Utility of rapid atrial pacing before and after TAVR with balloon-expandable valve in predicting permanent pacemaker implantation.

BACKGROUND: High-grade or complete atrioventricular block (AVB) requiring permanent pacemaker (PPM) implantation is a known complication of transcatheter aortic valve replacement (TAVR). Wenckebach AVB induced by rapid atrial pacing (RAP) after TAVR was previously demonstrated in an observational analysis to be an independent predictor for PPM. We sought to investigate the utility of both pre- and post-TAVR RAP in predicting PPM implantation. METHODS: In a single-center, prospective study, 421 patients underwent TAVR with balloon-expandable valves (BEV) between April 2020 and August 2021. Intraprocedural RAP was performed in patients without a pre-existing pacemaker, atrial fibrillation/flutter, or intraprocedural complete AVB to assess for RAP-induced Wenckebach AVB. The primary outcome was PPM within 30 days after TAVR. RESULTS: RAP was performed in 253 patients, of whom 91.3% underwent post-TAVR RAP and 61.2% underwent pre-TAVR RAP. The overall PPM implantation rate at 30 days was 9.9%. Although there was a numerically higher rate of PPM at 30 days in patients with RAP-induced Wenckebach AVB, it did not reach statistical significance (13.3% vs. 8.4%, p = 0.23). In a multivariable analysis, RAP-induced Wenckebach was not an independent predictor for PPM implantation at 30 days after TAVR. PPM rates at 30 days were comparable in patients with or without pre-TAVR pacing-induced Wenckebach AVB (11.8% vs. 8.2%, p = 0.51) and post-TAVR pacing-induced Wenckebach AVB (10.2% vs. 5.8%, p = 0.25). CONCLUSION: In patients who underwent TAVR with BEV, there were no statistically significant differences in PPM implantation rates at 30 days regardless of the presence or absence of RAP-induced Wenckebach AVB. Due to conflicting results between the present study and the prior observational analysis, future studies with larger sample sizes are warranted to determine the role of RAP during TAVR as a risk-stratification tool for significant AVB requiring PPM after TAVR.

The MRI appearance of myloglossus.

PURPOSE: This case report describes the MRI appearance and significance of the myloglossus muscle, a variant extrinsic tongue muscle. METHODS: The myloglossus muscle was incidentally discovered on imaging performed for head and neck cancer evaluation. RESULTS: The myloglossus is best visualized on non-fat saturated T2 MRI and has signal characteristics that match those of muscle. It originates at the angle of the mandible and inserts into the tongue between the styloglossus and hyoglossus. CONCLUSION: Accurate identification and delineation of the extrinsic muscles of the tongue, including the myloglossus, is essential for proper staging and treatment of head and neck cancers. This case report attempts to fill a void in depicting the MRI appearance of myloglossus muscle.

Headache neuroimaging: A survey of current practice, barriers, and facilitators to optimal use.

OBJECTIVE: The objective of this study was to understand current practice, clinician understanding, attitudes, barriers, and facilitators to optimal headache neuroimaging practices. BACKGROUND: Headaches are common in adults, and neuroimaging for these patients is common, costly, and increasing. Although guidelines recommend against routine headache neuroimaging in low-risk scenarios, guideline-discordant neuroimaging is still frequently performed. METHODS: We administered a 60-item survey to headache clinicians at the Veterans Affairs health system to assess clinician understanding and attitudes on headache neuroimaging and to determine neuroimaging practice patterns for three scenarios describing hypothetical patients with headaches. Descriptive statistics were used to summarize responses, stratified by clinician type (physicians or advanced practice clinicians [APCs]) and specialty (neurology or primary care). RESULTS: The survey was successfully completed by 431 of 1426 clinicians (30.2% response rate). Overall, 317 of 429 (73.9%) believed neuroimaging was overused for patients with headaches. However, clinicians would utilize neuroimaging a mean (SD) 30.9% (31.7) of the time in a low-risk scenario without red flags, and a mean 67.1% (31.9) of the time in the presence of minor red flags. Clinicians had stronger beliefs in the potential benefits (268/429, 62.5%) of neuroimaging compared to harms (181/429, 42.2%) and more clinicians were bothered by harms stemming from the omission of neuroimaging (377/426, 88.5%) compared to commission (329/424, 77.6%). Additionally, APCs utilized neuroimaging more frequently than physicians and were more receptive to potential interventions to improve neuroimaging utilization. CONCLUSIONS: Although a majority of clinicians believed neuroimaging was overused for patients with headaches, many would utilize neuroimaging in low-risk scenarios with a small probability of changing management. Future studies are needed to define the role of currently used red flags given their importance in neuroimaging decisions. Importantly, APCs may be an ideal target for future optimization efforts.

