A short RP tachycardia in congenitally corrected transposition. What is the mechanism?

A 51-year-old female with congenitally corrected transposition of great arteries (CCTGA), situs solitus, dextrocardia, atrial septal defect and persistent left superior vena cava underwent electrophysiology study for recurrent palpitations with documented narrow complex, short RP tachycardia. With a catheter in the region of the anterior mitral annulus, a His signal was recorded and HV interval was 35 msec. Tachycardia was induced with a ventricular extrastimulus. During the tachycardia there was 1:1 ventriculo-atrial conduction and central atrial activation with a VA interval of 20 msec. The recorded His signal could be seen after the QRS. What is the mechanism of the tachycardia?

Fixed bed column adsorption systems to remove 2,4-Dichlorophenoxyacetic acid herbicide from aqueous solutions using magnetic activated carbon.

The widespread use of 2,4-Dichlorophenoxyacetic acid (2,4-D) as a weedkiller has resulted in its persistence in the environment, leading to surface and groundwater pollution. In this study, the fixed bed column experiments were performed to remove 2,4-D from aqueous solutions using magnetic activated carbon derived from Peltophorum pterocarpum tree pods. The evaluation was done on effects of operating parameters such as bed depth (2-4 cm), influent flow rate (4.6-11.4 mL/min), and 2,4-D concentration (25-100 mg/L) on the breakthrough curves. The data fit well with the Yoon-Nelson and Thomas models, exhibiting high R2 values. Results indicated that lower flow rates, lower 2,4-D concentrations, and greater bed depths enhanced adsorption capacity, achieving up to 196.31 mg/g. Reusability studies demonstrated the material's potential for repeated use, while toxicity studies with Vigna radiata seeds confirmed the effectiveness of Fe3O4-CPAC in removing 2,4-D. This investigation highlights the promising application of Fe3O4-CPAC in fixed bed adsorption systems for efficient 2,4-D removal.

Multifunctional hydrophobin-like protein (HFB-NJ1): A versatile solution for wastewater treatment.

As wastewater contains a variety of contaminating bacteria and oily residues, there is an urgent need for environmentally safe bactericidal agents and surfactants which can be applied for wastewater treatment. The present study emphasizes on the potential of hydrophobin-like protein (HFB-NJ1) extracted from sporulating mycelia of Aspergillus sp. NJ1 for wastewater treatment. The purified HFB-NJ1, depicted the presence of one single protein band of molecular size approximately 11-12 kDa on silver-stained SDS-PAGE gel. HFB-NJ1 also presented properties such as surface modification of glass and stable emulsification of sunflower oil. HFB-NJ1 depicted exceptional antibacterial activity against bacterial pathogens such as Bacillus subtilis and Pseudomonas aeruginosa at low MIC of 0.5 µg/mL and 0.75 µg/mL respectively. Additionally, HFB-NJ1 depicted enhanced emulsification of various vegetable and petroleum-based oils (E24 > 80%). HFB-NJ1 effectively reduced gold ions, producing nanospheres with a size of 15.33 nm - a recognized antimicrobial agent. This study underscores the multifunctional attributes of HFB-NJ1, highlighting its efficacy in removing pathogenic bacteria, emulsifying organic compounds from wastewater, and demonstrating a reduction ability for nanoparticle synthesis.

Synthesis of magnetic biochar composite using Vateria indica fruits through in-situ one-pot hydro-carbonization for Fenton-like catalytic dye degradation.

