An article on "letter to the editor".

A 'Letter to the Editor' is an abbreviated form of communication where 'readers' can express their carefully considered scientific opinion about a recently published article in a journal. It is considered as 'post-publication peer review'. There are certain things that a letter writer and the 'editor' need to keep in mind while writing a 'Letter' for a journal. The 'editor' needs to curate the contents of the 'Letter' and make sure that there are no misinformation shared. The formatting, type, scope and the scientific quality of the 'Letter' depend on the journal that publishes them, and hence, different publications may require their 'letter writers' to present the information that they want in a certain way. The following article reflects an overview of the role of editors and writers, guidelines, scope, and format of the 'Letter to the Editor'.

Current trends in image-guided chest interventions.

Interventional radiology (IR) is a rapidly expanding medical subspecialty and refers to a range of image-guided procedural techniques. The image guidance allows real-time visualization and precision placement of a needle, catheter, wire and device to deep body structures through small incisions. Advantages include reduced risks, faster recovery and shorter hospital stays, lower costs and less patient discomfort. The range of chest interventional procedures keeps on expanding due to improved imaging facilities, better percutaneous assess devices and advancing ablation and embolization techniques. These advances permit procedures to be undertaken safely, simultaneously and effectively, hence escalating the role of IR in the treatment of chest disorders. This review article aims to cover the latest developments in some image-guided techniques of the chest, including thermal ablation therapy of lung malignancy, targeted therapy of pulmonary embolism, angioplasty and stenting of mediastinal venous/superior vena cava occlusion, pulmonary arteriovenous malformation treatment and bronchial artery embolization for haemoptysis.

Operationalising the "One Health" approach in India: facilitators of and barriers to effective cross-sector convergence for zoonoses prevention and control.

BACKGROUND: There is a strong policy impetus for the One Health cross-sectoral approach to address the complex challenge of zoonotic diseases, particularly in low/lower middle income countries (LMICs). Yet the implementation of this approach in LMIC contexts such as India has proven challenging, due partly to the relatively limited practical guidance and understanding on how to foster and sustain cross-sector collaborations. This study addresses this gap by exploring the facilitators of and barriers to successful convergence between the human, animal and environmental health sectors in India. METHODS: A mixed methods study was conducted using a detailed content review of national policy documents and in-depth semi-structured interview data on zoonotic disease management in India. In total, 29 policy documents were reviewed and 15 key informant interviews were undertaken with national and state level policymakers, disease managers and experts operating within the human-animal-environment interface of zoonotic disease control. RESULTS: Our findings suggest that there is limited policy visibility of zoonotic diseases, although global zoonoses, especially those identified to be of pandemic potential by international organisations (e.g. CDC, WHO and OIE) rather than local, high burden endemic diseases, have high recognition in the existing policy agenda setting. Despite the widespread acknowledgement of the importance of cross-sectoral collaboration, a myriad of factors operated to either constrain or facilitate the success of cross-sectoral convergence at different stages (i.e. information-sharing, undertaking common activities and merging resources and infrastructure) of cross-sectoral action. Importantly, participants identified the lack of supportive policies, conflicting departmental priorities and limited institutional capacities as major barriers that hamper effective cross-sectoral collaboration on zoonotic disease control. Building on existing informal inter-personal relationships and collaboration platforms were suggested by participants as the way forward. CONCLUSION: Our findings point to the importance of strengthening existing national policy frameworks as a first step for leveraging cross-sectoral capacity for improved disease surveillance and interventions. This requires the contextual adaptation of the One Health approach in a manner that is sensitive to the underlying socio-political, institutional and cultural context that determines and shapes outcomes of cross-sector collaborative arrangements.

Dentistry and the Pandemic: A Year of Reckoning.

In March 2020, the world that we know irrevocably changed forever. It feels like "Groundhog Day" all over again, and it seems that the nightmare is here to stay. It all began on the January 8, 2020, when China grimly announced that coronavirus disease-2019 (COVID-19) pandemic is caused by the "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2)1 but it was not until March 2020 that the situation swiftly careened out of control and is unequivocally posing the greatest challenge to humanity worldwide since the end of the Second World War. While the scientific community heroically galvanized itself and raced against time to provide viable solutions to this formidable foe in the form of vaccines, the worldwide dental fraternity has had to grapple with an extraordinary situation evolving in real-time and ensure that we responded robustly to this daunting health emergency that has spared no corner of our beloved planet. Initially, COVID-19 ensured cessation of all non-urgent dental care in most parts of the world but with increasingly significant inputs about the nature of the pathogen from the scientific community, the dental community has been able to cobble together a workable plan in reconfiguring and restructuring the dental practice in consonance with the situation at hand. It is fiendishly arduous to estimate the massive impact on the dental profession, but it is safe to assume it to be substantial.

