Brugada syndrome unmasked by fever: a comprehensive review of literature

Background: The Brugada pattern is identified on the EKG by a coved ST-segment elevation accompanied by a negative T wave in the early precordial leads in the absence of a cardiac structural abnormality. Brugada pattern and Brugada syndrome should be differentiated, as the latter is associated with an increased risk of sudden cardiac death. Methods: The literature was searched using multiple databases to identify all the articles on Brugada pattern. Data were screened and analyzed by independent authors. Results: Sixty articles, comprising 71 patients, were included in the study. The mean age of patients was 42.6 years, with a higher prevalence of Brugada pattern in men (83%) than women (17%). The most frequent findings associated with Brugada pattern was fever (83%). Other less common presentations included cough (21%), sore throat (10%), syncope (18%), abdominal pain (8%), and chest pain (7%). Comorbidities included pneumonia (30%), upper respiratory tract infections (14%) and smoking (14%). Among treatment modalities, 39% of patients had ICD placement performed, 44% received antibiotics, while 14% had supportive care. Adenosine was given to 3% of patients, while other antiarrhythmics like milrinone, amiodarone, sotalol, procainamide, flecainide, and nitroglycerin were given to 1% of patients. Most patients with Brugada syndrome had a satisfactory outcome, with only 4% mortality rate(WHAT ABOUT THE OTHER 11%?). Out of the 71 patients, 3% had persistent Brugada patterns, while 86% of patients recovered completely. There was no significant effect of ICD on mortality or Brugada pattern resolution (p 0.37). Conclusion: Our study shows that fever is the main reason for unmasking the Brugada pattern in patients with this channelopath

Estimation of biocidal potential of desert phytopowders for the management of citrus canker

Citrus is one of the most important fruit crops, throughout the world. It is a rich source of antioxidants and vitamin C. Citrus canker is a potential threat to its successful production. In current study, ten desert phytopowders including Xanthium strumarium, Dipterygium galucun, Leptadenia pyrotechnica, Haloxylon recurvum, Suaeda fruticosa, Salsola baryosma, Citrulus colocynthis, Abutilon indicum, Aerva javanica, and Calotropis procera at three different concentrations (5.0, 7.5 and 10.0%) were evaluated under in vitro conditions against Xanthomonas citri pv. citri. Among all phytopowders, X. strumarium and S. fruticosa, showed maximum inhibition zone (40 mm) followed by S. baryosma (38.50 mm) C. colocynthis (37 mm), Abutilon indicum (34 mm), H. recurvum (32 mm), D. galucun (30.5 mm), A. javanica, (29.50 mm), L. pyrotechnica, (29.5 mm) and C. procera (28 mm) as compared to control. Then, effective phytopowders were applied under greenhouse and field conditions @ 5.0, 7.5 and 10.0% against citrus canker. Combination of X. strumarium + S. baryosma showed minimum disease severity (22%) followed by X. strumarium (26%), X. strumarium + S. fruticosa (27%), S. fruticosa (27%), X. strumarium + S. baryosma (27%), and S. baryosma (29%) as compared to control. While in field experiment, the combination of X. strumarium + S. fruticosa showed significant results with minimum disease severity (32%) followed by S. fruticosa + S. baryosma (32%), X. strumarium + S. baryosma (33%), S. baryosma (35%), X. strumarium (36%) and S. fruticosa (36%) as compared to control. It is concluded that application of X. strumarium + S. baryosma phytopowders will be helpful for farmers to combat citrus canker

Cardiovascular Outcomes and Trends of Transcatheter vs. Surgical Aortic Valve Replacement Among Octogenarians With Heart Failure: A Propensity Matched National Cohort Analysis