Oxidative stress-mediated photoactivation of carbazole inhibits human skin cell physiology.

Prolonged exposure of the earth's surface to the sun's ultraviolet radiation may result in various skin diseases and cataract. Carbazole (CBZ), as a polycyclic-aromatic hydrocarbon (PAH), is blended with a five-member nitrogen-containing ring. It is found in cigarette smoke, coal, eye kohl, tattoo ink, and wood combustion and affects various types of flora and fauna. Our findings suggest that CBZ generates reactive oxygen species (ROS) like O2•- through type-I photodynamic reaction and causes phototoxicity in the human keratinocyte cell line (HaCaT), which has been proved by mitochondrial dehydrogenase and neutral red uptake assays. CBZ induces single strand DNA damage. We have investigated the involvement of the apoptotic pattern of cell death and confirmed it by cytochrome C release from mitochondria and caspase-9 activation. Similarly, photo-micronuclei formation was associated to CBZ-induced phototoxicity. The results of this study strongly support that the upregulation of bax, cyto-C, apaf-1, casp-9 and down regulation of bcl2, keap-1, nrf-2, and hmox-1 genes cause apoptopic cell death. Downregulation of antioxidant genes showed a significant amount of ROS generation by photosensitized CBZ. Therefore, the current study will be a step forward to safeguard human beings from sunlight-induced photosensitive CBZ prolonged exposure.

Sunscreen-induced expression and identification of photosensitive marker proteins in human keratinocytes under UV radiation.

Solar ultraviolet (UV) radiation is the main factor of photocarcinogenesis, photoaging, and photosensitivity; thus protection from biological damaging UV radiation is a concern. Sunscreens containing UV filters are the most preferred means of photoprotection but the safety and efficacy of UV filters are in question. Benzophenone (BP) and its derivatives, namely, benzophenone 1 (BP1), is commonly used in sunscreens as a UV blocker. The aim of this study was to assess the effects of BP and BP1 on the differential expression of proteins in human keratinocytes (HaCaT cells) under exposure to ultraviolet A radiation. Photosensitive proteins were screened from HaCaT cells by two-dimensional (2-D) gel electrophoresis, and identification of these differentially expressed proteins was performed by matrix-assisted laser desorption/ionization-time-of-flight (MALDI-TOF)/TOF mass spectrometry. Protein identification was performed using the search program MASCOT and a database made of SUMO and GhJMJ12 amino acid sequences. Our results showed that the proteins involved directly or indirectly in apoptosis are 70 kDa heat shock protein, long-chain specific acyl-CoA dehydrogenase, serine/threonine-protein kinase, and FAM78A protein, which were upregulated in comparison to control HaCaT cells. The expressions of binding immunoglobulin protein, podocalyxin-like protein, actin, cytoplasmic, and calreticulin precursors were downregulated. The altered protein expression indicated that cell growth arrest and apoptosis were potential mechanisms of cytotoxicity and genotoxicity of BPs. The results of 2-D gel electrophoresis followed by mass spectrometry showed expression of novel proteins involved in promoting or initiating apoptotic pathways. Hence, we conclude that BPs should be avoided as a UV blocker from sunscreens because of its potential to promote apoptotic proteins in human skin keratinocytes.

Teachers' and Parents' Perspectives on a Curricular Subject of "Religion and Spirituality" for Indian Schools: A Pilot Study Toward School Mental Health Program.