Autophagy: The "Pac-Man" within Us-Ally or Adversary?

Autophagy, first described by the Belgian biochemist Christian De Duve in 1963, is derived from the Greek word "autóphagos," which means "self-devouring." It is a cellular homeostatic process in which the body rids itself of flawed or damaged cells and other defective cellular organelles.1 The implication of defective autophagy in various human diseases has been well documented. The vital importance of autophagy is underscored by the fact that robust cellular health and function are intricately linked with it.

Effectiveness and safety of autologous platelet-rich plasma therapy with total contact casting versus total contact casting alone in treatment of trophic ulcer in leprosy: An observer-blind, randomized controlled trial.

BACKGROUND: Trophic ulcers secondary to leprosy pose a great stigma to patients and remain a challenge to the treating dermatologists. Platelet-rich plasma (PRP) introduces growth factors directly into the wound and aids in rapid healing. The role of PRP in the treatment of trophic ulcers in leprosy patients has not yet been established by randomized controlled trials. AIMS: To study the effectiveness and safety of autologous PRP therapy with total contact casting versus total contact casting alone in the treatment of trophic ulcers in leprosy. METHODS: In an observer-blind, randomized (1:1) controlled study, 118 patients were enrolled. PRP was prepared by the manual double-spin method (1600 rpm for 10 min followed by 4000 rpm for 10 min). After wound bed preparation, activated PRP was injected intra- and perilesionally, and platelet-poor plasma gel was applied over the ulcer bed. Occlusive dressings and total contact casting were then applied in Group A, and only total contact casting was applied in Group B. The same procedure was repeated every 2 weeks for 8 weeks. RESULTS: In all, 56 patients were analyzable in Group A and 52 in Group B. The surface area of the ulcer decreased significantly from first follow-up onward in both the groups (P < 0.001 in both the groups). Intergroup comparison showed that the reduction in the surface area of the ulcer was significantly more in Group A than in Group B from the first follow-up onward (P = 0.038) and the difference was maintained till the fifth follow-up (P < 0.001). At the end of the study, 91.10 ± 9.65% ulcer surface area reduction had occurred in Group A, whereas it was 79.77 ± 17.91% in Group B (P < 0.001). Trophic ulcers healed completely more often in paucibacillary leprosy patients (P < 0.001) and in those with a lower initial surface area of the ulcer (P < 0.001). LIMITATION: Short duration of treatment (8 weeks). CONCLUSION: PRP combined with total contact casting accelerates the healing of trophic ulcers of leprosy and is more effective than total contact casting alone. Complete remission is more likely to occur when the duration and surface area of ulcer are less and in the paucibacillary spectrum.

Prevalence and risk factors of anemia among pregnant women attending a public-sector hospital in Bangalore, South India.

BACKGROUND: Anemia affects almost two-thirds of pregnant women in developing countries and contributes to maternal mortality and low birthweight. According to the National Family Health Survey-4 reports, maternal anemia continues to be a public health problem. OBJECTIVE: To study the prevalence of anemia and its risk factors among pregnant women attending a public-sector hospital. MATERIALS AND METHODS: This study was nested within an ongoing cohort study "ÇASCADE" which is exploring the effect of prenatal exposure to maternal cortisol and psychological distress on infant development in Bangalore. The respondents were enrolled from the antenatal clinic at Jayanagar General Hospital, which is a sub-district hospital. A total of 280 women who fulfilled the eligibility criteria were enrolled. RESULTS: The prevalence of anemia was observed to be 33.9%; proportion of mild and moderate anemia was almost similar (48.4 and 49.5%). The mean hemoglobin level of all the participants was 11.33 ± 1.460 g/dl. The mean hemoglobin level concentration was high during early gestation with a slight decrease by 21-24 weeks. Prenatal depression but not anxiety appeared to be a strong predictor of anemia on bivariate as well as multivariate analysis. No association was observed with socio-demographic and obstetric variables. CONCLUSION: The burden of maternal anemia was considerably high in the study population. Although iron-folic acid supplementation is available under the national health program to address this issue, it is important to consider and address other risk factors when designing and implementing target interventions for anemia control in selected populations.

