Exercise-Induced Intraventricular Obstruction in a Child with Near Syncope and Chest Pain During Exercise

We report the case of a 10-year-old girl with two episodes of light-headedness and chest pain during exercise. She had an unremarkable clinical record, physical examination, ECG, and echocardiogram. Noninvasive ischemia tests were positive, but coronary angiography was normal. Exercise stress echocardiogram revealed an exercise-induced intra-left-ventricular obstruction with a peak gradient of 78 mmHg and replicated her symptoms. After starting beta-blocker therapy her clinical status improved and no residual obstruction was detected. The authors review this unsuspected clinical condition, seldom reported in the adult population and, to our knowledge, never before in a child

Percutaneous Closure of Patent Foramen Ovale after Anterior Spinal Cord Infarction

In patients with a patent foramen ovale (PFO) who have had a cryptogenic ischemic stroke, percutaneous closure reduces its recurrence risk. However, its role in spinal cord infarction (SCI) is less well-established. A few case reports describe the putative causative role of PFO in SCI. We present a case of a teenager with cryptogenic anterior SCI in the setting of a deep vein thrombosis and a high risk-PFO who underwent successful percutaneous closure.info:eu-repo/semantics/publishedVersio

Stenosis of the Branches of the Neopulmonary Artery after the Arterial Switch Operation: a Cardiac Magnetic Resonance Imaging Study

Background : The neonatal arterial switch operation (ASO) is now the standard of care for children born with transposition of the great arteries. Stenosis of the neopulmonary artery on long‑term follow up is a known complication. Methods : We performed a retrospective analysis of eleven patients who underwent a cardiac magnetic resonance imaging (MRI) due to echocardiographic evidence suggestive of stenosis of the neopulmonary artery or its branches (mean estimated Doppler gradient 48 mmHg, min 30 mmHg, max 70 mmHg). A comprehensive evaluation of anatomy and perfusion was done by cardiac MRI. Results : The branches of the neopulmonary artery (neo PA) showed decreased caliber in three patients unilaterally and in two patients, bilaterally. Magnetic resonance (MR) perfusion studies showed concomitant decreased flow, with discrepancy between the two lungs of 35/65% or worse, only in the three patients with unilateral obstruction, by two different MR perfusion methods. Conclusions : Cardiac MR can be used as a comprehensive non‑invasive imaging technique to diagnose stenosis of the branches of the neopulmonary after the ASO, allowing evaluation of anatomy and function of the neoPA, its branches, and the differential perfusion to each lung, thus facilitating clinical decision making

An Estimation of the Entomological Inoculation Rate for Ifakara: A Semi-Urban Area in a Region of Intense Malaria Transmission in Tanzania.

An entomological study on vectors of malaria and their relative contribution to Plasmodium falciparum transmission in the semi-urban area of Ifakara, south-eastern Tanzania, was conducted. A total of 32 houses were randomly sampled from the area and light trap catches (LTC) performed in one room in each house every 2 weeks for 1 year. A total of 147 448 mosquitoes were caught from 789 LTC; 26 134 Anopheles gambiae s.l., 615 A. funestus, 718 other anophelines and 119 981 culicines. More than 60% of the total A. gambiae s.l. were found in five (0.6%) LTCs, with a maximum of 5889 caught in a single trap. Of 505 A. gambiae s.l. speciated by polymerase chain reaction, 91.5% were found to be A. arabiensis. Plasmodium falciparum sporozoite enzyme-linked immunosorbent assay tests were performed on 10 108 anopheles mosquitoes and 39 (0.38%) were positive. Entomological inoculation rate (EIR) estimates were generated using a standard method and an alternative method that allows the calculation of confidence intervals based on a negative binomial distribution of sporozoite positive mosquitoes. Overall EIR estimates were similar; 31 vs. 29 [95% confidence interval (CI): 19, 44] infectious bites per annum, respectively. The EIR ranged from 4 (95% CI: 1, 17) in the cool season to 108 (95% CI: 69, 170) in the wet season and from 54 (95% CI: 30, 97) in the east of the town to 15 (95% CI: 8, 30) in the town centre. These estimates show large variations over short distances in time and space. They are all markedly lower than those reported from nearby rural areas and for other parts of Tanzania