Background: Heart failure (HF) is a complex clinical syndrome with symptoms and signs that result from any structural or functional impairment of ventricular filling or ejection of blood. Limited data is available regarding the in-hospital outcomes of TAVR compared to SAVR in the octogenarian population with HF. Methods: The National Inpatient Sample (NIS) database was used to compare TAVR versus SAVR among octogenarians with HF. The primary outcome was in-hospital mortality. The secondary outcome included acute kidney injury (AKI), cerebrovascular accident (CVA), post-procedural stroke, major bleeding, blood transfusions, sudden cardiac arrest (SCA), cardiogenic shock (CS), and mechanical circulatory support (MCS). Results: A total of 74,995 octogenarian patients with HF (TAVR-HF n = 64,890 (86.5%); SAVR n = 10,105 (13.5%)) were included. The median age of patients in TAVR-HF and SAVR-HF was 86 (83-89) and 82 (81-84) respectively. TAVR-HF had lower percentage in-hospital mortality (1.8% vs. 6.9%;p \u3c 0.001), CVA (2.5% vs. 3.6%; p = 0.009), SCA (9.9% vs. 20.2%; p \u3c 0.001), AKI (17.4% vs. 40.8%); p \u3c 0.001), major transfusion (26.4% vs 67.3%; p \u3c 0.001), CS (1.8% vs 9.8%; p \u3c 0.001), and MCS (0.8% vs 7.3%; p \u3c 0.001) when compared to SAVR-HF. Additionally, post-procedural stroke and major bleeding showed no significant difference. The median unmatched total charges for TAVR-HF and SAVR-HF were 194,561$and 246,100$ respectively. Conclusion: In this nationwide observational analysis, TAVR is associated with an improved safety profile for octogenarians with heart failure (both preserved and reduced ejection fraction) compared to SAVR

Can the genes communicate with each other after birth? An international cross‐sectional study

Abstract Background Various factors contribute to the pathogenesis of a disease. These include genetic factors, family history, and some idiopathic causes. Genetic makeup has an important role in the progression of disease. This is due to mutations in genetic material, that is, deoxyribonucleic acid (DNA). Methodology This is a cross‐sectional study that involved 5000 participants distributed across 250 countries. All the participants were randomly selected and asked to fill out the online survey. All the participants were fully informed about the study's purpose before providing their consent. Results The participants were distributed among 250 countries. Their age mean (standard deviation) is 46.7 (12.4). We discovered a significant difference between those who have genetic or congenital diseases and those who have a family history of the disease. Also, there is a statistically significant difference between the recurrence of the disease and the duration of the visits of close relatives who have the same disease. Conclusion The study suggests that there might be some ways, through gene waves or the environment, in which a gene changes the expression of other genes of similar sequence in different individuals when the required period of contact is provided. In the future, this theory might explain the idiopathic nature of some diseases

Brugada syndrome unmasked by fever: a comprehensive review of literature

Background The Brugada pattern is identified on the EKG by a coved ST-segment elevation accompanied by a negative T wave in the early precordial leads in the absence of a cardiac structural abnormality. Brugada pattern and Brugada syndrome should be differentiated, as the latter is associated with an increased risk of sudden cardiac death. Methods The literature was searched using multiple databases to identify all the articles on Brugada pattern. Data were screened and analyzed by independent authors. Results Sixty articles, comprising 71 patients, were included in the study. The mean age of patients was 42.6 years, with a higher prevalence of Brugada pattern in men (83%) than women (17%). The most frequent findings associated with Brugada pattern was fever (83%). Other less common presentations included cough (21%), sore throat (10%), syncope (18%), abdominal pain (8%), and chest pain (7%). Comorbidities included pneumonia (30%), upper respiratory tract infections (14%) and smoking (14%). Among treatment modalities, 39% of patients had ICD placement performed, 44% received antibiotics, while 14% had supportive care. Adenosine was given to 3% of patients, while other antiarrhythmics like milrinone, amiodarone, sotalol, procainamide, flecainide, and nitroglycerin were given to 1% of patients. Most patients with Brugada syndrome had a satisfactory outcome, with only 4% mortality rate(WHAT ABOUT THE OTHER 11%?). Out of the 71 patients, 3% had persistent Brugada patterns, while 86% of patients recovered completely. There was no significant effect of ICD on mortality or Brugada pattern resolution (p 0.37). Conclusion Our study shows that fever is the main reason for unmasking the Brugada pattern in patients with this channelopathy. ICD placement in such patients is not recommended as it has no mortality benefits

