Primitive orthogonal idempotents for R-trivial monoids

We construct a recursive formula for a complete system of primitive orthogonal idempotents for any $R$-trivial monoid. This uses the newly proved equivalence between the notions of $R$-trivial monoid and weakly ordered monoid.Comment: Journal of Algebra, 201

Acute electrocardiographic changes during smoking: An observational study

Objective To study the temporal relationship of smoking with electrophysiological changes. Design Prospective observational study. Setting Tertiary cardiac center. Participants Male smokers with atypical chest pain were screened with a treadmill exercise test (TMT). A total of 31 such patients aged 49.8±10.5 years, in whom TMT was either negative or mildly positive were included. Heart rate variability (HRV) parameters of smokers were compared to those of 15 healthy non-smoking participants. Interventions All patients underwent a 24 h Holter monitoring to assess ECG changes during smoking periods. Results Heart rate increased acutely during smoking. Mean heart rate increased from 83.8±13.7 bpm 10 min before smoking, to 90.5±16.4 bpm during smoking, (p <0.0001) and returned to baseline after 30 min. Smoking was also associated with increased ectopic beats (mean of 5.3/h prior to smoking to 9.8/h during smoking to 11.3/h during the hour after smoking; p <0.001). Three patients (9.7%) had significant ST–T changes after smoking. HRV index significantly decreased in smokers (15.2±5.3) as compared to non-smoking controls participants (19.4±3.6; p=0.02), but the other spectral HRV parameters were comparable. Conclusions Heart rate and ectopic beats increase acutely following smoking. Ischaemic ST–T changes were also detected during smoking. Spectral parameters of HRV analysis of smokers remained in normal limits, but more importantly geometrical parameter—HRV index—showed significant abnormality

Acute Suppuration of the Pancreatic Duct in a Patient with Tropical Pancreatitis

Background/Aim: Pancreatic sepsis secondary to infected necrosis, pseudocyst, or pancreatic abscess is a well-known clinical entity. Acute suppuration of the pancreatic duct (ASPD) in the setting of chronic calcific pancreatitis and pancreatic ductal obstruction with septicemia is a rare complication that is seldom reported. It is our aim to report a case of ASPD with Klebsiella ornithinolytica, in the absence of pancreatic abscess or infected necrosis. Case Report: A 46-year-old Asian-Indian man with chronic tropical pancreatitis who was admitted with recurrent epigastric pain that rapidly evolved into septic shock. A CT scan of abdomen revealed a dilated pancreatic duct with a large calculus. Broad-spectrum antibiotics, vasopressors and activated recombinant protein C were initiated. Emergency ERCP showed the papilla of Vater spontaneously expelling pus. Probing and stenting was instantly performed until pus drainage ceased. Repeat CT scan confirmed the absence of pancreatic necrosis or fluid collection, and decreasing ductal dilatation. Dramatic clinical improvement was observed within 36 hours after intervention. Blood cultures grew Klebsiella ornithinolytica. The patient completed his antibiotic course and was discharged. Conclusion: ASPD without pancreatic abscess or infected necrosis is an exceptional clinical entity that should be included in the differential diagnosis of pancreatic sepsis. A chronically diseased pancreas and diabetes may have predisposed to the uncommon pathogen. The presence of intraductal pancreatic stones obstructing outflow played a major role in promoting bacterial growth, suppuration and septicemia. Immediate drainage of the pancreatic duct with endoscopic intervention is critical and mandatory

Multiple echogenic liver masses from multifocal nodular steatosis in a 55-year-old male with chronic hepatitis C

AbstractHepatic steatosis is often seen in patients with hepatitis on screening ultrasound as generalized increased liver echogenecity. However, its nodular form can present as multiple echogenic masses, which can mimic hepatocellular carcinoma or metastasis by ultrasound and computed tomography. Small hepatocellular carcinomas are often hyperechoic and have a trend towards lower alpha-fetoprotein levels. Magnetic resonance imaging can accurately identify microscopic fat within the lesions and demonstrate lack of associated enhancing soft tissue. If this entity is not appropriately characterized using magnetic resonance imaging, it can lead to additional imaging workup and unnecessary biopsy

Role of modifying genes on the severity of rare mutation of MYH7 gene in hypertrophic obstructive cardiomyopathy

Hypertrophic Cardiomyopathy (HCM) is an autosomal dominant disorder due to mutations in sacromeric genes with variable penetrance. Hypertrophic Obstructive Cardiomyopathy (HOCM) is a major complication of Hypertrophic Cardiomyopathy. Unexplained hypertrophy in the Left Ventricle (LV) or Intraventricular Septum (IVS) had been the diagnostic criterion for HCM which is more often confirmed by the echocardiography. The frequency of HCM in general population is 1:500 and about 60-70% genetic predisposition is known. It has been observed that mutations in the Cardiac myosin binding proteinC (MYBPC3) gene causes late onset of disease with mild symptoms while mutations in the Beta Myosin Heavy chain (MYH7) gene leads to early onset with severe symptoms. Apart from Epigenetic and Environmental factors, modifier genes further complicate the situation leading to altered clinical outcome even among the same family members having identical mutation

Primitive orthogonal idempotents for R-trivial monoids

We construct a recursive formula for a complete system of primitive orthogonal idempotents for any R-trivial monoid. This uses the newly proved equivalence between the notions of R-trivial monoid and weakly ordered monoid

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy