Rate control is the key-Tachycardia induced Cardiomyopathy

Introduction: Tachycardia-induced cardiomyopathy is the systolic dysfunction that results from tachyarrhythmias. It presents symptoms of heart failure and can be reversed with rate control or normalization to sinus rhythm. The aim of presenting this case report is to the awareness of tachycardia-induced cardiomyopathy, which if recognized early can be reversed by the treatment. Case Presentation: A 62-year-old male with a history of tobacco use presented with orthopnea, palpitations, and exertional dyspnea. A month ago, he was seen by his primary care physician for palpitations and was diagnosed with new-onset atrial fibrillation. There was a gradual progression of his exertional symptoms to NYHA class IV that prompted him to come to the emergency room. Upon admission, he was noted to have atrial fibrillation with the rapid ventricular response at 140 bpm. An echocardiogram revealed an LV ejection fraction of 20 % with dilated LV and RV chambers. His heart rate was controlled with metoprolol and digoxin. He was started on a heart failure regimen. Ischemic cardiac workup was unremarkable. He was subsequently followed up in the clinic. The repeat cardiac echocardiogram was noted for marked improvement of LV systolic function and of the patient\u27s symptoms. He was continued on rate control and heart failure medications. Conclusion: Tachycardia-induced cardiomyopathy can result from various tachyarrhythmias including atrial fibrillation with a rapid ventricular response. In such cases, cardiomyopathy may develop over a few weeks to over a few years. Once tachycardia-induced cardiomyopathy is suspected, treatment should focus on rate control in addition to the management of heart failure. Our case demonstrates how increased awareness of tachycardia-induced cardiomyopathy helps in timely diagnosis and can be reversible

Ornamental Chasmophytes of Urumbikkara Hills, Western Ghats Region of Idukki District, Kerala, India

The present study on the ornamental chasmophytes in the rocky habitats of Urumbikkara hills of Idukki district, Kerala reveals that, there are about 52 species of ornamental chasmophytic plants belonging to 46 genera and 29 families were collected because of their aesthetic value in both domestic and rock garden practices. These chasmophytes also possess certain biological peculiarities with different interesting adaptations and flower colour which can attract many people for making domestic or rock garden for ornamental purposes and psychological beneficial

Assessment of knowledge and awareness among the pregnant women about their medication use in a tertiary care hospital

Background: Pregnancy is a physiological state where drug therapy is of particular concern. The pertinent use of drugs during pregnancy is beneficial as it affects not only the health of the pregnant woman but also the developing fetus. The study was carried out to access the knowledge and awareness regarding the drug use among pregnant women.Methods: Cross sectional descriptive study was conducted among 150 pregnant women for six-month duration. All the information was acquired through direct interview with the subjects and from treatment chart of subjects which were then recorded in a data collection form.Results: Majority of the subjects were under the age group of 18-28 years (50%). Most of the subjects predominantly has tertiary level of education (69%). Furthermore, 57% of the subjects were at the third trimester of their pregnancy. Knowledge regarding use of their own medications were significantly high (95%), which suggest that the subjects were well aware of their medications. Besides, 82% of the subjects had knowledge about the medications that were not to be consumed during pregnancy. In addition, 89% of the pregnant women did not take any over the counter medications and about 92% of the subjects did not treat themselves with any ayurvedic or homeopathic medications.Conclusions: Significant number of subjects were aware about their medication use. They ensured themselves and their developing fetus a better health.

Pilot randomized crossover study comparing the efficacy of transnasal disposable endosheath with standard endoscopy to detect Barrett's esophagus.

BACKGROUND AND STUDY AIMS: The transnasal endosheath endoscope is a new disposable technology with potential applicability to the primary care setting. The aim of this study was to evaluate the efficacy of transnasal endosheath endoscopy (TEE) for the detection of Barrett's esophagus, by comparing the diagnostic accuracy of TEE with that of standard endoscopy. PATIENTS AND METHODS: This was a prospective, randomized, crossover study performed in a single tertiary referral center. Consecutive patients undergoing surveillance for Barrett's esophagus or referred for diagnostic assessment were recruited. All patients were randomized to undergo TEE followed by standard endoscopy or the reverse. Endoscopy experiences and patient preferences were evaluated using a questionnaire. Endoscopic and histologic diagnosis of Barrett's esophagus, and optical image quality of both endoscopic procedures, were compared. RESULTS: A total of 21 of 25 patients completed the study. TEE had sensitivity and specificity of 100 % for an endoscopic diagnosis of Barrett's esophagus, and of 66.7 % and 100 %, respectively, for the histologic diagnosis of Barrett's esophagus. The mean optical quality of standard endoscopy was significantly better than that of TEE (7.11 ± 0.42 vs. 4.06 ± 0.27; P < 0.0001). However, following endoscopy, patients reported a significantly better experience with TEE compared with standard endoscopy (7.05 ± 0.49 vs. 4.35 ± 0.53; P = 0.0006), with 60 % preferring TEE and 25 % preferring sedated standard endoscopy. CONCLUSIONS: In this study, TEE had equal accuracy for an endoscopic diagnosis of Barrett's esophagus compared with standard endoscopy, at the expense of reduced image quality and a lower yield of intestinal metaplasia on biopsy. TEE was better tolerated and preferred by patients. Hence, TEE needs further evaluation in primary care as an initial diagnostic tool.This study was supported by funding from Cambridge Experimental Cancer Medicine Centre, NIHR Cambridge Biomedical Research Centre, and a core grant for RCF from the Medical Research Council. M.K.S. was supported by the BUPA Foundation.This is the author accepted manuscript. The final version is available from Thieme Publishing Group via http://dx.doi.org/10.1055/s-0034-139331