The present study reports the synthesis, characterization, and application of sustainable magnetic biochar composite. The inedible fruits of Vateria indica, a powerful ayurvedic plant were hydrothermally transformed into magnetic biochar (BC-Fe3O4) in a single step and characterized by several sophisticated techniques. FESEM analysis portrayed fibrous irregular mesh-like biochar with surface clustered Fe3O4 nanoparticles, while the incidence of carbon, oxygen, and iron in the elemental analysis by EDS established magnetic biochar formation. Numerous peaks consistent with planes of (220), (311), (400), (422), (511), (440), and (120) also substantiated the occurrence of magnetite nanoparticles and biochar respectively, as analyzed by XRD. XPS analysis showed signals at 285.65 eV, 533.28 eV, 711.08 eV, and 724.68 eV corroborating a strong C-O bond, O1s orbit, Fe2+, and Fe3+ respectively. BC-Fe3O4 was superparamagnetic with saturation magnetization of 4.74 emu/g, as per VSM studies, while its specific surface area, pore volume, and pore diameter were 5.74 m2/g, 0.029 cm3/g, and 20.86 nm respectively. The Fenton-like degradation of methylene blue (5.0-25.0 ppm) was accomplished by synthesized BC-Fe3O4, in the presence of H2O2. Within 180 min, almost complete degradation was achieved, with first-order kinetics having rate constants between 0.0299 and 0.0167 min-1. Stability and recyclability studies performed over 7 cycles exhibited unaltered degradation between 93.98 and 97.59%. This study exhibits the exceptional characteristics and degradation capabilities of BC-Fe3O4 synthesized from a sustainable plant biomass.

Machine learning and statistical physics modeling of tetracycline adsorption using activated carbon derived from Cynometra ramiflora fruit biomass.

The current investigation reports the usage of adaptive neuro-fuzzy inference system (ANFIS) and artificial neural network (ANN), the two recognized machine learning techniques in modelling tetracycline (TC) adsorption onto Cynometra ramiflora fruit biomass derived activated carbon (AC). Many characterization methods utilized, confirmed the porous structure of synthesized AC. ANN and ANFIS models utilized pH, dose, initial TC concentration, mixing speed, time duration, and temperature as input parameters, whereas TC removal percentage was designated as the output parameter. The optimized configuration for the ANN model was determined as 6-8-1, while the ANFIS model employed trimf input and linear output membership functions. The obtained results showed a strong correlation, indicated by high R2 values (ANNR2: 0.9939 & ANFISR2: 0.9906) and low RMSE values (ANNRMSE: 0.0393 & ANFISRMSE: 0.0503). Apart from traditional isotherms, the dataset was fitted to statistical physics models wherein, the double-layer with a single energy satisfactorily explained the physisorption mechanism of TC adsorption. The sorption energy was 21.06 kJ/mol, and the number of TC moieties bound per site (n) was found to be 0.42, conclusive of parallel binding of TC molecules to the adsorbent surface. The adsorption capacity at saturation (Qsat) was estimated to be 466.86 mg/g - appreciably more than previously reported values. These findings collectively demonstrate that the AC derived from C. ramiflora fruit holds great potential for efficient removal of TC from a given system, and machine learning approaches can effectively model the adsorption processes.

Arrhythmias in adult patients after Rastelli surgery: a single-centre experience.

BACKGROUND: Rastelli surgery is used for the correction of several CHDs. Although late-onset cardiac arrhythmias have emerged as a major complication after corrective surgeries, there is a paucity of data on arrhythmias after Rastelli surgery. METHODS: This retrospective cohort study was conducted on patients who had undergone Rastelli surgery and have been followed at the adult CHD clinic at our hospital. RESULTS: A total of 55 patients (36.4% female, age 22.2 ± 6.4 years) were followed for a median period of 24.2 (20.6-31.0) years. Tachyarrhythmias occurred in 21 (38.4 %) patients (n = 15 for atrial tachycardia, 5 for ventricular tachycardia, and 1 for both atrial and ventricular tachycardia). Older age at surgery was significantly associated with the risk of tachyarrhythmias (P = 0.022). Bradyarrhythmia occurred in 12 (21.8%) patients and consisted of perioperative AV block (n = 5), late AV block (n = 1), and sinus node dysfunction (n = 6). Nine (16.4%) patients underwent catheter ablation. The mechanisms of atrial arrhythmias include cavotricuspid isthmus-dependent and surgical scar-dependent intra-atrial reentrant tachycardias. Among the three patients who underwent ablation for ventricular tachycardia, all circuits were dependent on the scar at the base of the right ventricle to pulmonary artery conduit. Median survival free from any event (arrhythmia, death, or heart failure) was 31.6 (28.1-35.1) years after Rastelli surgery. CONCLUSIONS: The prevalence of arrhythmias late after Rastelli surgery is substantial and increases in the second decade after surgery. Older age at surgery is associated with a higher prevalence of arrhythmias.

