Acute severe mitral regurgitation: consideration of papillary muscle architecture

We present a case of an individual who presented with acute severe mitral regurgitation in the setting of an inferior ST elevation myocardial infarction. Both transthoracic and transesophageal echocardiography demonstrated a posteriorly directed eccentric jet of severe mitral regurgitation with flail anterior mitral valve leaflet attached presumably to the anterior papillary muscle. Intraoperative findings demonstrated rupture of the postero-medial papillary muscle attached via chords to the anterior mitral valve leaflet. This case serves to remind us that both the anterior and posterior leaflets of the mitral valve are attached to both papillary muscle heads. The direction and eccentricity of the mitral regurgitant jet on echocardiography helps to locate the leaflet involved, but not necessarily the coexisting papillary muscle pathology

The Current Status and Future Trajectory of Violent Jihadism

Violent Islamic jihadism remains a threat to the United States and its interests abroad. Al Qaeda will not be satisfied with the removal of American troops from the Middle East or the cessation of American engagement with Middle Eastern governments. Instead, al Qaeda and its ideological followers will continue to attack societies and countries that, in their view, threaten the ability of jihadists to construct a truly Islamic society. This thesis assesses jihadism and evaluates the current status of the jihadist movement. The first part of this thesis contains a discussion of important issues involving ideology that are critical for understanding jihadism. This thesis then examines jihadist groups throughout the Middle East and North Africa, their goals, and their capabilities. Jihadists are strategically prosecuting a global insurgency following the Arab Spring. Jihadists employ the internet as part of this insurgency. A critical factor in the future of jihadism is the role of Islamist organizations in the governments of Muslim countries. This thesis compares U.S. intervention in Libya and non-intervention in Syria in light of ongoing jihadist activity in those countries. Finally, this thesis presents an assessment of the future of jihadism and provides recommendations for U.S. counterterrorism policy. The United States must take aggressive action against jihadist groups in Africa and the Middle East. Protection of American interests, the security of allies abroad, and regional stability will continue to demand American leadership and military capabilities