Evaluation of the Prevalence of Oral Mucosal Lesions in a Population of Eastern Coast of South India.

OBJECTIVE/AIM: The aim of this study is to measure the association between oral mucosal lesions (OMLs) and habit of tobacco and alcohol in the population of Guntur city, Andhra Pradesh, South India. MATERIAL AND METHOD: A cross-sectional study was conducted on 300 participants in Guntur city with the habit of tobacco and alcohol consumption in various forms who were selected by stratified cluster random sampling technique. Guntur city was divided into four zones, that is, North, East, South, and West; and two administrative wards were randomly selected from each zone as clusters. Information was obtained by interviewing the participant regarding various tobacco-related habits followed by standardized clinical examination in the field. Clinical data were collected using a modified 1980 WHO Pro forma where the basis for diagnosis was established as per the criteria provided by the epidemiology guide for the diagnosis of oral mucosal diseases (WHO). Statistical tests such as Pearson Chi-square were exercised to test the significance, using SPSS version 19.0 with 0.05 as cutoff level of significance. RESULTS: Overall oral soft-tissue lesions were found in 42.4% of the study participants including nicotinic stomatitis, tobacco pouch keratosis, smokers melanosis, mild keratosis of the palate, and chewer's mucosa. In this study, nicotinic stomatitis was found to be the most common soft-tissue lesion among men, while leukoplakia was found to be the most common premalignant lesion with the prevalence being 5.7%. While oral submucous fibrosis was found to be the most common premalignant condition among women. It was found that 13.2% of illiterates (53) were having leukoplakia. In the present study, the lower labial mucosa and buccal mucosa were found to be the most common sites of occurrence of leukoplakia and oral submucous fibrosis. CONCLUSION: This study gives information on the association of OML in smokers, chewers, alcoholics, and those with mixed habits. This study highlighted six habit-related OML which included potentially malignant disorders such as leukoplakia and oral submucous fibrosis. Future case-control or cohort studies for individual lesions and with larger sample size are necessary to evaluate the risk for OML including potentially malignant conditions and oral cancer resulting from smoking and chewing habits.

Novel highly selective inhibitors of ubiquitin specific protease 30 (USP30) accelerate mitophagy.

Mitophagy is one of the processes that cells use to maintain overall health. An E3 ligase, parkin, ubiquitinates mitochondrial proteins prior to their degradation by autophagasomes. USP30 is an enzyme that de-ubiquitinates mitochondrial proteins; therefore, inhibiting this enzyme could foster mitophagy. Herein, we disclose the structure-activity relationships (SAR) within a novel series of highly selective USP30 inhibitors. Two structurally similar compounds, MF-094 (a potent and selective USP30 inhibitor) and MF-095 (a significantly less potent USP30 inhibitor), serve as useful controls for biological evaluation. We show that MF-094 increases protein ubiquitination and accelerates mitophagy.

Investigation of propagation dynamics of truncated vector vortex beams.

In this Letter, we experimentally investigate the propagation dynamics of truncated vector vortex beams generated using a Sagnac interferometer. Upon focusing, the truncated vector vortex beam is found to regain its original intensity structure within the Rayleigh range. In order to explain such behavior, the propagation dynamics of a truncated vector vortex beam is simulated by decomposing it into the sum of integral charge beams with associated complex weights. We also show that the polarization of the truncated composite vector vortex beam is preserved all along the propagation axis. The experimental observations are consistent with theoretical predictions based on previous literature and are in good agreement with our simulation results. The results hold importance as vector vortex modes are eigenmodes of the optical fiber.

Pattern of sexually transmitted infections: A profile from a rural- and tribal-based sexually transmitted infections clinic of a tertiary care hospital of Eastern India.

INTRODUCTION: Prevalence of Sexually transmitted infections (STI's) in developing nations is very high where the measures for STI treatment and prevention are limited. Enormous variation in clinical presentation make STI's very difficult to be studied epidemiologically. To know the exact prevalence of STI's is very important for a region or community for planning preventive strategies. The aim of the present study is to observe the pattern of sexually transmitted infections among the tribal and non-tribal population attending a rural and tribal base tertiary care Centre. METHOD: All the consecutive STI patients irrespective of age and sex attending the STI clinic were included. Thorough clinical examination and relevant investigations were done to know the different STI's present in them. They were divided into tribal and non-tribal group as per history and comparison of patterns of STI's done among the two groups. RESULT: Around 34% of STI patients were tribal. Majority of patients belong to 20-40 years of age. Sex ratio of tribal group was 1:0.86 and non-tribal group was 1:2.64. The difference is statistically significant. Commonest STI in both the group was Genital ulcer disease Herpetic but the occurrence of urethral discharge, genital scabies, and inguinal bubo were among the tribal group. Per vaginal discharge was the commonest STI among the female in both the groups. VDRL positivity was 1.16% and HIV positivity was 0.36% among STI clinic attendees. CONCLUSION: Tribal females need special attention for prevention of STI in tribal community.

