Idiopathic ventricular fibrillation in a previously healthy recreational athlete

There are several clinical challenges in the survivor of sudden cardiac arrest (SCA), including ensuring that a comprehensive diagnostic evaluation has been performed and providing counseling on return to activity. We report a case of a highly conditioned athlete who presented following aborted SCA during exercise with a diagnosis of idiopathic ventricular fibrillation arrest.

Recurrent takotsubo cardiomyopathy in a patient with hypertrophic cardiomyopathy leading to cardiogenic shock requiring VA-ECMO

Providing hemodynamic support for patients with hypertrophic cardiomyopathy and cardiogenic shock can be challenging because inotropic medications worsen intraventricular obstruction, and the effect of appropriate mechanical support remains undefined. We report a patient with hypertrophic cardiomyopathy in shock because of takotsubo cardiomyopathy requiring venoarterial extracorporeal membrane oxygenation and septal reduction for full recovery.

Enzymatic retting of Piper nigrum L. using commercial Pectinase(Peelzyme)

White peppers produced from Piper nigrum L. retted with different concentration of commercial pectinase (PeelZyme) and blanching treatment in hot water were compared. The effects of these treatments on surface morphology and piperine content of white berries was studied. PeelZyme at the concentration of 500 ppm successfully produced white berries after 5 days. However, white berries retted with PeelZyme at the concentration of 500 ppm without blanching gave the best surface morphology but there was a reduction in the piperine content by 3.04%. Blanching in hot water resulted in reduction of surface quality but an increase of piperine content up to 40% was obtained

Collegiate wrestler with a bicuspid aortic valve and aortic dilation

Bicuspid aortic valve and aortopathy are generally considered contraindications to isometric exercise. For athletes with mild disease at low risk of adverse events, a shared decision-making approach for continued sports participation is reasonable. We present a case of a collegiate wrestler with bicuspid aortic valve and aortopathy to illustrate shared decision making.

Effectiveness of cardiac resynchronization therapy by the frequency of revascularization procedures in ischemic cardiomyopathy patients

Background: It is not known whether the number of revascularizations modifies clinical outcomes in patients with ischemic cardiomyopathy (ICM) implanted with cardiac resynchronization therapy defibrillator (CRT-D) vs. an implantable cardioverter-defibrillator (ICD)-only. Methods: In Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT), we evaluated the effect of CRT-D vs. ICD-only on heart failure (HF) or death, on ventricular tachycardia (VT), ventricular fibrillation (VF) or death, and on reverse remodeling in 592 ICM patients with left bundle branch block, by the number of pre-enrollment revascularizations (0, 1 or ≥ 2 revascularizations). Results: There was a risk reduction of HF/death with CRT-D vs. ICD-only in all three sub-groups: ICM with no need for revascularization (HR 0.51 [0.26–1.02]; p = 0.055), ICM with 1 revascularization (HR 0.45 [0.30–0.70]; p < 0.001), and ICM with 2 or more revas­cularizations (HR 0.37 [0.20–0.66]; p < 0.001). Similarly, there was a risk reduction of VT/ /VF/death with CRT-D vs. ICD-only in patients with no need for revascularization (HR 0.55 [0.31–0.99]; p = 0.044); with 1 revascularization (HR 0.77 [0.51–1.18]; p = 0.23); or with ≥ 2 revascularizations (HR 0.63 [0.34–1.17]; p = 0.14). There was a similar degree of left ventricular reverse remodeling in all three subgroups (p > 0.05 for LVESV, LVEDV, and LAV percent change at 1-year follow-up). Conclusions: In ICM patients, CRT-D is associated with a reduction in HF or death and VT/VF or death — irrespective of the frequency of pre-enrollment revascularization procedures — and is accompanied by a similar degree of beneficial left ventricular reverse remodeling.

Application of Response Surface Methodology for Optimizing Process Parameters in the Production of Amylase by Aspergillus flavusNSH9 under Solid State Fermentation

Amylase is recognized as one of the important commercial enzymes. This group of enzymes has the ability in hydrolyzing starch into smaller oligosacharides. The present work aimed to determine the optimum fermentation conditions for maximum production of crude amylase enzyme by Aspergillus flavus NSH9 employing response surface methodology (RSM).Central composite design (CCD) was applied to determine the optimal fermentation condition with respect to the four main process parameters such as temperature, initial moisture content, pH and the incubation period. Solid state fermentation (SSF) was performed using 5.0 g of sago hampas inoculated with 1x107sporesmL-1following the experimental design obtained using CCD and further optimized by RSM. The initial moisture, pH and temperature showed significant effect on the amylase production (p<0.05). The maximum amylase activity produced was achieved and recorded as 1.055 ± 0.03U mL-1after four days of fermentation period with 100% (v/v) moisture holding capacity, pH 6.5 and temperature at 28°C. The optimum fermentation conditions for amylase production was determined with A. flavusNSH9 on sago hampas

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Honors Senior Project

In the first section of a three part series looking at health care reform, this segment analyzes a brief history of healthcare, a comparison of selected health care systems in the world, and the ethical and moral basis for health care systems in the respective countries. After analyzing the health care systems in England, France, and Germany, the ethical basis for health care in America will be established. It is important to analyze important paradigm shifts in healthcare as the latest is advent of employee sponsored healthcare. Without this advancement, it is very difficult for a majority of individuals to access healthcare because of its high, rising costs. Before getting into the ethical dimension of healthcare in America, the healthcare systems of the United Kingdom, France, and Germany will be analyzed in order to illustrate the driving force for healthcare in the respective countries. British citizens believe healthcare is a public service, French citizens believe in the concept of solidarité when thinking of healthcare reform, and German citizens believe healthcare is an inalienable right as it was given to them by Iron Chancellor. Furthermore, comparing health outcomes – life expectancy and infant mortality rates – and healthcare costs – as a percent of gross domestic product – will exemplify how these European countries have both better health outcomes and lower costs with universal healthcare. Finally, the ethical and moral basis for healthcare in the United Kingdom, France, and Germany will be used to analyze whether or not healthcare is considered a right in the United States

Qohwal al-misriyin

dalam buku ini berisi tentang cerita-cerita pendek tentang mesir157 hlm.; 20cm