Sudden cardiac arrest and coexisting mitral valve prolapse: a case report and literature review

The aetiology of sudden cardiac arrest can often be identified to underlying cardiac pathology. Mitral valve prolapse is a relatively common valvular pathology with symptoms manifesting with increasing severity of mitral regurgitation (MR). It is unusual for severe MR to be present without symptoms, and there is growing evidence that this subset of patients may be at increased risk of sudden cardiac arrest or death. The difficulty lies in identifying those patients at risk and applying measures that are appropriate to halting progression to cardiac arrest. This article examines the association of mitral valve prolapse with cardiac arrests, the underlying pathophysiological process and the strategies for identifying those at risk

The Effect of Different Irrigant Activation Methods on Postoperative Pain After Endodontic Retreatment

Objective: This study was designed to evaluate the effect of different irrigant activation methods on post operative pain after endodontic retreatment. Materials and Methods : Seventy eight patients need non surgical retreatment in mandibular first molar were involved in the study. The retreatment was performed in two visits ,at first visit cases were randomly divided into three groups according to methods of irrigant activation after root canal retreatment with protaper next rotary Ni-TI system. Group A (n=26) Root canals were irrigated using 2.6% sodium hypochlorite (NaOCl) with manual dynamic agitation using master cone Group B (n=26) Root canals were irrigated using 2.6% sodium hypochlorite (NaOCl) using ultrasonic machine (ultra-x) for 60 seconds. Group C (n=26) Root canals were irrigated using 2.6% sodium hypochlorite (NaOCl) with NaviTip (29-gauge 27 mm) with double side tip. At second visit after one week, obturation was performed using modified single cone technique ans access cavity was filled with coronal restoration. After two visits root canal treatment and a specific method of agitation, depending on each group, the patients were given a questionnaire on which the patient would mark the degree of pain in a scale from 0 to 10 at 6, 12, 24, 48 72 hrs and one week post-obturation. Data were statistically analyzed with a significance level of P ≤0.05. Results: At 6,12,24 hrs, there was significant difference between the groups in pain intensity where control group C (Navitip with side vented needle) showed more pain scores than in the intervention groups (Ultra X and manual dynamic agitation). On the other hand, at 48, 72 hours and 7 days post- operative ,there was no statistically significant difference in pain among tested groups. Conclusion: Agitation of the irrigation is reliable safe to clinican and effective as final step irrigation protocol with successful management of postoperative pain in retreatment cases. The intensity of postoperative pain decreased with time regardless of final irrigation protocol used

Improving throughput and fairness by improved channel assignment using topology control based on power control for multi-radio multichannel wireless mesh networks

Multi-radio multi-channel (MRMC) wireless mesh networks (WMNs) achieve higher throughput using multiple simultaneous transmissions and receptions. However, due to limited number of non-overlapping channels, such networks suffer from co-channel interference, which degrades their performance. To mitigate co-channel interference, effective channel assignment algorithms (CAAs) are desired. In this article, we propose a novel CAA, Topology-controlled Interference-aware Channel-assignment Algorithm (TICA), for MRMC WMNs. This algorithm uses topology control based on power control to assign channels to multi-radio mesh routers such that co-channel interference is minimized, network throughput is maximized, and network connectivity is guaranteed. We further propose to use two-way interference-range edge coloring, and call the improved algorithm Enhanced TICA (e-TICA), which improves the fairness among flows in the network. However, the presence of relatively long links in some topologies leads to conflicting channel assignments due to their high interference range. To address this issue, we propose to utilize minimum spanning tree rooted at the gateway to reduce conflicting channels, and in turn, improve medium access fairness among the mesh nodes. We call the improved algorithm e-TICA version 2 (e-TICA2). We evaluate the performance of the proposed CAAs using simulations in NS2. We show that TICA significantly outperforms the Common Channel Assignment scheme in terms of network throughput, and e-TICA and e-TICA2 achieve better fairness among traffic flows as compared to TICA. It is also shown that e-TICA2 leads to improved network throughput, as compared to TICA and e-TICA

