Predictors of Mortality Amongst Recipients of Implantable Cardioverter Defibrillators for Secondary Prevention of Cardiac Arrest

BACKGROUND: Implantable Cardioverter-defibrillators (ICD) reduce mortality in survivors of cardiac arrest (CA). We investigated the predictors of mortality after ICD implantation in survivors of CA. METHODS: Retrospective review of clinical records and social security death index of all patients who received an ICD in a preexisting database of survivors of CA at the University of Pittsburgh Medical Center was performed. Multivariate analyses using the Cox proportional hazard model were performed with backward elimination to identify independent predictors of the time to death, and Kaplan-Meier curves were plotted. RESULTS: Eighty patients (64 men) with a mean age of 64.4+/-12.5 years were followed for 4.7+/-2.3 years after ICD implantation. Survival rates were 93.8%, 65% and 50% at 1, 5, and 10 years, respectively. Independent predictors of time to death were determined to include age (hazard ratio (HR) = 1.91 per 10-year increase, p = 0.003), serum creatinine > or = 1.3 mg/dL (HR = 2.56, p = 0.004), and QRS width >120 ms (HR = 5.14, p = 0.012). CONCLUSIONS: In this sample of ICD recipients secondary to CA, older age, elevated serum creatinine, and wider QRS duration were independent predictors of mortality. The presence of more than one risk factor in the same patient was associated with higher mortality rates. Whether interventions such as biventricular pacing can offset this increase risk of death warrants further investigation

Is there an association between vitamin D and risk of stroke?: a North Indian study

Background: Vitamin D deficiency is present in India in epidemic proportions despite plenty of sunshine. Reduced plasma 25(OH) D concentrations as a diagnostic marker of vitamin D deficiency have been in past decade associated with several well-established risk factors for ischaemic stroke, such as arterial hypertension, thrombosis, atherosclerosis. The aims and objectives of this study was to compare the serum 25(OH) D levels between the first ever acute stroke patients and healthy controls.Methods: A cross-sectional, case control study was conducted in a tertiary care hospital in New Delhi situated in north India. Serum 25‑hydroxyvitamin D (25(OH) D) levels in 85 patients of ischemic stroke, presenting within 7 days of onset of stroke was measured and was compared with 70 age and gender matched controls.Results: The mean age was 61.02±11.58 years and 58.63±11.28 years in cases and controls respectively. Females constituted 37.6% of the total number of cases and 43.4% of the controls. The age and gender-distribution were comparable between the cases and controls. The median value (IQR) of serum 25(OH) vitamin D level was 7.94 ng/mL (4.59-14.00) in the cases and it was 8.82 ng/mL (5.59-14.70) in the controls. The difference between the serum 25(OH) vitamin D levels of the two groups was not found to be statistically significant.Conclusions: There is a high prevalence of biochemical hypo-vitaminosis D in apparently healthy Indians of all age and sex groups despite adequate sunshine. There is no association between low vitamin D levels and stroke

Cloning and expression of the levanase gene in Alcaligenes eutrophus H16 enables the strain to hydrolyze sucrose

Friehs K, Lafferty RM. Cloning and expression of the levanase gene in Alcaligenes eutrophus H16 enables the strain to hydrolyze sucrose. Journal of Biotechnology. 1989;10(3-4):285-291.Genetic engineering methods were used to enhance the substrate spectrum of Alcaligenes eutrophus H16, a poly-[beta]-hydroxybutyric acid (PHB) producer. Using parts of the vector pMMB33 and a 2.5 kb DNA fragment of the Bacillus subtilis chromosome a plasmid was constructed bearing the gene for levanase, an enzyme able to hydrolyze various saccharides. After transfer of the levanase gene by triparental conjugation, the gene, controlled by its own Bacillus subtilis promoter, is expressed in Alcaligenes eutrophus H16 and enables the strain to hydrolyze sucrose. However, growth on sucrose is limited; i.e. the sucrose is not transported efficiently into the cell and/or the levanase is not secreted into the medium

Adverse reaction to Coartem (artemether/lumefantrine) resulting in oculogyric crisis

