A probable case of right atrial myxoma presenting with features of restrictive cardiomyopathy

Cardiac tumors are very rare and most frequently benign. Myxomas are the most common primary cardiac tumors accounting for about 50% of cases. The clinical presentation of atrial myxomas depends on size, anatomical location and their effects on the surrounding structures rather than the histological type. Restrictive cardiomyopathy can present with features of heart failure with typical massive ascites out of proportion to peripheral oedema known as egg on stick appearance. We present a case of a probable right atrial myxoma in a 20year old lady mimicking restrictive cardiomyopathy. Case report: Mrs. HD, a 20-year old Fulani lady was referred to us with 3 years history of progressive abdominal swelling, dyspnea on exertion and easy fatiguability. No orthopnea, paroxysmal nocturnal dyspnea, chest pain, palpitation or syncope. Relevant examination findings include a chronically ill looking young lady, with egg on stick appearance and mild pitting pedal edema. She had tachycardia, blood pressure 90/70mmHg & elevated Jugular venous pressure. The liver was palpable about 4cm below the right costal margin and there was massive ascites demonstrable by fluid thrill. Trans- thoracic echocardiography revealed huge, well-defined right atrial mass measuring 64 x 35 x 56.8 mm attached to the superior wall of the atrium on apical four chamber view. Conclusion:Atrial mass should be considered in the differential diagnosis of a patient presenting with features of restrictive cardiomyopathy. Echocardiography and histology are required for definitive diagnosis

Multi-criteria decision analysis for the evaluation and screening of sustainable aviation fuel production pathways

The aviation sector, a significant greenhouse gas emitter, must lower its emissions to alleviate the climate change impact. Decarbonization can be achieved by converting low-carbon feedstock to sustainable aviation fuel (SAF). This study reviews SAF production pathways like hydroprocessed esters and fatty acids (HEFA), gasification and Fischer–Tropsch Process (GFT), Alcohol to Jet (ATJ), direct sugar to hydrocarbon (DSHC), and fast pyrolysis (FP). Each pathway's advantages, limitations, cost-effectiveness, and environmental impact are detailed, with reaction pathways, feedstock, and catalyst requirements. A multi-criteria decision framework (MCDS) was used to rank the most promising SAF production pathways. The results show the performance ranking order as HEFA > DSHC > FP > ATJ > GFT, assuming equal weight for all criteria

Varicocele: Management and the continuing controversies

Varicoceles have long been associated with infertility. Despite this long history, there remains much controversy regarding their aetiology and management. The aim of this review is to present the most current information on the management of varicoceles and to highlight some of the management controversies: Association of varicocele with male infertility; Management of varicocele in adolescent; safety and effectiveness of varicocele embolization and management of subclinical varicoceles. It is hoped that this review study will stimulate further research into this condition in order to find a more common ground regarding its management

Multi-criteria decision analysis for the evaluation and screening of sustainable aviation fuel production pathways

<p>The aviation sector, a significant greenhouse gas emitter, must lower its emissions to alleviate the climate change impact. Decarbonization can be achieved by converting low-carbon feedstock to sustainable aviation fuel (SAF). This study reviews SAF production pathways like hydroprocessed esters and fatty acids (HEFA), gasification and Fischer–Tropsch Process (GFT), Alcohol to Jet (ATJ), direct sugar to hydrocarbon (DSHC), and fast pyrolysis (FP). Each pathway’s advantages, limitations, cost-effectiveness, and environmental impact are detailed, with reaction pathways, feedstock, and catalyst requirements. A multi-criteria decision framework (MCDS) was used to rank the most promising SAF production pathways. The results show the performance ranking order as HEFA > DSHC > FP > ATJ > GFT, assuming equal weight for all criteria.</p&gt

Influence of systolic blood pressure on outcomes in Nigerians with peripartum cardiomyopathy

