Presentation of basilar artery stroke secondary to patent foramen ovale: a diagnosis made with a 'selfie'.

We report the case of a woman in her late 20s, with no significant medical history, who was found unresponsive at home. Her mother revealed a 'selfie' sent to her by the patient 30 min prior to collapse which revealed bilateral ptoses. Initial brain imaging with non-contrast CT of the brain revealed nil of note. A multiphase CT angiogram revealed an acute basilar artery thrombosis. She underwent timely thrombolysis and was transferred for endovascular thrombectomy. Further evaluation with an aim to define the aetiology revealed the diagnosis of patent foramen ovale with a resultant paradoxical embolism. The differential diagnoses of unexplained rapidly evolving neurology with reduced Glasgow coma scale, and relevant appropriate investigations are discussed in this case report.

Predictive value of high-sensitivity troponin for significant coronary artery disease in new-onset atrial fibrillation with rapid ventricular response.

BACKGROUND: High-sensitivity troponin-T (HS-cTnT) levels are often measured in patients presenting with atrial fibrillation (AF), with many subjected to unnecessary invasive assessments. The significance of a normal or mildly raised HS-cTnT in this context is poorly understood. This study aimed to determine the predictive value of HS-cTnT for significant coronary artery disease (CAD) in new AF with rapid ventricular response. We also compared the discriminative ability of HS-cTnT to suspected angina for significant CAD. METHODS: We examined patients presenting with new AF to two tertiary Irish centers in a defined period. Those included had HS-cTnT taken at presentation and subsequent ischemic evaluation. RESULTS: Of 5350 cases screened for inclusion, 281 were deemed eligible. Of these, 148 and 133 patients had a positive and negative index HS-cTnT, respectively. Of those with negative HS-cTnT, 13 (9.8%) had significant CAD versus 51 (34.5%) with positive HS-cTnT (P < 0.001). Positive Hs-cTnT status remained significant upon multivariate analysis (OR, 2.9; 95% CI, 1.37-6.14; P = 0.005). A similar model where HS-cTnT was replaced with suspected angina produced an OR of 1.64 (95% CI, 0.75-3.59; P = 0.213). A logistic model determined optimal cutoff value for HS-cTnT to be less than 30 ng/l, producing a negative predictive value of 91.8% and area under the receiver operative curve of 83.36. CONCLUSION: HS-cTnT exhibits potential as an effective screening biomarker to predict nonsignificant CAD in new rapid AF, allowing more targeted and rationalized ischemic testing. HS-cTnT may also be a more accurate predictor of significant CAD than clinically suspected stable angina.Graphical abstract: http://links.lww.com/MCA/A540.

Colchicine-regeneration of an old drug.

Immunomodulation by colchicine is a well-established therapy for targeting inflammatory pathways in gout, pericarditis and Behchet's disease. In more recent times, evidence has emerged demonstrating a potential role for colchicine in several cardiac conditions. This article aims to summarise the evidence behind the established guidelines for use of low-dose colchicine in pericarditis and examine the evolving evidence for its use in cardiovascular disease and most recently COVID-19.

Homochiral Mn3+ Spin-Crossover Complexes: A Structural and Spectroscopic Study.

Structural, magnetic, and spectroscopic data on a Mn3+ spin-crossover complex with Schiff base ligand 4-OMe-Sal2323, isolated in crystal lattices with five different counteranions, are reported. Complexes of [Mn(4-OMe-Sal2323)]X where X = ClO4- (1), BF4- (2), NO3- (3), Br- (4), and I- (5) crystallize isotypically in the chiral orthorhombic space group P21212 with a range of spin state preferences for the [Mn(4-OMe-Sal2323)]+ complex cation over the temperature range 5-300 K. Complexes 1 and 2 are high-spin, complex 4 undergoes a gradual and complete thermal spin crossover, while complexes 3 and 5 show stepped crossovers with different ratios of spin triplet and quintet forms in the intermediate temperature range. High-field electron paramagnetic resonance was used to measure the zero-field splitting parameters associated with the spin triplet and quintet states at temperatures below 10 K for complexes 4 and 2 with respective values: DS=1 = +23.38(1) cm-1, ES=1 = +2.79(1) cm-1, and DS=2 = +6.9(3) cm-1, with a distribution of E parameters for the S = 2 state. Solid-state circular dichroism (CD) spectra on high-spin complex 1 at room temperature reveal a 2:1 ratio of enantiomers in the chiral conglomerate, and solution CD measurements on the same sample in methanol show that it is stable toward racemization. Solid-state UV-vis absorption spectra on high-spin complex 1 and mixed S = 1/S = 2 sample 5 reveal different intensities at higher energies, in line with the different electronic composition. The statistical prevalence of homochiral crystallization of [Mn(4-OMe-Sal2323)]+ in five lattices with different achiral counterions suggests that the chirality may be directed by the 4-OMe-Sal2323 ligand.