Background Artemether/lumefantrine (AL), sold under the brand name Coartem, is the most common artemisinin-based combination therapy for the treatment of malaria. Drug-induced oculogyric crisis is a neurological disorder characterized by frequent upward deviations of the eye. In the literature, no cases of Coartem-induced oculogyric crisis have been reported in Ghana. Case presentation A 19-year-old male patient, who presented fever measuring 37.9 °C, general body pains, and weakness was prescribed with antimalarial therapy artemether/lumefantrine, Coartem®, from a local pharmacy. Just after initiation of treatment, the patient complained of double vision, involuntary upward eye deviation, and inability to close both eyes. The patient was diagnosed with Coartem-induced oculogyric crisis and was treated with the cessation of the causing agent and intramuscular injection of promethazine hydrochloride. Conclusions When a patient exhibits a neurological disorder, such as oculogyric crisis, with normal conscious state and normal vital signs, special attention should be given to obtaining a history of recently administered medications. Clinicians should recognize adverse reactions to drugs based on a thorough patient history and examination. The goal of this report was to present Coartem-induced oculogyric crisis.This research was supported by Basic Science Research Program funded by the Ministry of Education (2017R1D1A1B04029339) and by grant no 03-2019-0043 from the SNUDH Research Fund

Blueprint for a Scalable Photonic Fault-Tolerant Quantum Computer

Photonics is the platform of choice to build a modular, easy-to-network quantum computer operating at room temperature. However, no concrete architecture has been presented so far that exploits both the advantages of qubits encoded into states of light and the modern tools for their generation. Here we propose such a design for a scalable and fault-tolerant photonic quantum computer informed by the latest developments in theory and technology. Central to our architecture is the generation and manipulation of three-dimensional hybrid resource states comprising both bosonic qubits and squeezed vacuum states. The proposal enables exploiting state-of-the-art procedures for the non-deterministic generation of bosonic qubits combined with the strengths of continuous-variable quantum computation, namely the implementation of Clifford gates using easy-to-generate squeezed states. Moreover, the architecture is based on two-dimensional integrated photonic chips used to produce a qubit cluster state in one temporal and two spatial dimensions. By reducing the experimental challenges as compared to existing architectures and by enabling room-temperature quantum computation, our design opens the door to scalable fabrication and operation, which may allow photonics to leap-frog other platforms on the path to a quantum computer with millions of qubits.Comment: 38 pages, many figures. Comments welcom

Diagnostic utility of endobronchial ultrasound features in differentiating malignant and benign lymph nodes

Endobronchial ultrasound (EBUS) features have been shown to be useful in predicting etiology of enlarged malignant lymph nodes. However, there is dearth of evidence especially from developing countries. We assessed the EBUS characteristics across various mediastinal and hilar lymphadenopathies. In this prospective study, all patients with mediastinal and hilar lymphadenopathy on CT Chest and who were planned for EBUS-FNA (Fine Needle Aspiration) were included. EBUS features of lymph nodes studied were shape, size, margins, echogenicity, central hilar structure (CHS), coagulation necrosis sign and colour power doppler index (CPDI). These were scored and compared between benign and malignant lymphadenopathies. A total of 86 lymph nodes in 46 patients were prospectively studied of which 23 (26.7%) were malignant, 27 (31.3%) tuberculosis and 36 (41.8%) sarcoidosis. There was significant difference between malignant and benign lymph nodes in terms of CHS [central hilar structutre] (p=0.011), margins (p=0.036) and coagulation necrosis sign (p<0.001). On comparison of features of malignancy and tuberculosis, there were significant differences in margins (p=0.016) and coagulation necrosis sign (p 0.001). However, when malignancy and sarcoidosis was compared, there were differences in echogenicity (p=0.002), CHS (p=0.009) and coagulation necrosis sign (p<0.001). Only coagulation necrosis sign was found to be highly consistent with malignant lymph nodes. The other features cannot be used to distinguish malignant from benign lymph nodes, especially in a developing country like India where tuberculosis is a common cause of mediastinal lymphadenopathy