Background: The relationship between blood pressure (BP) trajectories and outcomes in patients with peripartum cardiomyopathy (PPCM) is not clear. Aim: The study aimed to assess the clinical features and outcomes (all-cause mortality and unrecovered left ventricular [LV] systolic function) of PPCM patients grouped according to their baseline systolic BP (SBP). Patients and Methods: PPCM patients presenting to 14 tertiary hospitals in Nigeria were consecutively recruited between June 2017 and March 2018 and then followed up till March 2019. SBP at first presentation was used to categorize the patients into seven groups: <90, 90-99, 100-109, 110-119, 120-129, 130-139, and ≥140 mmHg. Unrecovered LV systolic function was defined as echocardiographic LV ejection fraction (LVEF) below 55% at the last profiling. Results: Two hundred and twenty-seven patients were recruited and followed up for a median of 18 months. Of these, 4.0% had <90 mmHg, 16.3% had 90-99 mmHg, 24.7% had 100-109 mmHg, 24.7% had 110-119 mmHg, 18.5% had 120-129 mmHg, 7.5% had 130-139 mmHg, and 4.4% had ≥140 mmHg of SBP at presentation. The highest frequency of all-cause mortality was recorded among patients with SBP ≤90 mmHg (30.8%) followed by those with 90-99 mmHg (20.5%) (P = 0.076), while unrecovered LV systolic function did not differ significantly between the groups (P = 0.659). In a Cox proportional regression model for all-cause mortality, SBP <90 mmHg had a hazard ratio (HR) of 4.00 (95% confidence interval [CI] 1.49-10.78, P = 0.006), LVEF had an HR of 0.94 (95% CI 0.91-0.98, P = 0.003, B = 0.06%), and use of angiotensin-converting enzyme or angiotensin receptor and/or β-receptor blockers had an HR of 1.71 (95% CI 0.93-3.16, P = 0.085). However, SBP was not associated with LV function recovery. Conclusion: In our cohort of PPCM patients, one-fifth was hypotensive at presentation. SBP <90 mmHg at presentation was associated with a four-fold higher risk of all-cause mortality during a median follow-up of 18 months

Incidence, clinical characteristics, and risk factors of peripartum cardiomyopathy in Nigeria : results from the PEACE Registry

Aims: The aim of this study was to describe the incidence, clinical characteristics and risk factors of peripartum cardiomyopathy (PPCM) in Nigeria. Methods and Results: The study was conducted in 22 hospitals in Nigeria, and PPCM patients were consecutively recruited between June 2017 and March 2018. To determine factors associated with PPCM, the patients were compared with apparently healthy women who recently delivered, as controls. Four hundred six patients were compared with 99 controls. The incidence and disease burden (based on the rate of consecutive recruitment of subjects) varied widely between the six geographical zones of Nigeria. From the North-West zone, 72.3% of the patients was recruited, where an incidence as high as 1 per 96 live births was obtained in a centre, while the disease was uncommon (7.6% of all recruited patients) in the South. Majority of the patients (76.6%) and controls (74.8%) (p = 0.694) were of Hausa-Fulani ethnic group. Atrial fibrillation, intracardiac thrombus, stroke, and right ventricular systolic dysfunction were found in 1.7%, 6.4%, 2.2%, and 54.9% of the patients, respectively. Lack of formal education (odds ratio [OR] 3.08, 95% confidence interval [1.71, 5.53]; P < 0.001), unemployment (OR: 3.28 [2.05, 5.24]; P < 0.001), underweight (OR: 13.43 [4.17, 43.21]; P < 0.001) and history of pre-eclampsia (OR: 9.01 [2.18, 37.75]; P = 0.002) emerged as independent PPCM risk factors using regression models. Customary hot baths (OR: 1.24 [0.80, 1.93]; P = 0.344), pap enriched with dried lake salt (OR: 1.20 [0.74, 1.94]; P = 0.451), and Hausa-Fulani ethnicity (OR: 1.11 [0.67, 1.84]; P = 0.698) did not achieve significance as PPCM risk factors. Conclusions: In Nigeria, the burden of PPCM was greatest in the North-West zone, which has the highest known incidence. PPCM was predicted by sociodemographic factors and pre-eclampsia, which should be considered in its control at population level. Postpartum customary birth practices and Hausa-Fulani ethnicity were not associated with PPCM in Nigeria