Speciation of common Gram-negative pathogens using a highly multiplexed high resolution melt curve assay

The identification of the bacterial species responsible for an infection remains an important step for the selection of antimicrobial therapy. Gram-negative bacteria are an important source of hospital and community acquired infections and frequently antimicrobial resistant. Speciation of bacteria is typically carried out by biochemical profiling of organisms isolated from clinical specimens, which is time consuming and delays the initiation of tailored treatment. Whilst molecular methods such as PCR have been used, they often struggle with the challenge of detecting and discriminating a wide range of targets. High resolution melt analysis is an end-point qPCR detection method that provides greater multiplexing capability than probe based methods. Here we report the design of a high resolution melt analysis assay for the identification of six common Gram-negative pathogens; Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, Pseudomonas aeruginosa, Salmonella Sp, and Acinetobacter baumannii, and a generic Gram-negative specific 16S rRNA control. The assay was evaluated using a well characterised collection of 113 clinically isolated Gram-negative bacteria. The agreement between the HRM assay and the reference test of PCR and sequencing was 98.2% (Kappa 0.96); the overall sensitivity and specificity of the assay was 97.1% (95% CI: 90.1–99.7%) and 100% (95% CI: 91.78–100%) respectively

Medical Therapies for Uterine Fibroids - A Systematic Review and Network Meta-Analysis of Randomised Controlled Trials

BACKGROUND: Uterine fibroids are common, often symptomatic and a third of women need repeated time off work. Consequently 25% to 50% of women with fibroids receive surgical treatment, namely myomectomy or hysterectomy. Hysterectomy is the definitive treatment as fibroids are hormone dependent and frequently recurrent. Medical treatment aims to control symptoms in order to replace or delay surgery. This may improve the outcome of surgery and prevent recurrence. PURPOSE: To determine whether any medical treatment can be recommended in the treatment of women with fibroids about to undergo surgery and in those for whom surgery is not planned based on currently available evidence. STUDY SELECTION: Two authors independently identified randomised controlled trials (RCT) of all pharmacological treatments aimed at the treatment of fibroids from a list of references obtained by formal search of MEDLINE, EMBASE, Cochrane library, Science Citation Index, and ClinicalTrials.gov until December 2013. DATA EXTRACTION: Two authors independently extracted data from identified studies. DATA SYNTHESIS: A Bayesian network meta-analysis was performed following the National Institute for Health and Care Excellence-Decision Support Unit guidelines. Odds ratios, rate ratios, or mean differences with 95% credible intervals (CrI) were calculated. RESULTS AND LIMITATIONS: A total of 75 RCT met the inclusion criteria, 47 of which were included in the network meta-analysis. The overall quality of evidence was very low. The network meta-analysis showed differing results for different outcomes. CONCLUSIONS: There is currently insufficient evidence to recommend any medical treatment in the management of fibroids. Certain treatments have future promise however further, well designed RCTs are needed

The evolving SARS-CoV-2 epidemic in Africa: insights from rapidly expanding genomic surveillance

Investment in SARS-CoV-2 sequencing in Africa over the past year has led to a major increase in the number of sequences generated, now exceeding 100,000 genomes, used to track the pandemic on the continent. Our results show an increase in the number of African countries able to sequence domestically, and highlight that local sequencing enables faster turnaround time and more regular routine surveillance. Despite limitations of low testing proportions, findings from this genomic surveillance study underscore the heterogeneous nature of the pandemic and shed light on the distinct dispersal dynamics of Variants of Concern, particularly Alpha, Beta, Delta, and Omicron, on the continent. Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve, while the continent faces many emerging and re-emerging infectious disease threats. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

A year of genomic surveillance reveals how the SARS-CoV-2 pandemic unfolded in Africa

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