Empathic mediators for distance learning courses

Conferência Internacional realizada em Lisboa de 15-16 de novembro de 2018.Online distance learning introduces several challenges, such as the dependence of online tools, the asynchronous communication between teachers and students, and the lack of synchronous social engagement level that inclassroom teaching can leverage. The existence of an online tutor 24 hours/day would be an interesting asset to potentially work as an additional learning support tool. The Virtual Tutoring project aims at the development of solutions involving anthropomorphic 3D avatars that work as both virtual online tutors in the Moodle e-learning platform as well as coaches in a mobile application that interact empathically with the students by predicting their emotional state and selecting appropriate emotion regulation strategies. This paper presents the current status of the project, preliminary evaluations with students, and future developments.This work was developed in the context of the FCT project PTDC/IVC-PEC/3963/2014 with the support of the R&D units of his authors.info:eu-repo/semantics/publishedVersio

Draft Genome Sequence of Frankia Strain G2, a Nitrogen-Fixing Actinobacterium Isolated from Casuarina equisetifolia and Able To Nodulate Actinorhizal Plants of the Order Rhamnales

Frankia sp. strain G2 was originally isolated from Casuarina equisetifolia and is characterized by its ability to nodulate actinorhizal plants of the Rhamnales order, but not its original host. It represents one of the largest Frankia genomes so far sequenced (9.5 Mbp)

The Evolution of Copulation Frequency and the Mechanisms of Reproduction in Male Anolis Lizards

The evolution of many morphological structures is associated with the behavioral context of their use, particularly for structures involved in copulation. Yet, few studies have considered evolutionary relationships among the integrated suite of structures associated with male reproduction. In this study, we examined nine species of lizards in the genus Anolis to determine whether larger copulatory morphologies and higher potential for copulatory muscle performance evolved in association with higher copulation rates. In 10–12 adult males of each species, we measured the size of the hemipenes and related muscles, the seminiferous tubules in the testes, and the renal sex segments in the kidneys, and we assessed the fiber type composition of the muscles associated with copulation. In a series of phylogenetically-informed analyses, we used field behavioral data to determine whether observed rates of copulation were associated with these morphologies.We found that species with larger hemipenes had larger fibers in the RPM (the retractor penis magnus, a muscle that controls hemipenis movement), and that the evolution of larger hemipenes and RPM fibers is associated with the evolution of higher rates of copulatory behavior. However, the sizes of the seminiferous tubules and renal sex segments, and the muscle fiber composition of the RPM, were not associated with copulation rates. Further, body size was not associated with the size of any of the reproductive structures investigated. The results of this study suggest that peripheral morphologies involved in the transfer of ejaculate may be more evolutionarily labile than internal structures involved in ejaculate production

Health and socioeconomic resource provision for older people in South Asian countries: Bangladesh, India, Nepal, Pakistan and Sri Lanka evidence from NEESAMA

Background: The global population is ageing rapidly, with low- and middle-income countries (LMICs) undergoing a fast demographic transition. As the number of older adults in LMICs increases, services able to effectively address their physical and mental health needs will be increasingly important. Objective: We review the health and socioeconomic resources currently available for older people in South Asian countries, Bangladesh, India, Nepal, Pakistan and Sri Lanka, to identify gaps in available resources and assess areas for improvement. Methods: We conducted a search of grey and published literature via Google Search, Compendex, EBSCO, JSTOR, Medline, Ovid, ProQuest databases, Scopus and Web of Science. Data on population demographics, human resources, health funding and social protection for older people were extracted. Local informants were consulted to supplement and verify the data. Results: In the study countries, the number of health professionals with expertise in elderly care was largely unknown, with minimal postgraduate training programmes available in elderly medicine or psychiatry. Older adults are therefore cared for by general physicians, nurses and community health workers, all of whom are present in insufficient numbers per capita. Total average healthcare expenditure was 2.5–5.5% of GDP, with 48.1–72.0% of healthcare costs covered by out-of-pocket payments. Pakistan did not have a social pension; only India and Nepal offered financial assistance to people with dementia; and all countries had disproportionately low numbers of care elderly homes. Conclusions: Inadequate healthcare funding, a shortage of healthcare professionals and insufficient government pension and social security schemes are significant barriers to achieving universal health coverage in LMICs. Governing bodies must expand training pro-grammes for healthcare providers for older adults, alongside increasing social protection to improve access to those in need and to prevent catastrophic health expenditure

Synthesis of dimeric analogs of adenophostin A that potently evoke Ca2+ release through IP3 receptors.

Inositol 1,4,5-trisphosphate receptors (IP3Rs) are tetrameric intracellular channels through which many extracellular stimuli initiate the Ca2+ signals that regulate diverse cellular responses. There is considerable interest in developing novel ligands of IP3R. Adenophostin A (AdA) is a potent agonist of IP3R and since some dimeric analogs of IP3R ligands are more potent than the corresponding monomer; we considered whether dimeric AdA analogs might provide agonists with increased potency. We previously synthesized traizolophostin, in which a simple triazole replaced the adenine of AdA, and showed it to be equipotent to AdA. Here, we used click chemistry to synthesize four homodimeric analogs of triazolophostin, connected by oligoethylene glycol chains of different lengths. We evaluated the potency of these analogs to release Ca2+ through type 1 IP3R and established that the newly synthesized dimers are equipotent to AdA and triazolophostin.University Grants Commission India (Senior Research Fellowship), Department of Science and Technology India (Swarnajayanti Fellowship, Ramanujan Fellowship), Wellcome TrustThis is the author accepted manuscript. The final version is available from The Royal Society of Chemistry via http://dx.doi.org/10.1039/c6ra19413