An unusual ECG lead reversal.

Lead reversals are a common cause of electrocardiographic abnormality, which can lead to a false diagnosis like chamber enlargement, myocardial ischemia or infarction. Isolated limb lead reversals and chest lead reversals are common in clinical practice. This article reports a rare case where multiple limb and chest leads were reversed due to the reversal of cables leading to a false diagnosis of myocardial ischemia.

Conflicting responses with simultaneous atrioventricular pacing. What is the mechanism?

A 60-year-old woman presented with recurrent episodes of palpitations, documented short RP, narrow QRS tachycardia and absence of preexcitation in the electrocardiogram during sinus rhythm. During an electrophysiology study, programmed stimulation induced a narrow QRS tachycardia with cycle length of 380 ms, VA interval of 164 ms and earliest atrial activation in the His region. Ventricular overdrive pacing failed to entrain the atrium even with isoprenaline infusion and atrial burst pacing repeatedly terminated the tachycardia. Difference in AH interval with pacing and SVT was 27 msec. Simultaneous atrial and ventricular pacing was done with atrial pacing from the high right atrium and showed a His signal as the first return electrogram suggestive of atrioventricular nodal reentrant tachycardia (AVNRT). The manoeuvre was repeated with atrial pacing from the proximal coronary sinus and showed an atrial signal as the first return electrogram suggestive of atrial tachycardia (AT). What is the explanation for the conflicting results of the two pacing maneuvers?

Early dose of Adenosine, postRadiofrequency abLation of accessory pathwaY in determining acute procedural success (EARLY study).

INTRODUCTION: Post ablation of the accessory pathway (AP), the patient is observed in the catheterization laboratory for a variable period for resumption of pathway conduction. Aim of the study was to determine whether the administration of intravenous adenosine at 10 min after ablation of AP would have the same diagnostic accuracy as waiting for 30 min in predicting the resumption of AP conduction. METHODS: This was a prospective interventional study conducted in two centers. Post ablation of the AP, intravenous adenosine was administered at 10 min to look for dormant pathway conduction. The response was recorded as positive (presence of pathway conduction), negative (absence), or indeterminate (not able to demonstrate AV and VA block and inability to ascertain AP conduction). RESULTS: The study included 110 procedures performed in 109 patients. Adenosine administration at 10 min showed positive result in 3 cases (2.7%), negative result in 99 cases (90%) and indeterminate result in 8 cases (7.3%). Reconnection of accessory pathway at 30 min postablation was seen in 8 cases (7.3%). Of these 8 cases, 10 min adenosine administration showed positive test in 3 patients and negative test in 5 patients. Adenosine test at 10 min has a sensitivity, specificity, positive predictive value, and negative predictive value of 37.5%, 100%, 100%, and 94.9% in identifying the recurrence of accessory pathway conduction at 30 min, respectively. CONCLUSION: Absence of pathway conduction on administration of adenosine 10 min postablation does not help predict the absence of resumption of conduction thereafter.

Comparison of electrocardiographic parameters between left bundle optimized cardiac resynchronization therapy (LOT-CRT) and left bundle branch pacing-cardiac resynchronization therapy (LBBP-CRT).