Religious-spiritual (R/S) education helps medical students cope with caregiving stress and gain skills in interpersonal empathy needed for clinical care. Such R/S education has been introduced into K-12 and college curricula in some developed nations and has been found to positively impact student's mental health. Such a move has not yet been seen in the Indian education system. This paper aimed to examine perspectives of teachers and parents in India on appropriateness, benefits, and challenges of including R/S education into the school curriculum and also to gather their impressions on how a R/S curriculum might promote students' health. A cross-sectional study of religiously stratified sample of teachers and parents was initiated in three preselected schools in India and the required sample size (N = 300) was reached through snowballing technique. A semi-structured questionnaire, with questions crafted from "Religion and Spirituality in Medicine, Physicians Perspective" (RSMPP) and "American Academy of Religion's (AAR) Guidelines for Religious Literacy," was used to determine participants' perspectives. Findings revealed that teachers' and parents' "comfort in integrating R/S into school curriculum" was associated with their gender (OR 1.68), education status (OR 1.05), and intrinsic religiosity (OR 1.05). Intrinsic religiosity was significantly (p = 0.025) high among parents while "intrinsic spirituality" was high (p = 0.020) among teachers. How participants' R/S characteristics influence their support of R/S education in school is discussed. In conclusion, participants believe R/S education will fosters students' emotional health and interpersonal skills needed for social leadership. A curriculum that incorporates R/S education, which is based on AAR guidelines and clinically validated interpersonal spiritual care tools would be acceptable to both teachers and parents.

Photosensitized 2-amino-3-hydroxypyridine-induced mitochondrial apoptosis via Smac/DIABLO in human skin cells.

The popularity of hair dyes use has been increasing regularly throughout the world as per the demand of hair coloring fashion trends and other cosmetic products. 2-Amino-3-hydroxypyridine (A132) is widely used as a hair dye ingredient around the world. We are reporting first time the phototoxicity mechanism of A132 under ambient environmental UV-B radiation. It showed maximum absorption in UV-B region (317 nm) and forms a photoproduct within an hour exposure of UV-B irradiation. Photocytotoxicity of A132 in human keratinocytes (HaCaT) was measured by mitochondrial (MTT), lysosomal (NRU) and LDH assays which illustrated the significant reduction in cell viability. The role of reactive oxygen species (ROS) generation for A132 phototoxicity was established photo- chemically as well as intracellularly. Noteworthy, formation of tail DNA (comet assay), micronuclei and cyclobutane pyrimidine dimers (CPDs) (immunocytochemistry) formation confirmed the photogenotoxic potential of dye. Cell cycle study (sub-G1peak) and staining with EB/AO revealed the cell cycle arrest and apoptosis. Further, mitochondrial mediated apoptosis was corroborated by reduced MMP, release of cytochrome c and upregulation of caspase-3. Release of mitochondrial Smac/DIABLO in cytoplasm demonstrated the caspase dependent apoptotic cell death by photolabile A132 dye. In-addition increased Bax/Bcl2 ratio again proved the apoptosis. Thus, study suggests that A132 induces photogenotoxicity, phototoxicity and apoptotic cell death through the involvement of Smac/DIABLO in mitochondrial apoptosis via caspase dependent manner. Therefore, the long term use of A132 dye and sunlight exposure jointly increased the oxidative stress in skin which causes premature hair loss, damage to progenitor cells of hair follicles.

Head and neck reconstructive surgery: what the radiologist needs to know.

UNLABELLED: Head and neck reconstructive surgery after cancer ablative surgery is now commonly performed with closure of the surgical defects by microvascular free tissue transfer. The most common flaps used for reconstruction are the radial forearm flap, the anterolateral thigh flap and fibula flap. Radiographic appearance of these flaps depends on the individual components of the flap, and may consist of skin, fat, muscle and/or bone. There are various adverse outcomes in these patients, the most significant being tumour recurrence that typically occurs at the flap margins. Other flap complications include flap necrosis from vascular thrombosis or infection. The goal of this article is to enhance radiologists' familiarity with different methods of flap reconstruction, flap margins and vascular anastomoses that will lead to a better appreciation of expected postoperative radiographic appearance. KEY POINTS: • Flaps are the most common reconstructive techniques used in neck cancer surgery. • Imaging appearance of flaps depends on their components and time since surgery. • Most tumour recurrence after reconstruction occurs at the margins of the flap.

PREVALENCE OF CONGENITAL HEART DISEASE IN RURAL COMMUNITIES OF PAKISTAN.