Validation of a geographic weighted regression analysis as a tool for area-wide integrated pest management programs for Ceratitis capitata Wiedemann (Diptera: Tephritidae) on Terceira Island, Azores

Extrapolation from quantitative sampling to the surrounding areas is an essential feature of many aspects of real world applications in pest management decision-making. However, these decisions are only as good as the accuracy of the methods that provided the information. The problem of estimating Mediterranean fruit fly population densities from trap grids is a specific case. The efficiency of three methods to estimate fruit flies trapped per day values for non-sampled areas in Terceira Island is evaluated, the inverse distance weighted, ordinary Kriging and the geographic weighted regression (GWR). Each method has its own specificities and merits. The results demonstrate that the GWR method is capable of estimating hotspots for the next season and can be used to identify ecological corridors over a non-sampled area. The high spatial heterogeneity and topographical conditions present on Terceira Island may explain why a more mathematically complex method is more reliable than simpler methods for use in possible future wide-area control program for medfly

Patent Foramen Ovale Closure with the BioSTAR Bioabsorbable Implant

Os autores apresentam o caso clínico de uma doente de 35 anos, sexo feminino, que recorreu ao hospital da área da residência por parésia do membro superior direito, tendo sido diagnosticado AVC isquémico por Ressonância Magnética Nuclear Cranio-Encefálica (RMN-CE). A investigação da fonte embólica levou ao diagnóstico, por ecocardiograma transesofágico, de foramen oval patente (FOP), com shunt direito-esquerdo espontâneo. Em Maio de 2009 foi efectuado encerramento percutâneo do FOP com dispositivo bioreabsorvível “BioSTAR®”, sob controlo ecocardiográfico. Efectuou ecocardiograma transtorácico após o primeiro, terceiro e sexto mês pós-procedimento e ecocardiograma transesofágico aos nove meses, mostrando sempre adequada colocação do dispositivo, sem presença de shunt residual, sem qualquer intercorrência clínica durante este período. Os autores discutem a importância do desenvolvimento de dispositivos bioabsorvíveis para encerramento de FOP, e as suas vantagens em comparação com os dispositivos sintéticos previamente utilizados

A fixed point formula for the index of multi-centered N=2 black holes

We propose a formula for computing the (moduli-dependent) contribution of multi-centered solutions to the total BPS index in terms of the (moduli-independent) indices associated to single-centered solutions. The main tool in our analysis is the computation of the refined index Tr(-y)^{2J_3} of configurational degrees of freedom of multi-centered BPS black hole solutions in N=2 supergravity by localization methods. When the charges carried by the centers do not allow for scaling solutions (i.e. solutions where a subset of the centers can come arbitrarily close to each other), the phase space of classical BPS solutions is compact and the refined index localizes to a finite set of isolated fixed points under rotations, corresponding to collinear solutions. When the charges allow for scaling solutions, the phase space is non-compact but appears to admit a compactification with finite volume and additional non-isolated fixed points. We give a prescription for determining the contributions of these fixed submanifolds by means of a `minimal modification hypothesis', which we prove in the special case of dipole halo configurations.Comment: 61 pages, 3 figure

All solutions of the localization equations for N=2 quantum black hole entropy

We find the most general bosonic solution to the localization equations describing the contributions to the quantum entropy of supersymmetric black holes in four-dimensional N=2 supergravity coupled to n_v vector multiplets. This requires the analysis of the BPS equations of the corresponding off-shell supergravity (including fluctuations of the auxiliary fields) with AdS2 \times S2 attractor boundary conditions. Our work completes and extends the results of arXiv:1012.0265 that were obtained for the vector multiplet sector, to include the fluctuations of all the fields of the off-shell supergravity. We find that, when the auxiliary SU(2) gauge field strength vanishes, the most general supersymmetric configuration preserving four supercharges is labelled by n_v+1 real parameters corresponding to the excitations of the conformal mode of the graviton and the scalars of the n_v vector multiplets. In the general case, the localization manifold is labelled by an additional SU(2) triplet of one-forms and a scalar function.Comment: 27 page