BACKGROUND: In patients undergoing cardiac resynchronization therapy using left bundle branch area pacing (LBBP-CRT), the addition of a coronary sinus lead, that is, Left bundle optimized CRT (LOT-CRT) might confer additional benefits. OBJECTIVES: To compare the electrocardiographic characteristics between LBBP-CRT and LOT-CRT MATERIALS AND METHODS: Patients with non-ischemic cardiomyopathy (NICMP) and left bundle branch block (LBBB) with left ventricular ejection fraction <35% who underwent implantation of an atrial lead, a left bundle lead, and a coronary sinus lead were included in this prospective study. Digital 12-lead electrocardiograms were recorded in three pacing modes-AAI, DDD with pacing from the LBB lead (LBBP-CRT), and DDD with pacing from both left bundle and coronary sinus leads (LOT-CRT). QRS duration (QRSd), QRS area, QT interval, and T peak-T end (TpTe) intervals were compared. RESULTS: Among 24 patients, QRSd reduced from 167 ± 21.2 ms to 134.5 ± 23.6 ms with LBBP-CRT (p < .001) and 129.5 ± 18.6 ms with LOT-CRT (p < .001) without a significant difference between LBBP-CRT and LOT-CRT (p = .15). Patients with QRS duration with LBBP-CRT > 131 ms showed a significant reduction in QRSd with LOT-CRT (p = .03). QT interval was reduced with both modes of CRT. LOT-CRT was associated with a greater reduction in QRS area (p = .001), TpTe interval (p = .03), and TpTe/QT ratio (p = .013) compared to LBBP-CRT. CONCLUSIONS: In patients with NICMP and LBBB, there was no significant difference in QRSd with LOT-CRT compared to LBBP-CRT. However, in patients with QRSd > 131 ms after LBBP-CRT, LOT-CRT resulted in a significantly narrower QRS.

Removal of an agricultural herbicide (2,4-Dichlorophenoxyacetic acid) using magnetic nanocomposite: A combined experimental and modeling studies.

This study focused on modeling the removal of one of the widely used agricultural herbicides known as 2,4-Dichlorophenoxyacetic acid (2,4-D) using polypyrrole-coated Fe2O3 nanoparticles (Fe2O3@PPy). The Fe2O3@PPy nanocomposite was synthesized by surface-coating the Tabebuia aurea leaf extract synthesized Fe2O3 nanoparticles with polypyrrole. After characterization, the adsorptive potential of the nanocomposite for removing 2,4-D from aqueous solution was examined. Central composite design (CCD) was employed for optimizing the adsorption, revealing an adsorption efficiency of 90.65% at a 2,4-D concentration of 12 ppm, a dosage of 3.8 g/L, an agitation speed of 150 rpm, and 196 min. Adsorption dataset fitted satisfactorily to Langmuir isotherm (R2: 0.984 & χ2: 0.054) and pseudo-second-order kinetics (R2: 0.929 & χ2: 0.013) whereas the exothermic and spontaneous nature were confirmed via the thermodynamic study. The predictive models, including adaptive neuro-fuzzy inference system (ANFIS), artificial neural network (ANN), and response surface methodology (RSM), demonstrated good precision for the prediction of 2,4-D adsorption, with respective R2 of 0.9719, 0.9604, and 0.9528. Nevertheless, statistical analysis supported ANFIS as the better forecasting tool, while RSM was the least effective. The maximum adsorption capacity of 2,4-D onto the Fe2O3@PPy nanocomposite was 7.29 mg/g, significantly higher than a few reported values. Therefore, the Fe2O3@PPy nanocomposite could serve as a competent adsorbent to remove 2,4-D herbicide from aqueous streams.

Magnetic activated carbon synthesized using rubber fig tree leaves for adsorptive removal of tetracycline from aqueous solutions.