BACKGROUND: Prevalence of Congenital Heart Disease (CHD) is well established in most of the developed countries, where childbirth is obligatory in hospitals and allied facilities. In rural Pakistan the situation is reverse, where most of deliveries take place in homes by traditional birth attendants' therefore true prevalence of CHD in our population is unknown. In rural Pakistan almost 80% children are born at home hence the figures are unknown. This study was designed, to determine the prevalence of congenital heart disease in rural Pakistan. METHODS: During a cross-sectional survey of rural population belonging to major ethnic groups living in three provinces of Pakistan to determine the prevalence of rheumatic heart disease (RHD), CHD rates were calculated as a sub study. Nine thousand four hundred and seventy-six (9476) subjects of all ages were screened using cluster sampling technique. Socio-demographic variables were recorded. Auscultation and short physical examination performed for initial screening and final diagnosis was confirmed on M-mode/2D/Doppler. RESULTS: Thirty two patients had RHD, 25 Patients identified with CHD and another 7 patients had mixed CHD & RHD. Overall prevalence for CHD was 3.4/1000. The commonest lesion was Atrial Septal Defect (ASD) 40%, Ventricular Septal Defect (VSD) 35%, Aortic Stenosis (AS) 10%, Atrio Ventricular Septal Defect (AVSD) 5%. CONCLUSION: This is the first study to report CHD prevalence from multiethnic representative sample from rural communities of Pakistan. Apparently CHD rate seems less compared with facility based data because records of still stillbirths are not available and autopsies are not performed as routine. Very high infant mortality from rural areas of Pakistan also favours high prevalence for CHD; however these figures represent an overall picture of CHD in a community where medical facilities are lacking.

Efficacy and safety of novel oral anticoagulants in patients with cervical artery dissections.

BACKGROUND: American and European guidelines support antiplatelet agents and anticoagulants as reasonable treatments of cervical artery dissection (CAD), though randomized clinical trials are lacking. The utility of novel oral anticoagulants (NOAC), effective in reducing embolic stroke risk in non-valvular atrial fibrillation (NVAF), has not been reported in patients with CAD. We report on the use, safety, and efficacy of NOACs in the treatment of CAD. METHODS: We retrospectively identified patients diagnosed with CAD at a single academic center between January 2010 and August 2013. Patients were categorized by their antithrombotic treatment at hospital discharge with a NOAC (dabigatran, rivaroxaban, or apixaban), traditional anticoagulant (AC: warfarin or treatment dose low-molecular weight heparin), or antiplatelet agent (AP: aspirin, clopidogrel, or aspirin/extended-release dypyridamole). Using appropriate tests, we compared the baseline medical history, presenting clinical symptoms and initial radiographic characteristics among patients in the 3 treatment groups. We then evaluated for the following outcomes: recurrent stroke, vessel recanalization, and bleeding complications. p values <0.05 were considered significant. RESULTS: Of the 149 included patients (mean age 43.4 years; 63.1% female; 70.5% vertebral artery CAD), 39 (26.2%), 70 (47.0%), and 40 (26.8%) were treated with a NOAC, AC, and AP, respectively. More patients with severe stenosis or occlusion were treated with NOAC than with AC or AP (61.8 vs. 60.0 vs. 22.5%, p = 0.002). Other baseline clinical and radiographic findings, including the presence of acute infarction and hematoma, did not differ between the 3 treatment groups. One hundred and thirty-five (90.6%) patients had clinical follow-up (median time 7.5 months) and 125 (83.9%) had radiographic follow-up (median time 5 months) information. There were 2 recurrent strokes in the NOAC group and 1 in each of the AC and AP groups (p = 0.822). There were more major hemorrhagic events in the AC group (11.4%) compared to the NOAC (0.0%) and AP (2.5%) groups (p = 0.034). Three patients treated with NOAC and none treated with AC or AP had a worsened degree of stenosis on follow-up imaging (8.6 vs. 0.0 vs. 0.0%, p = 0.019). CONCLUSION: Compared to traditional anticoagulants for CAD, treatment with NOACs is associated with similar rates of recurrent stroke, fewer hemorrhagic complications, but greater rates of radiographic worsening. These data suggest that NOACs may be a reasonable alternative in the management of CAD. Prospective validation of these findings is needed.

Photosensitized mefloquine induces ROS-mediated DNA damage and apoptosis in keratinocytes under ambient UVB and sunlight exposure.