BRCA1 regulation on ß-hCG: a mechanism for tumorigenicity in BRCA1 defective breast cancer.

Human chorionic gonadotropin ß (ß-hCG) has been implicated in breast tumorigenesis. However, the role of this hormone is highly controversial as certain studies suggest it has anti-tumor properties while others have found it to be pro-tumorigenic. To unveil the truth, we have analyzed the expression of ß-hCG in breast cancer. We identified for the first time that ß-hCG expression is linked to BRCA1 status and its overexpression is seen in BRCA1 mutated breast cancer cells, BRCA1 conditional knockout mouse breast cancer tissues and BRCA1 floxed basal cell carcinoma (BCC) tissues. An analysis of three large, transcriptomic data sets from TCGA (The Cancer Genome Atlas) expression profile confirmed the inverse correlation between BRCA1 and ß-hCG in human breast cancer. Using ChIP and luciferase assays, we also demonstrated that the cancer cells with wild-type but not mutant BRCA1 directly repress the expression of ß-hCG by binding to its promoter. Further, ß-hCG promotes migration and invasion predominantly in BRCA1 mutant breast cancer cells. Interestingly, stable overexpression of ß-hCG in BRCA1 mutant but not wild-type breast cancer cells results in the formation of spheres even on monolayer cultures. The cells of these spheres show high expression of both EMT and stem cell markers. Since ß-hCG belongs to a cysteine knot family of proteins like TGFß and TGFß signaling is deregulated in BRCA1 defective tumors, we checked whether ß-hCG can mediate signaling through TGFßRII in BRCA1 mutated cells. We found for the first time that ß-hCG can bind and phosphorylate TGFßRII, irrespective of LHCGR status and induce proliferation in BRCA1 defective cells. Our results confirmed that there exists a transcriptional regulation of BRCA1 on ß-hCG and BRCA1 mutation promotes ß-hCG mediated tumorigenesis through TGFßRII signaling. Thus inhibiting ß-hCG-TGFßRII could prove an effective treatment strategy for BRCA1 mutated tumors.

Outcome of Azacitidine Therapy in Acute Myeloid Leukemia Is not Improved by Concurrent Vorinostat Therapy but Is Predicted by a Diagnostic Molecular Signature.

Purpose: Azacitidine (AZA) is a novel therapeutic option in older patients with acute myeloid leukemia (AML), but its rational utilization is compromised by the fact that neither the determinants of clinical response nor its mechanism of action are defined. Co-administration of histone deacetylase inhibitors, such as vorinostat (VOR), is reported to improve the clinical activity of AZA, but this has not been prospectively studied in patients with AML.Experimental Design: We compared outcomes in 259 adults with AML (n = 217) and MDS (n = 42) randomized to receive either AZA monotherapy (75 mg/m2 × 7 days every 28 days) or AZA combined with VOR 300 mg twice a day on days 3 to 9 orally. Next-generation sequencing was performed in 250 patients on 41 genes commonly mutated in AML. Serial immunophenotyping of progenitor cells was performed in 47 patients.Results: Co-administration of VOR did not increase the overall response rate (P = 0.84) or overall survival (OS; P = 0.32). Specifically, no benefit was identified in either de novo or relapsed AML. Mutations in the genes CDKN2A (P = 0.0001), IDH1 (P = 0.004), and TP53 (P = 0.003) were associated with reduced OS. Lymphoid multipotential progenitor populations were greatly expanded at diagnosis and although reduced in size in responding patients remained detectable throughout treatment.Conclusions: This study demonstrates no benefit of concurrent administration of VOR with AZA but identifies a mutational signature predictive of outcome after AZA-based therapy. The correlation between heterozygous loss of function CDKN2A mutations and decreased OS implicates induction of cell-cycle arrest as a mechanism by which AZA exerts its clinical activity. Clin Cancer Res; 23(21); 6430-40. ©2017 AACR.

2,3-Dideoxyglucosides of selected terpene phenols and alcohols as potent antifungal compounds.