The current study emphasizes the activated carbon fabrication from rubber fig leaves, the establishment of its composite with iron oxide nanoparticles (RFAC@Fe2O3), and its relevance in the adsorptive elimination of tetracycline. The physical and functional properties of RFAC@Fe2O3 nanocomposite were uncovered by multiple approaches. Elemental analysis portrayed the existence of carbon, oxygen, and iron, while FESEM analysis revealed that Fe2O3 nanoparticle agglomerates were entrenched in the activated carbon matrix rendering it a rough abrasive texture. FT-IR analysis reported the presence of functional groups attributing to CC, -OH, crystalline iron oxide, and Fe-O stretching vibrations, and XRD corroborated graphitic crystalline structure, oxygenated functional groups attached to carbon accompanied by crystalline plane corresponding to Fe2O3 nanoparticles. XPS spectra depicted signature peaks for C, O, and Fe, while VSM studies designated its superparamagnetic nature. The high surface area (662.73 m2/g), pore size (3.12 nm), and mesoporous nature of RFAC@Fe2O3 make it apt for the adsorption of pollutants from contaminated samples. The adsorption of tetracycline (50 ppm) by RFAC@Fe2O3 was maximum at pH 4.0. As the nanocomposite dosage and stirring speed increased to 2.0 g/L and 150 rpm, maximum adsorption was observed due to more active binding sites and improved mixing. Freundlich isotherm along with pseudo-second-order model well described adsorption process divulging that tetracycline was adsorbed onto RFAC@Fe2O3 composite in multi-layers by chemisorption. Thermodynamic analysis signified negative values for ΔG°, while positive values for ΔH° and ΔS were obtained, indicating spontaneous feasible endothermic adsorption.

Green synthesized cobalt oxide nanoparticles with photocatalytic activity towards dye removal.

The present study aimed at the synthesis of cobalt oxide nanoparticles (CONPs) mediated by leaf extract of Muntingia calabura using a rapid and simple method and evaluation of its photocatalytic activity against methylene blue (MB) dye. UV-vis absorption spectrum showed multiple peaks with an optical band gap of 2.05 eV, which was concordant with the literature. FESEM image signified the irregular-shaped, clusters of CONPs, and EDX confirmed the existence of the Co and O elements. The sharp peaks of XRD spectrum corroborated the crystalline nature with a mean crystallite size of 27.59 nm. Raman spectrum substantiated the purity and structural defects. XPS signified the presence of Co in different oxidation states. FTIR image revealed the presence of various phytochemicals present on the surface and the bands at 515 and 630 cm-1 designated the characteristic Co-O bonds. VSM studies confirmed the antiferromagnetic property with negligible hysteresis. The high BET specific surface area (10.31 m2/g) and the mesoporous nature of the pores of CONPs signified the presence of a large number of active sites, thus, indicating their suitability as photocatalysts. The CONPs degraded 88% of 10 mg/L MB dye within 300 min of exposure to sunlight. The degradation of MB dye occurred due to the formation of hydroxyl free radicals on exposure to sunlight, which followed first-order kinetics with rate constant of 0.0065 min-1. Hence, the CONPs synthesized herein could be applied to degrade other xenobiotics and the treatment of industrial wastewater and environmentally polluted samples.

Adsorptive removal of AB113 dye using green synthesized hydroxyapatite/magnetite nanocomposite.

In the present study, magnetite nanoparticles (Fe3O4NPs) synthesized using Thunbergia grandiflora leaf extract as a reducing agent were doped with hydroxyapatite sourced from waste bivalve clamshells to produce hydroxyapatite/magnetite nanocomposite (HA/Fe3O4NPs). The magnetic nanocomposite was examined using several characterization techniques. The results of XRD and FESEM, analysis showed HA/Fe3O4NPs have a crystalline phase and irregular spherical particles respectively. EDAX and FTIR confirmed the presence of specific elements and functional groups of both iron oxide and hydroxyapatite nanoparticles respectively. The surface area and superparamagnetic property of the composite were determined by BET and VSM analysis. Central Composite Design (CCD) was used to optimize the adsorption process to remove of AB113 from aqueous solutions. The optimal adsorption efficiency was found out to be 94.38% at pH 8, AB113 dye concentration 54 ppm, HA/Fe3O4NPs dose 84 mg, and an agitation speed of 174 rpm. The monolayer Langmuir isotherm was the best model with a sorption capacity of 109.98 mg/g which was higher than the reported values. The pseudo-second-order kinetic model displayed a good fit with an R2 = 0.99. Thermodynamic parameters were assessed which confirmed the exothermic adsorption process. Therefore, the synthesized magnetic nanocomposite can be employed as a novel nanoadsorbent for the removal of anionic dyes from waste effluents.