The present study illustrates the photosensitizing behavior of mefloquine (MQ) in human skin keratinocytes under ambient doses of UVB and sunlight exposure. Photochemically, MQ generated reactive oxygen species superoxide radical, hydroxyl radical, and singlet oxygen through type I and type II photodynamic reactions, respectively, which caused photooxidative damage to DNA and formed localized DNA lesions cyclobutane pyrimidine dimers. Photosensitized MQ reduced the viability of keratinocytes to 25 %. Significant level of intracellular reactive oxygen species (ROS) generation was estimated through fluorescence probe DCF-H2. Increased apoptotic cells were evident through AO/EB staining and phosphatidyl serine translocation in cell membrane. Single-stranded DNA damage was marked through single-cell gel electrophoresis. Mitochondrial membrane depolarization and lysosomal destabilization were evident. Upregulation of Bax and p21 and downregulation of Bcl-2 genes and corresponding protein levels supported apoptotic cell death of keratinocyte cells. Cyclobutane pyrimidine dimers (CPDs) were confirmed through immunofluorescence. In addition, hallmarks of apoptosis and G2/M phase cell cycle arrest were confirmed through flow cytometry analysis. Our findings suggest that MQ may damage DNA and produce DNA lesions which may induce differential biological responses in the skin on brief exposure to UVB and sunlight.

Natural history of rheumatic heart disease, a 12 years observational study "penicillin bites the muscle but heals the heart".

BACKGROUND: Rheumatic Heart Disease (RHD) is amajor cause of cardiovascular morbidity and mortality in young individuals, in developing countries. Long term studies regarding natural history of RHD in Pakistan have not been reported in literature. We present our follow up observations on RHD patients at the end of 12 years since our first survey conducted in rural communities in 1994. METHODS: Our study patients were known cases of RHD, diagnosed in cross sectional survey of rural areas of Rahimyar Khan in 1994. Second survey conducted in 2006, in which these RHD patients were evaluated in detail with history/Physical examination, 12 lead ECG, X-ray chest PA view and Echo/Doppler studies at Sheikh Zayed Medical College Rahimyar Khan. RESULTS: Out of 57 patients enrolled in 1994, 21 patients (37%) were available for further evaluation. Overall mortality was 23%. Male to female ratio was 1:1.62. Age ranges between 20- 80 years with mean of 43 years. Only 6 patients (29%) were taking rheumatic prophylaxis (RP) and six patients had recurrent RF. Five patients (24%) developed new aortic regurgitation (AR) and 38% increased in grade of severity of lesions on Echo (none of them was on RP). Regression of mild lesions noted in six patients (all of them were on RP). Two patients underwent surgery. 10% developed new atrial fibrillation. CONCLUSION: Unabated RF/RHD led to a very high mortality. Favourable out come observed with prophylaxis even for short period on mild or moderate RHD. Patients not on RP had severe diseases. This small study is a big blow to our claims of combating RF/RHD in the 21st century.

Machine learning-driven predictions and interventions for cardiovascular occlusions.

BACKGROUND: Cardiovascular diseases remain a leading cause of global morbidity and mortality, with heart attacks and strokes representing significant health challenges. The accurate, early diagnosis and management of these conditions are paramount in improving patient outcomes. The specific disease, cardiovascular occlusions, has been chosen for the study due to the significant impact it has on public health. Cardiovascular diseases are a leading cause of mortality globally, and occlusions, which are blockages in the blood vessels, are a critical factor contributing to these conditions. OBJECTIVE: By focusing on cardiovascular occlusions, the study aims to leverage machine learning to improve the prediction and management of these events, potentially helping to reduce the incidence of heart attacks, strokes, and other related health issues. The use of machine learning in this context offers the promise of developing more accurate and timely interventions, thus improving patient outcomes. METHODS: We analyze diverse datasets to assess the efficacy of various machine learning algorithms in predicting heart attacks and strokes, comparing their performance to pinpoint the most accurate and reliable models. Additionally, we classify individuals by their predicted risk levels and examine key features that correlate with the incidence of cardiovascular events. The PyCaret machine learning library's Classification Module was key in developing predictive models which were evaluated with stratified cross-validation for reliable performance estimates. RESULTS: Our findings suggest that machine learning can significantly improve the prediction accuracy for heart attacks and strokes, facilitating earlier and more precise interventions. We also discuss the integration of machine learning models into clinical practice, addressing potential challenges and the need for healthcare professionals to interpret and apply these predictions effectively. CONCLUSIONS: The use of machine learning for risk stratification and the identification of modifiable factors may empower preemptive approaches to cardiovascular care, ultimately aiming to reduce the occurrence of life-threatening events and improve long-term patient health trajectories.

The Role of ArtificiaI Intelligence in Brain Tumor Diagnosis: An Evaluation of a Machine Learning Model.