The antifungal activities of novel 2,3-unsaturated and 2,3-dideoxy 1-O-glucosides of carvacrol, thymol, and perillyl alcohol were tested against Aspergillus flavus, Aspergillus ochraceus, Fusarium oxysporum, Saccharomyces cerevisiae and Candida albicans. In the agar well diffusion tests, zones of inhibition for the derivatives of carvacrol, thymol and perillyl alcohol were higher (15-30mm) in the case of filamentous fungi than those for the parent compounds. Their MIC and MFC values indicated that the 2,3-unsaturated and 2,3-dideoxy 1-O-glucosides of carvacrol and thymol exhibited more fungicidal activity than the other compounds. Further, the 2,3-dideoxyglucosides of carvacrol and thymol, exhibited antitoxigenic effects against A. ochraceus and A. flavus and inhibited the production of ochratoxin and aflatoxin-B2. Propidium iodide influx assay demonstrated the lysis of C. albicans cells by carvacrol and its 2,3-unsaturated 1-O-glucoside and the loss of the membrane integrity. These new 2,3-dideoxyglucosides can be useful as antifungal agents and condiments in foods.

A phantom study on the behavior of Acuros XB algorithm in flattening filter free photon beams.

To study the behavior of Acuros XB algorithm for flattening filter free (FFF) photon beams in comparison with the anisotropic analytical algorithm (AAA) when applied to homogeneous and heterogeneous phantoms in conventional and RapidArc techniques. Acuros XB (Eclipse version 10.0, Varian Medical Systems, CA, USA) and AAA algorithms were used to calculate dose distributions for both 6X FFF and 10X FFF energies. RapidArc plans were created on Catphan phantom 504 and conventional plans on virtual homogeneous water phantom 30 × 30 × 30 cm(3), virtual heterogeneous phantom with various inserts and on solid water phantom with air cavity. Dose at various inserts with different densities were measured in both AAA and Acuros algorithms. The maximum % variation in dose was observed in (-944 HU) air insert and minimum in (85 HU) acrylic insert in both 6X FFF and 10X FFF photons. Less than 1% variation observed between -149 HU and 282 HU for both energies. At -40 HU and 765 HU Acuros behaved quite contrarily with 10X FFF. Maximum % variation in dose was observed in less HU values and minimum variation in higher HU values for both FFF energies. Global maximum dose observed at higher depths for Acuros for both energies compared with AAA. Increase in dose was observed with Acuros algorithm in almost all densities and decrease at few densities ranging from 282 to 643 HU values. Field size, depth, beam energy, and material density influenced the dose difference between two algorithms.

Oryzanol as natural antioxidant for improving sunflower oil stability.

Sunflower oil is being made shelf stable by the incorporation of synthetic antioxidants such as tertiary butyl hydroquinone (TBHQ), while natural antioxidants like oryzanol and tocopherols can also be used. The aim of the current investigation was to evaluate the antioxidant effect of natural oryzanol (Oz) concentrate (15.5 % oryzanol) and purified Oz (80 % oryzanol) on oxidative and thermal stability of sunflower oil. Sunflower oil was incorporated with Oz concentrate to provide 0, 0.12, 0.25, 0.50, 0.84, 1.0, 1.60, 2.0, 2.5 and 3.20 % oryzanol in the oil, stored for 5 weeks at 37 °C and oxidative stability was evaluated. It was found that the oryzanol concentrate showed good antioxidant effect with increase in concentration of oryzanol. In another set of experiments, sunflower oil containing purified Oz at 1 % level individually and in combination with 0.1 % α- tocopherol (α-T) was heated at 120 °C for 24 h to evaluate thermal stability. Sunflower oil containing 1 % Oz (80 % purity) showed 98.40 % and sunflower oil containing 1 % Oz and 0.1 % α-T showed 108.75 % antioxidant effect compared to TBHQ taken as 100 %. The study indicated that sunflower oil containing 1 % Oz (80 % purity) and 0.1 % α-T combination provides a synergistic effect in inhibiting primary and secondary products and showed highest thermal stability. SFO containing 1 % Oz added as concentrate also showed good antioxidant effect during storage. Hence, instead of using synthetic antioxidants like TBHQ, we can add natural oryzanol (purified or as concentrate) to sunflower oil to increase its oxidative and thermal stability.

Synthesis and antibacterial properties of 2,3-dideoxyglucosides of terpene alcohols and phenols.