Green synthesized hydroxyapatite nanoadsorbent for the adsorptive removal of AB113 dye for environmental applications.

The present work reports the synthesis of hydroxyapatite (HAp) via the green chemistry approach by using the leaf extract of copper pod tree and its adsorptive potential to remove Acid blue 113 (AB113) dye. FESEM-EDS characterization of the synthesized HAp confirmed rod-shaped HAp with prominent Ca and P elements. The crystallinity of HAp was ascertained by XRD and thermal stability was analyzed by TGA. The colloidal suspension stability was determined as - 17.7 mV by Zeta potential analyzer. The mesoporous structure was affirmed via BET studies with a high magnitude of specific surface area. TEM studies substantiated the rod-shaped HAp as observed in FESEM. The signals specific to HAp were observed in XPS studies. Adsorption of AB113 on the synthesized HAp was examined by varying the process parameters. Batch experiments resulted in an optimum dye removal of 92.72% at a pH of 8, 1 g/L of CP-HAp nps dosage, 20 ppm AB113 concentration, 120 min contact time, 150 rpm agitation speed and at room temperature. The maximum adsorption capacity reached 120.48 mg/g. Multifarious isotherms characterized the adsorption with Freundlich isotherm (R2 > 0.968) dominating Langmuir indicating multilayer adsorption. The experimental data reasonably matched pseudo-second-order kinetics with R2 exceeding 0.99. Thermodynamic investigations underlined the spontaneity and exothermicity of the processes. Results showed the suitability of the HAp nanoadsorbent to remove AB113 from wastestreams.

Synthesis of hydroxyapatite nanoparticles using Acacia falcata leaf extract and study of their anti-cancerous activity against cancerous mammalian cell lines.

This study deals with the synthesis of hydroxyapatite nanoparticles (HAPnps) mediated by Acacia falcata leaf extract. Aggregates of needle-shaped crystalline nanostructures were confirmed by FE-SEM and TEM analysis. Well-defined rings in the SAED patterns corroborated the polycrystalline nature of the HAPnps. Individual elements present in the HAPnps were attested by the specific signals for Ca, P, and O in the EDS and XPS analyses. The distinct peaks observed in the XRD spectrum matched well with the HAP hexagonal patterns with a mean crystallite size of 55.04 nm. The FTIR study unveiled the coating of the nanoparticles with the biomolecules from Acacia falcata leaves. The suspension HAPnps exhibited polydispersity (0.446) and remarkable stability (zeta potential: - 31.9 mV) as evident from DLS studies. The pore diameter was 25.7 nm as obtained from BET analysis, suggesting their mesoporous nature. The HAPnps showed the cytotoxic effect on A549 lung and MDA-MB231 breast carcinoma cell lines, with an IC50 value of 55 µg/mL. The distortion of the cell membrane and cell morphology, along with the chromatin condensation and cell necrosis on treatment with HAPnps were detected under fluorescence microscopy post acridine orange/ethidium bromide dye staining. This study reports the anti-cancerous potential of non-drug-loaded plant-mediated HAPnps. Therefore, the HAPnps obtained in this investigation could play a vital role in the biomedical field of cancer therapy.

Photocatalytic degradation of methylene blue dye using newly synthesized zirconia nanoparticles.

