Percutaneous transvenous mitral commissurotomy in a case of situs inversus, dextrocardia and rheumatic mitral stenosis

Situs inversus with dextrocardia is a rare congenital disorder. There is rare coincidence of rheumatic severe mitral stenosis in a patient with situs inversus and dextrocardia. Technical difficulties for doing percutaneous transvenous mitral commissurotomy (PTMC) in such patients are well known and there are few reports of PTMC in situs inversus with dextrocardia. Here we report a case of 53 year old female with situs inversus and dextrocardia where PTMC was successfully done with a few modifications of standard Inoue technique. The patient had dyspnea on exertion of NYHA class III with initial mitral valve area of 0.8 cm2 and severe pulmonary arterial hypertension with PA systolic pressure of 106 mmHg. Femoral vein access was performed from the left side to align the septal puncture needle and balloon to the left sided IVC and to facilitate LV entry. Septal descent of the septal puncture needle (Brockenbrough needle) was performed in the AP view with the needle rotated from 12 o’clock to 7 o’clock position instead of 5 o’clock position. The right border of the spine was used as a landmark for trans-septal puncture. The LA pressure fell from 19 mmHg to 9 mmHg with no residual gradient across the valve. PA systolic pressure dropped to 48 mmHg. Echocardiography showed a well-divided anterior commissure with a MVA of 1.8 cm2 and mild mitral regurgitation with mild pulmonary hypertension. In summary, PTMC is feasible in the rare patient with dextrocardia with additional modifications of the Inoue technique and protocols for groin and septal puncture.Keywords: Mitral commissurotomy; Inoue technique; Situs inversus;Dextrocardia; Rheumatic mitral stenosi

Does the clinical profile of Gujarati patients with Takayasu’s aortoarteritis differ from other Indians?

Takayasu’s aortoarteritis is a well-known yet rare form of large vesselvasculitis. It is a chronic inflammatory diseas, which has remained an enigma since it was first described a century ago. The present study was done to document the demographic profile, clinical course, complications and survival of 30 consecutive patients with aortoarteritis in the Gujarati population of western India. The study used non-invasive (color doppler, CT and MR angiography) and invasive techniques (conventional angiography) to document the vessels involved. The study showed almost equal incidence of disease in males and females in the Gujarati population unlike in other studied populations. Incidence of type-III aortoarteritis was the most common and left renal involvement was found to be significantly more common than right renal involvement in the present study. There was no mortality during the study period.KEY WORDS: Vasculitis; Takayasu’s aortoarteritis; Clinical profile; Gujaratipopulatio

A study on the knowledge, attitude and practice of junior doctors to adverse drug event reporting in a tertiary care hospital, Manipur

Background: The aim of the present study is to find out the ways to improve the status of adverse drug effect (ADE) reporting to the pharmacovigilance centres.Methods: The present study is a cross-sectional study with purposive sampling. Descriptive statistics is used for analysing the data from the questionnaire using frequencies and percentages.Results: The response on the questionnaire was 77.7%. The 90 participants knew the definition of ADE. The 91 participants want to report the ADEs of newly marketed drugs. Only 70 participants know about the existence of PvPI. The 80 participants did not consider all OTC drugs to be safe. 95 participants opined that all Herbal and non-allopathic drugs are not safe. The 69 participants replied that no ADE monitoring centre was available in SHIJA hospitals and research institute Pvt. Ltd. Though 90 participants knew the definition of ADE, only 85.1% of them considered to report it as a professional obligation. Maximum ADEs are seen with skin, paediatric and elderly patients as opined by 57.4% of the participants. Varied opinions of occurrence of ADEs according to the participants with polypharmacy was 70.3% and with foods and drinks was 40.6%. Although 85.1% participants have the attitude of reporting ADE, only 63.4% participants have good clarity when reporting and filling the ADE forms with careful observation of the risks and behaviour of the patients.Conclusions: To promote ADE reporting, a regular awareness cum sensitization programme coupled with CME program is necessary at various levels of health-care providers

Density Functional Theory Study of Structural and Electronic Properties of Group V Transition Metal Carbides

The structural and electronic properties of group V transition metalcarbides: VC, NbC and TaC are studied using density functional theory with generalized gradient approximation for the exchange and correlation potential. Lattice constants, bulk moduli, elastic constants, energy band diagrams, density of states of the carbides are reported and their trends are discussed. From the band diagrams, the band separation, zone-centre d band splitting, non metal p and s band splitting, width of 2p band, and 4d band explains the insight of electronic structure of these compounds