Pulmonary Tuberculosis After Gastric Bypass: A Very Rare Complication

Laparoscopic Roux-en-Y gastric bypass (RYGB) is the most commonly performed bariatric surgical procedure with successful outcomes. RYGB has multiple positive outcomes, including sustained weight reduction, resolution of co-morbidities and improvement in the overall health. RYGB has many complications like any other surgery, but the development of tuberculosis (TB) either pulmonary or extra-pulmonary secondary to RYGB is very rare. We present a 32-year-old female with the history of a successful RYGB three years ago, who presented with signs and symptoms of possible TB which was later confirmed with sputum acid-fast bacilli and sputum culture. She was treated with anti-tuberculosis treatment (ATI') drugs for six months with complete resolution of her symptoms. We recommend raising awareness in the health care professionals about this rare complication of RYGB in the need of time

Chemical modifications of boron nitride nanotubes with heterocyclic molecules: A DFT study

The density functionals M06–2X and B3LYP were exploited for investigating the impact of modifying the surface of a boron nitride nano-tube (BNNT) with the furan molecule in terms of energy, electronics, and geometry. According to the density functional theory (DFT) results, BNNT had a strong interaction with the furan molecule. So, the adhesion of the furan molecule onto the surface of BNNT was consistent with the chemical functionalization. Furthermore, the computed density of states indicated that the electronic features of the BNNT were adjusted with a partial chemical modification. Also, the functional energy raised by enhancing the electron donation property of the functional groups, which was due to the rise in the electrical conductance of BNNT in contrast with the pristine BNNT. Retaining the electronic features of BNNT and the increased solubility demonstrated that using furan to chemically modify BNNTs could be a useful method to purify them

Cardiovascular Outcomes of Transcatheter Aortic Valve Implantation in Patients With Chronic Kidney Disease in Octogenarian Population

Limited data are available regarding in-hospital outcomes of transcatheter aortic valve implantation (TAVI) in the octogenarian population with chronic kidney disease (CKD). We sought to study the cardiovascular outcomes of TAVI in CKD hospitalization with different stages at the national cohort registry. We used the National Inpatient Sample database to compare TAVI CKD low-grade (LG) (stage I to IIIa, b) versus TAVI CKD high-grade (HG) (stage IV to V) in octogenarians. Outcomes such as inpatient mortality, cardiogenic shock, new permanent pacemaker implantation, acute kidney injury), sudden cardiac arrest, mechanical circulatory support, major bleeding, transfusion, and resource utilization were compared between the 2 cohorts. A total of 74,766 octogenarian patients (TAVI CKD-HG n = 12,220; TAVI CKD-LG n = 62,545) were included in our study. On matched analysis, TAVI CKD-HG had higher odds of in-hospital mortality (adjusted odds ratio [aOR] 2.18, 95% confidence interval [CI] 1.0-2.5, p \u3c 0.0001), cardiogenic shock (aOR 1.22, 95% CI 1.07 to 1.39, p = 0.0019), permanent pacemaker implantation (aOR 1.14, 95% CI 1.06 to 1.23, p = 0.0006), acute kidney injury (aOR 1.19, 95% CI 1.13 to 1.27, p \u3c 0.0001), sudden cardiac arrest (aOR 1.32, 95% CI 1.09 to 1.61, p = 0.004), major bleeding (aOR 1.1, 95% CI 1.006 to 1.22, p \u3c 0.0368) and higher rates of blood transfusion (aOR 1.62, 95% CI 1.5 to 1.75, p \u3c 0.0001) when compared with the TAVI CKD-LG cohort. However, there was no statistically significant difference in the odds of cerebrovascular accident and mechanical circulatory support use between the 2 groups