Zirconium oxide nanoparticles (ZrO2NPs) were prepared using the leaf extract of Muntingia calabura as a reductant. The absorption peak at 232 nm confirmed the signature peak for ZrO2NPs with band energy at 5.07 eV. The ZrO2NPs were tetragonal and highly crystalline, possessing a mean diameter of 14.83 nm as confirmed by XRD studies. The lattice constants (a = 0.362 nm and c = 0.511 nm) were consistent with the literature. Spherical nanoaggregates (29.25 nm) were seen in FESEM image and the specific signals for Zr and O were noticed in EDS image. The tetragonal phase of the ZrO2NPs were further confirmed from the XPS and Raman studies. PL spectrum had a sharp emission at 493 nm. The FTIR spectrum revealed the presence of various functional groups. ZrO2NPs were thermally stable with 5.76% total weight loss - as revealed from TGA profile. The photocatalytic breakdown of methylene blue (MB) dye under the influence of solar irradiation was performed using ZrO2NPs which exhibited 89.11% degradation within 5 h. Hence, the synthesized ZrO2NPs can be used as an alternate potential photocatalyst for the degradation of various dyes present in waste streams.

Synthesis, characterization and anticancer activity of the green-synthesized hematite nanoparticles.

The conventional synthesis of hematite nanoparticles (HNPs) is expensive and creates secondary contaminants. Therefore, to combat these issues, there is a requirement for a cheap, effective, and eco-friendly technique. Herein, HNPs were prepared using the fruit extract of Spondias pinnata - an abundant source available in Western-coastal India. The polyphenolic compounds aided the synthesis process and the entire procedure was very rapid. The obtained HNPs had needle-like morphology with agglomerations due to the magnetic interactions as seen in FESEM and HRTEM images. Fe and O elements were noticed in EDS results. The crystalline nature and crystal phase were confirmed from XRD and SAED patterns. The lattice parameters of HNPs were in tandem with the literature. Fe-O crystalline vibrations were noticed in FTIR studies. VSM results portrayed the superparamagnetic nature of HNPs with a high magnetic saturation value of 8.949 emu/g and a negligible hysteresis loop. Thermal stability was ascertained using TGA results with 32% overall weight loss. XPS studies revealed the existence of pure HNPs with signature peaks. Raman spectrum showed the bands specific for HNPs, comparable to the commercial one. In addition, the HNPs were mesoporous with a high surface area (72.04 m2/g) - higher than the commercial one. The anticancer potential of the HNPs was successfully demonstrated against two mammalian cancer cell lines. Therefore, the HNPs synthesized in this study could be applied in various biomedical fields, especially for anticancer formulations.

Coumel's sign reversed: What is the mechanism?

A patient presented with documented narrow QRS tachycardia. During electrophysiological study, he has orthodromic reciprocating tachycardia with atrial activation consistent with left free wall accessory pathway. With induction of tachycardia, beats with LBBB morphology have shorter cycle length than those with narrow QRS. What is the mechanism?

Sudden death and its predictors in myocardial infarction survivors in an Indian population.

OBJECTIVE: This study was conducted to assess the incidence of sudden cardiac death (SCD) in post myocardial infarction patients and to determine the predictive value of various risk markers in identifying cardiac mortality and SCD. METHODS: Left ventricular function, arrhythmias on Holter and microvolt T wave alternans (MTWA) were assessed in patients with prior myocardial infarction and ejection fraction ≤ 40%. The primary outcome was a composite of cardiac death and resuscitated cardiac arrest during follow up. Secondary outcomes included total mortality and SCD. RESULTS: Fifty-eight patients were included in the study. Eight patients (15.5%) died during a mean follow-up of 22.3 ± 6.6 months. Seven of them (12.1%) had SCD. Among the various risk markers studied, left ventricular ejection fraction (LVEF) ≤ 30% (Hazard ratio 5.6, 95% CI 1.39 to 23) and non-sustained ventricular tachycardia (NSVT) in holter (5.7, 95% CI 1.14 to 29) were significantly associated with the primary outcome in multivariate analysis. Other measures, including QRS width, heart rate variability, heart rate turbulence and MTWA showed no association. CONCLUSIONS: Among patients with prior myocardial infarction and reduced left ventricular function, the rate of cardiac death was substantial, with most of these being sudden cardiac death. Both LVEF ≤30% and NSVT were associated with cardiac death whereas only LVEF predicted SCD. Other parameters did not appear useful for prediction of events in these patients. These findings have implications for decision making for the use of implantable cardioverter defibrillators for primary prevention in these patients.