Stroke secondary to calcific bicuspid aortic valve: Case report and literature review

SummaryBackgroundAortic valve calcification is common in rheumatic endocarditis, elderly patients, and congenital bicuspid aortic valve. It is not a recognized risk factor for stroke. We report a case of non-calcific embolization from calcified bicuspid aortic valve.MethodsA 52-year-old male with bicuspid aortic valve presented with aphasia and right arm weakness of less than 3h duration. CT head revealed hypodensity in the left middle cerebral artery (MCA) distribution and laboratory testing showed factor V leiden heterozygosity. The patient improved after intra-arterial tissue plasminogen activator (t-PA), but developed recurrence of right sided hemiparesis and silent myocardial infarction (MI). Cerebral angiography revealed clot in the left MCA. The patient received t-PA followed by transcatheter clot retrieval and was started on anticoagulation.ConclusionsEmbolization from calcific bicuspid aortic valves can lead to stroke and MI. Conservative management with anticoagulation for treatment of associated poststagnation thrombosis or aortic valve replacement as treatment is debatable. This patient was successfully managed with anticoagulation

ANALYTICAL METHOD DEVELOPMENT AND VALIDATION FOR KNOWN AND UNKNOWN IMPURITIES PROFILING FOR CARVEDILOL PHARMACEUTICAL DOSAGE FORM (TABLETS)

Objective: The aim of the research work to develop a simple, sensitive, rugged, robust and specific novel gradient stability indicating reverse phase HPLC method for quantitative determination of known and unknown impurities profiling of Carvedilol pharmaceutical dosage forms (Tablets). Methods: Chromatographic separation has been achieved on an Inertsil ODS 3V column (150 mm x 4.6 mm, 5μm) with mobile phase consisting Mobile phase-A (Water, Acetonitrile and Trifluroacetic acid in the ratio of 80:20:0.1 v/v/v respectively and pH adjusted to 2.0 with dilute potassium hydroxide solution) and Mobile phase-B (Water and acetonitrile in the ratio of 100:900 v/v respectively) delivered at flow rate of 1.0 ml min-1 and the detection wavelength 240 nm. The column compartment temperature maintained at 40 °C. Results: Resolution between Carvedilol and its impurities has been achieved greater than 1.5. The developed method was validated as per ICH guidelines. Analytical method found Precise, Linear, accurate, specific, rugged and robust. Conclusion: Developed and validated novel analytical method can be used to for impurity profile analysis of Carvedilol Pharmaceutical dosage form (Tablets)

Paediatric lateral humeral condyle fractures managed by k-wire fixation, should the wires be buried or left exposed: a dilemma

Background: Fractures of the lateral condyle of the humerus in children are common injuries. If displaced or unstable they may require surgical reduction and fixation with Kirschner wires (K-wires). These may be passed through the skin and left exposed or buried subcutaneously.Methods: A prospective study was carried out in department of orthopaedics at my college from January 2019 to March 2020.  A total number of 37 subjects were included in the study.Results: Patients were followed for a period of 3 months and results were drawn on basis of union, infection, carrying angle at the elbow, and range of motion (ROM) which was assessed by clinico-radiological means.Conclusions: Buried wire group has shown better union rate than exposed group, wires could be removed under local anaesthesia thereby avoiding any major procedure and also the risk of infection is low making this a better option than the exposed cohort

ROLE OF PLATELET-RICH PLASMA INJECTIONS IN TENNIS ELBOW; A PROSPECTIVE STUDY

Aims and Objectives: The aim of this study is to evaluate the efficacy of platelet-rich plasma (PRP) injections in chronic/recalcitrant cases of lateral epicondylitis in comparison to steroid injections and their role in averting surgical procedures. Methods: A prospective study was carried out in the Post Graduate Department of Orthopaedics, Government Medical College and Hospital, Jammu, from July 21 to June 22. Results: The patients managed with PRP injections tend to have a better outcome in long-term follow-up than the steroid group and the results in our study have been found to be statistically significant (p<0.05). Conclusion: We consider PRP injection for intractable lateral epicondylitis of the elbow, not only a safe but also very effective tool in reducing symptoms as well as averting the need for surgical intervention in this difficult cohort of patients

Algebraic Branching Programs, Border Complexity, and Tangent Spaces

Nisan showed in 1991 that the width of a smallest noncommutative single-(source,sink) algebraic branching program (ABP) to compute a noncommutative polynomial is given by the ranks of specific matrices. This means that the set of noncommutative polynomials with ABP width complexity at most $k$ is Zariski-closed, an important property in geometric complexity theory. It follows that approximations cannot help to reduce the required ABP width. It was mentioned by Forbes that this result would probably break when going from single-(source,sink) ABPs to trace ABPs. We prove that this is correct. Moreover, we study the commutative monotone setting and prove a result similar to Nisan, but concerning the analytic closure. We observe the same behavior here: The set of polynomials with ABP width complexity at most $k$ is closed for single-(source,sink) ABPs and not closed for trace ABPs. The proofs reveal an intriguing connection between tangent spaces and the vector space of flows on the ABP. We close with additional observations on VQP and the closure of VNP which allows us to establish a separation between the two classes

C10Pred: A first machine learning based tool to predict C10 family cysteine peptidases using sequence-derived features

Streptococcus pyogenes, or group A Streptococcus (GAS), a gram-positive bacterium, is implicated in a wide range of clinical manifestations and life-threatening diseases. One of the key virulence factors of GAS is streptopain, a C10 family cysteine peptidase. Since its discovery, various homologs of streptopain have been reported from other bacterial species. With the increased affordability of sequencing, a significant increase in the number of potential C10 family-like sequences in the public databases is anticipated, posing a challenge in classifying such sequences. Sequence-similarity-based tools are the methods of choice to identify such streptopain-like sequences. However, these methods depend on some level of sequence similarity between the existing C10 family and the target sequences. Therefore, in this work, we propose a novel predictor, C10Pred, for the prediction of C10 peptidases using sequence-derived optimal features. C10Pred is a support vector machine (SVM) based model which is efficient in predicting C10 enzymes with an overall accuracy of 92.7% and Matthews’ correlation coefficient (MCC) value of 0.855 when tested on an independent dataset. We anticipate that C10Pred will serve as a handy tool to classify novel streptopain-like proteins belonging to the C10 family and offer essential information