Meta-Analysis Comparing Distal Radial Versus Traditional Radial Percutaneous Coronary Intervention or Angiography

Data comparing outcomes of distal radial (DR) and traditional radial (TR) access of coronary angiography and percutaneous coronary intervention (PCI) are limited. Online databases including Medline and Cochrane Central databases were explored to identify studies that compared DR and TR access for PCI. The primary outcome was the rate of radial artery occlusion (RAO) and access failure. Secondary outcomes included access site hematoma, access site bleeding, access site pain, radial artery spasm, radial artery dissection, and crossover. Unadjusted odds ratios (ORs) with a random-effect model, 95% confidence interval (CI), and p \u3c 0.05 were used for statistical significance. Metaregression was performed for 16 studies with 9,973 (DR 4,750 and TR 5,523) patients were included. Compared with TR, DR was associated with lower risk of RAO (OR 0.51, 95% CI 0.29 to 0.90, I2 = 42.6%, p = 0.02). RAO was lower in DR undergoing coronary angiography rather than PCI. Access failure rate (OR 1.77, 95% CI 0.69 to 4.55, I2 87.36%, p = 0.24), access site hematoma (OR 1.11, 95% CI 0.68 to 1.83, I2 0%, p = 0.68), access site pain (OR 2.22, 95% CI 0.28 to 17.38, I2 0%, p = 0.45), access site bleeding (OR 1.11, 95% CI 0.16 to 7.62, I2 85.11%, p = 0.91), radial artery spasm (OR 0.79, 95% CI 0.49 to 1.29, I2 0%, p = 0.35), radial artery dissection (OR 1.63, 95% CI 0.46 to 5.84, I2 0%, p = 0.45), and crossover (OR 1.54, 95% CI 0.64 to 3.70, I2 25.48%, p = 0.33) did not show any significant difference. DR was associated with lower incidence RAO when compared with TR, whereas other procedural-related complications were similar

Investigation of effective parameters in the production of alumina gel through the sol-gel method

Sol-gel chemistry is currently applied as one of the most widely used methods for synthesis of nanoparticles. In this method hydrolysis and poly-condensation reactions occur when the gel precursors are mixed with water and catalyst. The further condensation of sol particles into a three-dimensional network produces a gel. There are several parameters that effect on gelation time such as the molar ratio of alkoxide to water, the rate of hydrolysis, the type and amount of catalyst used, initial concentration of precursors and the temperature of hydrolysis and drying. Encapsulated solvent can be removed from a gel by either evaporative drying or supercritical drying. Where the resulting solids are known as a xerogel and an aerogel, respectively. During the drying process due to the surface tension of the liquid, a capillary pressure gradient is built in the pore walls, which is able to collapse most part of the pore volume. The volume shrinkage may be prevented by supercritical drying. The strength, thermal stability, pore structure and morphology of aerogels are keys to success for wider applications such as catalyst supports, thermal and acoustic insulators and adsorbents. Among catalyst support materials, alumina became popular recently due to its highly thermal and chemical stability and higher porosity. In the present study, synthesis of alumina gel as a support for nano-catalysts through hydrolysis of aluminum tri-sec-butoxide (ASB) in ethanol was investigated. The gel synthesis was carried out at 32 and 60 °C with different concentrations of water and precursor and different types and amounts of acid as catalyst. Rate of gel formation, efficiency of hydrolysis and polymerization and amount of gel production were measured and discussed. Results showed that acid addition around 0.2 ml and water to ASB malar ratio of 2 at 60 °C maximized the amount of gel produced and minimized the gelation time. Then, the alumina gel that synthesized at optimum conditions was dried by two different methods, at atmospheric pressure and temperature and at supercritical conditions of carbon dioxide and the results of Scanning Electron Microscopy were compared