This research study explores of the effectiveness of a machine learning image classification model in the accurate identification of various types of brain tumors. The types of tumors under consideration in this study are gliomas, meningiomas, and pituitary tumors. These are some of the most common types of brain tumors and pose significant challenges in terms of accurate diagnosis and treatment. The machine learning model that is the focus of this study is built on the Google Teachable Machine platform (Alphabet Inc., Mountain View, CA). The Google Teachable Machine is a machine learning image classification platform that is built from Tensorflow, a popular open-source platform for machine learning. The Google Teachable Machine model was specifically evaluated for its ability to differentiate between normal brains and the aforementioned types of tumors in MRI images. MRI images are a common tool in the diagnosis of brain tumors, but the challenge lies in the accurate classification of the tumors. This is where the machine learning model comes into play. The model is trained to recognize patterns in the MRI images that correspond to the different types of tumors. The performance of the machine learning model was assessed using several metrics. These include precision, recall, and F1 score. These metrics were generated from a confusion matrix analysis and performance graphs. A confusion matrix is a table that is often used to describe the performance of a classification model. Precision is a measure of the model's ability to correctly identify positive instances among all instances it identified as positive. Recall, on the other hand, measures the model's ability to correctly identify positive instances among all actual positive instances. The F1 score is a measure that combines precision and recall providing a single metric for model performance. The results of the study were promising. The Google Teachable Machine model demonstrated high performance, with accuracy, precision, recall, and F1 scores ranging between 0.84 and 1.00. This suggests that the model is highly effective in accurately classifying the different types of brain tumors. This study provides insights into the potential of machine learning models in the accurate classification of brain tumors. The findings of this study lay the groundwork for further research in this area and have implications for the diagnosis and treatment of brain tumors. The study also highlights the potential of machine learning in enhancing the field of medical imaging and diagnosis. With the increasing complexity and volume of medical data, machine learning models like the one evaluated in this study could play a crucial role in improving the accuracy and efficiency of diagnoses. Furthermore, the study underscores the importance of continued research and development in this field to further refine these models and overcome any potential limitations or challenges. Overall, the study contributes to the field of medical imaging and machine learning and sets the stage for future research and advancements in this area.

Biomechanical Effects of Seizures on Cerebral Dynamics and Brain Stress.

Epilepsy is one of the most common neurological disorders globally, affecting about 50 million people, with nearly 80% of those affected residing in low- and middle-income countries. It is characterized by recurrent seizures that result from abnormal electrical brain activity, with seizures varying widely in manifestation. The exploration of the biomechanical effects that seizures have on brain dynamics and stress levels is relevant for the development of more effective treatments and protective strategies. This study uses a blend of experimental data and computational simulations to assess the brain's physical response during seizures, particularly focusing on the behavior of cerebrospinal fluid and the resulting mechanical stresses on different brain regions. Notable findings show increases in stress, predominantly in the posterior gyri and brainstem, during seizures and an evidence of brain displacement relative to the skull. These observations suggest a dynamic and complex interaction between the brain and skull, with maximum shear stress regions demonstrating the limited yet essential protective role of the CSF. By providing a deeper understanding of the mechanical changes occurring during seizures, this research supports the goal of advancing diagnostic tools, informing more targeted treatment interventions, and guiding the creation of customized therapeutic strategies to enhance neurological care and protect against the adverse effects of seizures.

Prompt delivery of thrombolytic therapy: experience with chest pain units and emergency medical services.

OBJECTIVE: To reduce the reperfusion time with thrombolytics. METHODS: The study was done at Sheikh Zayed Hospital, Rahimyar Khan, between January and October 2009, and comprised all consecutive patients with ST segment Myocardial Infarction presenting to the hospital in emergency. In phase one, emergency medical services of Rescue 1122 were utilised to minimize transportation time and thrombolytics were instituted in the Emergency Department or the Coronary Care Unit. In Phase II, a chest pain unit was established in the Emergency Department and all patients were thrombolysed there. A proforma describing Total time, Door-to-needle time, demographics, reperfusion criteria, immediate and delayed complications was filled up for each patient. Comparative groups were analysed using Chi-square and Kruskal-Wallis tests, and p < 0.05 was considered statistically significant. RESULTS: A total of 291 patients were enrolled. Of them 15 (5.15%) were rescued by the emergency medical services, while 276 (94.84%) presented themselves or were referred. Mean age was 51 +/- 11.5 years. There were 245 (84%) males. Thirty (10.30%) patients were thrombolysed at the Chest Pain Unit; 216 (74.22%) at the Coronary Care Unit; and 45 (15.46%) in the Emergency Department. Total time was 3:52, 5:29, and 4:55 hours respectively (p = 0.003). Door-to-needle time was significantly reduced in the chest pain unit (p = 0.0001). Total time was minimum in emergency medical services (p = 0.0001). ST segment resolution > 70% was maximum in the chest pain unit (p = 0.0001). CONCLUSION: There was remarkable reduction in Total time utilising emergency medical services and door-to-needle time by establishing the chest pain unit. It is strongly recommended thatsuch units be developed in all districts and tertiary care hospitals as a cost-effective facility.