Essential oils and their oxygenated terpene constituents possess potent antimicrobial properties. In the present study, a facile synthetic route to the 2,3-dideoxy 1-O-glucosides of important phenols and terpene alcohols in excellent yields (85-96%) has been delineated. Studies on their antimicrobial action against four food-borne pathogens--Bacillus cereus, Staphylococcus aureus, Escherichia coli and Yersinia enterocolitica--demonstrated that the zone of inhibition, in general, was higher for the 2,3-unsaturated 1-O-glucoside derivatives (1b-6b) and the corresponding saturated glucosides (1c-5c) when compared to the parent alcohols/phenols (1-6). The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) values for these derivatives too were generally lower than those of the parent compounds. Furthermore, the time-kill and bacteriolysis assays too demonstrated the greater antimicrobial potential of the derivatives. The 2,3-dideoxy 1-O-glucosides of phenols and terpene alcohols were more effective in their antimicrobial action than the corresponding parent compounds. The study indicated that these novel derivatives can find useful application in control of food-related pathogenic microbes in foods.

Comparative evaluation of bovine derived hydroxyapatite and synthetic hydroxyapatite graft in bone regeneration of human maxillary cystic defects: a clinico-radiological study.

INTRODUCTION: Bone grafts are frequently used in the treatment of bone defects. Bone harvesting can cause postoperative complications and sometimes does not provide a sufficient quantity of bone. Therefore, synthetic biomaterials have been investigated as an alternative to autogenous bone grafts. AIM AND OBJECTIVES: The aim of this study was to evaluate and compare bovine derived hydroxyapatite (BHA) and synthetic hydroxyapatite (SHA) graft material as bone graft substitute in maxillary cystic bony defects. Patients were analyzed by computerized densitometric study and digital radiography. MATERIALS AND METHODS: In this study, 12 patients in each group were included randomly after clinical and radiological evaluation. The integration of hydroxyapatite was assessed with mean bone density, surgical site margin, and radiological bone formation characteristics, of the successful graft cases using computer densitometry and radio-visiograph. Statistical analysis was carried out using Mann-Whitney U-test, Wilcoxon matched pairs test and paired t-test. RESULTS: By the end of 24 th week, the grafted defects radiologically and statistically showed similar volumes of bone formation. However, the significant changes observed in the formation of bone and merging of material and surgical site margin at 1 st week to 1 st month. The results were significant and correlating with all the parameters showing the necessity of the grafting for early bone formation. However, the bone formation pattern is different in both BHA and SHA group at 3 rd month interval with significant P value. CONCLUSION: Both BHA and SHA graft materials are biocompatible for filling bone defects, showing less resorption and enhanced bone formation with similar efficacy. Our study showed maximum bone healing within 12 weeks of grafting of defects. The BHA is economical; however, price difference between the two is very nominal.

Prognostic significance of a multimarker strategy of biomarkers in acute heart failure.

BACKGROUND: Heart failure (HF) is a growing public health problem. Patients often present to emergency department (ED) with acute onset dyspnea where a rapid triage is required to avoid misdiagnosis and to institute appropriate therapy. An objective risk-stratification in the ED is warranted to identify patients at high risk of adverse outcomes, so that more intensive therapy and vigilant follow-up after discharge are instituted. METHODS AND RESULTS: Fifty two consecutive acute HF (AHF) patients in NYHA class III/IV were enrolled for the present study. N-terminal pro B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hsTropT), high-sensitivity C-reactive protein (hsCRP) and Uric acid (UA) were evaluated at admission; a second sample for NT-proBNP and hsTropT was obtained 48h later. The end-point of the study, a composite of cardiovascular death, rehospitalisation for worsening HF symptoms and refractory HF was reached in 32.7% of patients during a median follow-up of 4.8mnth. Although, hsTropT (>0.014ng/ml), hsCRP (>0.5mg/dl) and UA (>5.6mg/dl for females and >7 mg/dl for males) were elevated in the vast majority of patients (92.3%, 75% and 63.5% respectively), baseline and changing patterns of NT-proBNP following treatment were the only predictors of adverse outcomes on follow-up. A significant correlation between hsTropT, hsCRP and UA was observed suggesting a link between inflammation, myocyte injury and oxidative stress in AHF. CONCLUSION: Baseline and changing patterns of NT-proBNP predicted adverse outcomes on follow-up suggesting that a strategy of serial measurement of NT-proBNP could prove invaluable in early risk stratification. Further research is needed to understand the link between inflammation, myocyte injury and oxidative stress in AHF which could provide potential therapeutic targets.