence intervals (CI) were calculated using Cox’s regression model. Mean age (SD) was 61 (12.8) years. Majority (77%) had a prior ischemic heart disease. Mean EF (SD) was 25% (8.7). Median follow-up period was 379 days. Fifty-four (27.5%) patients died (at least 12 [22.2%] sudden deaths) and 102 (52%) experienced combined event of death or repeat hospitalization for SHF. Factors independently associated with death included (HR [95% CI]), serum sodium (0.94 [0.90e0.97]), admission pulse (1.02 [1.01e1.04]), systolic blood pressure (0.98 [0.97e0.99]), and severe mitral regurgitation (1.90 [1.03e3.48]). Conclusions: Admission for new or recent onset SHF predicts a grave 1-year prognosis in Indo-Asians. Measures to prevent ischemic heart disease and its sequelae are essential because developing nations simply cannot afford to treat and manage heart failure

Increased platelet reactivity in idiopathic pulmonary fibrosis is mediated by a plasma factor

Introduction Idiopathic Pulmonary Fibrosis (IPF) is a progressive, incurable fibrotic interstitial lung disease with a prognosis worse than many cancers. Its pathogenesis is poorly understood. Activated platelets can release pro-fibrotic mediators that have the potential to contribute to lung fibrosis. We determine platelet reactivity in subjects with IPF compared to age-matched controls. Methods Whole blood flow cytometry was used to measure platelet-monocyte aggregate formation, platelet P-selectin expression and platelet fibrinogen binding at basal levels and following stimulation with platelet agonists. A plasma swap approach was used to assess the effect of IPF plasma on control platelets. Results Subjects with IPF showed greater platelet reactivity than controls. Platelet P-selectin expression was significantly greater in IPF patients than controls following stimulation with 0.1 µM ADP (1.9% positive ±0.5 (mean ± SEM) versus 0.7%±0.1; p = 0.03), 1 µM ADP (9.8%±1.3 versus 3.3%±0.8; p<0.01) and 10 µM ADP (41.3%±4.2 versus 22.5%±2.6; p<0.01). Platelet fibrinogen binding was also increased, and platelet activation resulted in increased platelet-monocyte aggregate formation in IPF patients. Re-suspension of control platelets in plasma taken from subjects with IPF resulted in increased platelet activation compared to control plasma. Conclusions IPF patients exhibit increased platelet reactivity compared with controls. This hyperactivity may result from the plasma environment since control platelets exhibit increased activation when exposed to IPF plasma

Association between Pus Cells and Semen Parameters in Infertile Pakistani Males

Objectives: This study evaluated the association between pus cells and semen parameters in infertile Pakistani males. Methods: A cross-sectional descriptive study was carried out in the Department of Reproductive Physiology/Health, National Institute of Health, Islamabad, Pakistan, from 2004 to 2009. A total of 1,521 subjects were analysed, along with 97 proven fathers as controls. Results: The mean of pus cells was 7.43 ± 0.43, 4.35 ± 0.34, and 4.26 ± 0.17 per high field in teratozoospermic, oligoasthenozoospermic, and asthenozoospermic groups, respectively, while it was 3.25 ± 0.26, 3.10 ± 0.19, and 2.98 ± 0.04 per high field in azoospermic, oligozoospermic and the proven father groups, respectively. The fewest pus cells were observed among proven fathers, which varied non-significantly (P >0.05) with all cases, except with teratozoospermic, oligozoospermic, and oligoasthenozoospermic cases. Pus cells showed an inverse relationship to sperm motility and count, except in azoospemia cases. Similarly, the fewest pus cells were observed among groups where normal forms where significantly more frequent (P <0.05). More pus cells were observed in cases where motility, and concentration or morphology was compromised. Similarly, low pus cell counts were seen in cases where sperm had the fewest head and neck defects. All kinds of sperm defects varied non-significantly (P >0.05) between proven fathers and normal concentration cases. Conclusion: High pus cell counts were observed in various subclasses of infertile patients. Ignorance of this pyospermic factor will make pyospermic patients to be misdiagnosed as normozoospermic. Therefore, the presence of pyospermia must be considered by physicians as a male infertility factor