Modeling Dynamics of the Cardiovascular System Using Fluid-Structure Interaction Methods.

Using fluid-structure interaction algorithms to simulate the human circulatory system is an innovative approach that can provide valuable insights into cardiovascular dynamics. Fluid-structure interaction algorithms enable us to couple simulations of blood flow and mechanical responses of the blood vessels while taking into account interactions between fluid dynamics and structural behaviors of vessel walls, heart walls, or valves. In the context of the human circulatory system, these algorithms offer a more comprehensive representation by considering the complex interplay between blood flow and the elasticity of blood vessels. Algorithms that simulate fluid flow dynamics and the resulting forces exerted on vessel walls can capture phenomena such as wall deformation, arterial compliance, and the propagation of pressure waves throughout the cardiovascular system. These models enhance the understanding of vasculature properties in human anatomy. The utilization of fluid-structure interaction methods in combination with medical imaging can generate patient-specific models for individual patients to facilitate the process of devising treatment plans. This review evaluates current applications and implications of fluid-structure interaction algorithms with respect to the vasculature, while considering their potential role as a guidance tool for intervention procedures.

Left-Sided Presentation of Acute Appendicitis in a Patient With Situs Inversus Totalis.

Situs inversus totalis (SIT) is a rare condition characterized by mirror-image reversal of the thoracoabdominal organs. Although appendiceal pain is typically located in the right lower quadrant, in SIT, this can occur in the left lower quadrant. We present a case of a 40-year-old male with no medical history who complained of acute left lower quadrant pain, nausea, and vomiting with no other symptoms. A computed tomography scan revealed SIT and left-sided acute appendicitis (LSAA), which was managed surgically. This case highlights the importance of including appendicitis in the differential diagnosis for left lower quadrant pain.

Understanding Traumatic Brain Injuries in Military Personnel: Investigating the Dynamic Interplay of the Cerebrospinal Fluid and Brain During Blasts.

Background It is estimated that around 450,000 traumatic brain injury cases have occurred in the 21st century with possible under-reporting. Computational simulations are increasingly used to study the pathophysiology of traumatic brain injuries among US military personnel. This approach allows for investigation without ethical concerns surrounding live subject testing. Methodology The pertinent data on head acceleration is applied to a detailed 3D model of a patient-specific head, which encompasses all significant components of the brain and its surrounding fluid. The use of finite element analysis and smoothed-particle hydrodynamics serves to replicate the interaction between these elements during discharge through simulation of their fluid-structure dynamics. Results The stress levels of the brain are assessed at varying time intervals subsequent to the explosion. The regions where there is an intersection between the skull and brain are observed, along with the predominant orientations in which displacement of the brain occurs resulting in a brain injury. Conclusions It has been determined that the cerebrospinal fluid is inadequate in preventing brain damage caused by multiple abrupt directional shifts of the head. Accordingly, additional research must be undertaken to enhance our comprehension of the injury mechanisms linked with consecutive changes in acceleration impacting the head.

Transient Ischemic Attack in a Patient With Poland Syndrome With Dextrocardia.

This report discusses the case of a patient with a past medical history of Poland syndrome and dextrocardia who was admitted for a transient ischemic attack. Poland syndrome is a rare genetic condition characterized by underdevelopment of chest wall musculature that presents with a variety of associations that may or may not be present in each case. This case report intends to discuss a unique presentation of Poland syndrome with dextrocardia, one of the rare conditions associated with Poland syndrome, as well as the treatment of Poland syndrome as a whole and possible associated complications.