Coumarin Partitioning in Model Biological Membranes: Limitations of log P as a Predictor.

Time-resolved fluorescence measurements were used to quantify partitioning of three different 7-aminocoumarin derivatives into DPPC vesicle bilayers as a function of temperature. The coumarin derivatives were structurally equivalent except for the degree of substitution at the 7-amine position. Calculated log P (octanol: water partitioning) coefficients, a common indicator that correlates with bioconcentration, predict that the primary amine (coumarin 151 or C151) would experience a ∼40-fold partition enrichment in polar organic environments (log PC151 = 1.6) while the tertiary amine's (coumarin 152 or C152) concentration should be >500 times enhanced (log PC152 = 2.7). Both values predict that partitioning into lipid membranes is energetically favorable. Time-resolved emission spectra from C151 in solutions containing DPPC vesicles showed that within detection limits, the solute remained in the aqueous buffer regardless of temperature and vesicle bilayer phase. C152 displayed a sharp uptake into DPPC bilayers as the temperature approached DPPC's gel-liquid crystalline transition temperature, consistent with previously reported results ([ J. Phys. Chem. B 2017, 121, 4061-4070]). The secondary amine, synthesized specifically for these studies and dubbed C151.5 with a measured log P value of 1.9, partitioned into the bilayer's polar head group with no pronounced temperature dependence. These experiments illustrate the limitations of using a gross descriptor of preferential solvation to describe solute partitioning into complex, heterogeneous systems having nanometer-scale dimensions. From a broader perspective, results presented in this work illustrate the need for more chemically informed tools for predicting a solute tendency for where and how much it will bioconcentrate within a biological membrane.

From thioether substituted porphyrins to sulfur linked porphyrin dimers: an unusual SNAr via thiolate displacement?

Treatment of meso 2-ethylhexyl-3-mercaptopropionate substituted porphyrins with base at room temperature generated a porphyrin thiolate anion which in situ reacted in a nucleophilic aromatic substitution (SNAr) reaction with remaining thioether derivative. This reaction yielded S-linked bisporphyrins in good yields, with mechanistic insight obtained via displacement reactions. Additionally, SNAr of the thioether chain was achieved using S- and organolithium nucleophiles.

The diagnostic accuracy of fecal calprotectin during the investigation of suspected pediatric inflammatory bowel disease.

OBJECTIVES: Fecal calprotectin (FC) is elevated in patients with inflammatory bowel disease (IBD). Studies evaluating FC during the initial investigation of children with suspected IBD have been limited, especially with regard to their small patient groups. We aimed to evaluate the diagnostic accuracy of FC in a large regional cohort of children undergoing full upper and lower endoscopy for suspected IBD, comparing FC with six common blood parameters. METHODS: Using a retrospective case-control design all FC measurements carried out between 2005 and 2010 in children <18 years old were obtained. All IBD and non-IBD patients who had a FC measurement available before full endoscopic evaluation for suspected bowel inflammation were examined. FC was measured using the PhiCal Test. Multivariate analyzes and receiver operating characteristic curve generation were used to derive significance. RESULTS: A total of 190 patients (91 IBD and 99 non-IBD controls) met the inclusion criteria. Median FC at diagnosis for the IBD group was 1,265 µg/g (interquartile range (IQR) 734-2,024 µg/g), compared with 65 µg/g (IQR 20-235 µg/g) in controls (P<0.001). FC levels did not vary significantly between patients with Crohn's disease, ulcerative colitis, and IBD unclassified and were not influenced by age or disease location. FC was found to be far superior to commonly utilized blood parameters such as C-reactive protein and white cell count (both P<0.01), with an area under the curve of 0.93 (95% confidence interval 0.89-0.97). CONCLUSIONS: This study demonstrates that FC is an invaluable tool in determining those children who may require endoscopy for suspected IBD, and elevated values should prompt further investigation.