Impacts of household sources on air pollution at village and regional scales in India

Approximately 3 billion people worldwide cook with solid fuels, such as wood, charcoal, and agricultural residues. These fuels, also used for residential heating, are often combusted in inefficient devices, producing carbonaceous emissions. Between 2.6 and 3.8 million premature deaths occur as a result of exposure to fine particulate matter from the resulting household air pollution (Health Effects Institute, 2018a; World Health Organization, 2018). Household air pollution also contributes to ambient air pollution; the magnitude of this contribution is uncertain. Here, we simulate the distribution of the two major health-damaging outdoor air pollutants (PM2:5 and O3) using state-of-thescience emissions databases and atmospheric chemical transport models to estimate the impact of household combustion on ambient air quality in India. The present study focuses on New Delhi and the SOMAARTH Demographic, Development, and Environmental Surveillance Site (DDESS) in the Palwal District of Haryana, located about 80 km south of New Delhi. The DDESS covers an approximate population of 200 000 within 52 villages. The emissions inventory used in the present study was prepared based on a national inventory in India (Sharma et al., 2015, 2016), an updated residential sector inventory prepared at the University of Illinois, updated cookstove emissions factors from Fleming et al. (2018b), and PM2:5 speciation from cooking fires from Jayarathne et al. (2018). Simulation of regional air quality was carried out using the US Environmental Protection Agency Community Multiscale Air Quality modeling system (CMAQ) in conjunction with the Weather Research and Forecasting modeling system (WRF) to simulate the meteorological inputs for CMAQ, and the global chemical transport model GEOS-Chem to generate concentrations on the boundary of the computational domain. Comparisons between observed and simulated O3 and PM2:5 levels are carried out to assess overall airborne levels and to estimate the contribution of household cooking emissions

Wideband THz time domain spectroscopy based on optical rectification and electro-optic sampling

We present an analytical model describing the full electromagnetic propagation in a THz time-domain spectroscopy (THz-TDS) system, from the THz pulses via Optical Rectification to the detection via Electro Optic-Sampling. While several investigations deal singularly with the many elements that constitute a THz-TDS, in our work we pay particular attention to the modelling of the time-frequency behaviour of all the stages which compose the experimental set-up. Therefore, our model considers the following main aspects: (i) pump beam focusing into the generation crystal; (ii) phase-matching inside both the generation and detection crystals; (iii) chromatic dispersion and absorption inside the crystals; (iv) Fabry-Perot effect; (v) diffraction outside, i.e. along the propagation, (vi) focalization and overlapping between THz and probe beams, (vii) electro-optic sampling. In order to validate our model, we report on the comparison between the simulations and the experimental data obtained from the same set-up, showing their good agreement

Benign cervical multi-nodular goiter presenting with acute airway obstruction: a case report

<p>Abstract</p> <p>Introduction</p> <p>Benign cervical goiters rarely cause acute airway obstruction.</p> <p>Case presentation</p> <p>We report the case of a 64-year-old woman of African descent who presented with acute shortness of breath. She required immediate intubation and later a total thyroidectomy for a benign cervical multi-nodular goiter with no retrosternal tracheal compression.</p> <p>Conclusion</p> <p>Benign multi-nodular goiters are commonly left untreated once euthyroid. Peak inspiratory flow rates should be measured via spirometry in all goiters to assess the degree of tracheal compression. Once tracheal compression is identified, an elective total thyroidectomy should be performed to prevent morbidity and mortality from acute airway obstruction.</p

One-step isolation and biochemical characterization of a highlyactive plant PSII monomeric core

We describe a one-step detergent solubilization protocol for isolating a highly active form of Photosystem II (PSII) from Pisum sativum L. Detailed characterization of the preparation showed that the complex was a monomer having no light harvesting proteins attached. This core reaction centre complex had, however, a range of low molecular mass intrinsic proteins as well as the chlorophyll binding proteins CP43 and CP47 and the reaction centre proteins D1 and D2. Of particular note was the presence of a stoichiometric level of PsbW, a low molecular weight protein not present in PSII of cyanobacteria. Despite the high oxygen evolution rate, the core complex did not retain the PsbQ extrinsic protein although there was close to a full complement of PsbO and PsbR and partial level of PsbP. However, reconstitution of PsbP and PsbPQ was possible. The presence of PsbP in absence of LHCII and other chlorophyll a/b binding proteins confirms that LHCII proteins are not a strict requirement for the assembly of this extrinsic polypeptide to the PSII core in contrast with the conclusion of Caffarri et al. (2009)