Synthetic Heroin-Induced Parkinsonism

Parkinson\u27s disease is a slowly progressive, neurodegenerative disorder affecting one in 1,000 of the general population; its incidence increases with age, but the cause remains unknown. The disease is characterized pathologically by a loss of neurons from the pigmented substantia nigra pars compacta, and a triad of physical symptoms of rigidity, tremor, and bradykinesia or akinesia . Thus the clinical condition of Parkinson\u27s disease is a rather complex disorder with a variety of physical symptoms due to neuronal damage in a number of brain regions. Additional brain regions also affected in clinical Parkinson\u27s disease include the ventral tegmental area, locus coeruleus, serotonergic dorsal raphe system, and the dorsal motor nucleus of the vagus ( I) . Furthermore, it has been suggested that damage to these various regions of the brain leads to a variety of motor and mental disorders (depression and dementia) that are specific to the damage in each of these neuronal systems (2) . Loss of norepinephrine may lead to depression; the incidence of depression varies between 20 to 90 percent in Parkinson\u27s disease, and many of these patients show favorable responses to tricyclic antidepressants

Comprehensive TCAD Simulation Study of High Voltage (>650V) Common Drain Bidirectional AlGaN/GaN HEMTs

A broad TCAD simulation analysis of a monolithic common drain bidirectional GaN HEMT was performed. We used gate-to-gate distances of 4 microns and 6 microns for the devices optimized with two field plates. The breakdown voltages were 675V and 915V respectively. Inclusion of field plates near both the gates produced electric field peaks at the opposite ends of the transistor simultaneously. This resulted in better electric field management or higher blocking voltage per unit length. Consequently, the 675V monolithic bidirectional HEMT had an impressive 40% improvement in on-resistance than its 650V typical series/parallel counterpart.Comment: 3 pages, 7 figure

A Comprehensive Review of COVID-19: Associated Endocrine Manifestations

Coronavirus disease 2019 (COVID-19) has played a significant part in systematic damage, affecting lives and leading to significant mortality. The endocrine system is one of the systems affected by this pandemic outbreak. The relationship between them has been identified in previous and ongoing research. The mechanism through which severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) can achieve this is similar to that for organs that express angiotensin-converting enzyme 2 receptors, which is the primary binding site of the virus. Endocrine cells widely express angiotensin-converting enzyme 2 receptors and transmembrane serine protease 2, the primary mediators initiating the acute phase of the disease. This review aimed to identify and discuss the endocrine complications of COVID-19. This primary focus is on presenting thyroid disorders or newly diagnosed diabetes mellitus (DM). Thyroid dysfunction with subacute thyroiditis, Graves’ disease, and hypothyroidism caused by primary autoimmune thyroiditis has been reported. Pancreatic damage leads to type 1 DM because of the autoimmune nature of the disease and type 2 DM because of post inflammatory insulin resistance. Because follow-up data on COVID-19 on the endocrine glands are limited, long-term investigations are needed to assess specific effects

Feasibility of diagnosis of postcardiotomy tamponade by miniaturized transesophageal echocardiography.

BACKGROUND: Pericardial tamponade after cardiac surgery is a critical diagnosis that can be difficult to diagnose using conventional cardiac monitoring. Transesophageal echocardiography can provide comprehensive information to make the diagnosis but is not always available, whereas transthoracic echocardiography has its utility limited because of the body habitus or other surgical effects. New monitoring devices, miniaturized hemodynamic transesophageal echocardiography (hTEE), which allows point of care assessment of cardiac filling and functions, may aid in diagnosis of postcardiotomy tamponade. METHODS: From May 2011 to July 2013, 21 patients underwent hTEE to rule out pericardial tamponade for clinical suspicion of tamponade after open heart surgery. The hTEE images were reviewed, and the patient outcomes were analyzed. RESULTS: Nine patients showed no evidence of pericardial collection and did not require reexploration. Two patients showed a presence of small hematoma without ventricular compression and also did not undergo exploration. Ten patients were positive for pericardial tamponade (effusion or hematoma with ventricular compression); eight of these cases underwent emergent surgical exploration. Of the two patients who did not undergo immediate reoperation, one was managed by chest tube manipulation and the other patient underwent subsequent surgical exploration after his extensive coagulopathy was corrected by medical treatment. CONCLUSIONS: The diagnosis of pericardial tamponade postcardiotomy is feasible using a disposable hTEE based on our limited experience. We avoided unnecessary explorations while concomitantly made prompt diagnosis in emergent situations. The hTEE device was a valuable tool in hemodynamic management in the intensive care unit, allowing rapid evaluations

Evaluation of Ventricular Repolarization in Patients Undergoing Cardiac Resynchronization Therapy (CRT) Using Two Modalities: Conventional Biventricular Pacing vs. His-Bundle Pacing

Introduction: Permanent His-bundle pacing (HBP) is being used as an alternative to biventricular pacing (BiVP) for CRT. HBP preserves the physiologic pattern of ventricular activation and markedly reduces ventricular dyssynchrony. While ventricular depolarization with HBP vs. BiVP has been studied, the effects of the 2 modalities on repolarization have not been compared. The purpose of this study was to compare ventricular repolarization in patients with HBP and BiVP. We hypothesize that HBP provides more physiologic repolarization as compared to BiVP. Methods: ECG repolarization parameters were analyzed in patients who underwent HBP and BiVP using the first available ECG post implant. Parameters included: 1) T Peak – T End (Tp-TeApical): Tp-Te in lead V5, and if not measurable, then in V4/V6 2) Tp-TeTotal: Earliest T peak to the latest T end across all precordial leads 3) T Peak Dispersion: Absolute difference between the earliest and latest T peaks across all precordial leads. Data was compared using a two-tailed unequal variance Student’s t-test. Results: Data from 23 HBP patients and 23 BiVP patients was analyzed. The average HBP Tp-TeApical of 74 ± 7ms was less than the BiVP Tp-TeApical of 112 ± 15ms (p\u3c0.01). Similarly, average HBP Tp-TeTotal of 106 ± 11ms was smaller than the BiVP Tp-TeTotal of 145 ± 17ms (p\u3c0.01). The difference between Tpeak dispersion between the two groups was not significant. Conclusion: Tp-Te interval, a known measure of dispersion of repolarization and marker of arrhythmic risk, is more physiologic (lower) with HBP as compared to BiVP. These data suggest that in addition to physiologic depolarization, HBP also provides physiologic repolarization and potentially lower arrhythmic risk compared to BiVP