An Unusual Case of Takotsubo Cardiomyopathy with Cardiac Arrest: The Importance of Clinical Context in Implanted Cardioverter Defibrillator Candidacy.

Takotsubo syndrome (TTS), also known as stress-induced cardiomyopathy, is characterized by acute heart failure, reversible left ventricular dysfunction, and other complications such as life-threatening arrhythmias. The management of TTS is challenging due to its unpredictable clinical course and the lack of evidence-based treatment recommendations. In this case report, we present a 71-year-old female who developed TTS with ventricular tachycardia (VT) cardiac arrest following septic shock and an exploratory laparotomy for appendicitis. Despite the presence of VT cardiac arrest and a left ventricular ejection fraction of 30-35%, an implanted cardioverter-defibrillator (ICD) was not indicated due to the rapid and satisfactory recovery of the patient's ventricular function. This case highlights the importance of considering the clinical context and the transient nature of TTS in the decision-making process for ICD candidacy.

Impact of Air-Drying Temperatures on Drying Kinetics, Physicochemical Properties, and Bioactive Profile of Ginger.

Ginger (Zingiber officinale Roscoe) is a perishable commodity that requires proper processing to maintain its bioactivity. This study evaluated the effect of different air-drying temperatures (50 °C, 60 °C, and 70 °C) on ginger's drying kinetics and quality attributes. For an enhanced understanding of the drying kinetics, we employed a detailed approach by combining an existing drying model (namely, Midilli) with the Arrhenius model. This combined model facilitates a thorough analysis of how temperature and time concurrently affect the moisture ratio, offering more profound insights into the drying mechanism. A higher drying rate was achieved at 70 °C, yet elevated drying temperatures could compromise the quality attributes of ginger slices. Ginger slices dried at 50 °C displayed improved physicochemical properties and less color browning. The evaluation of the bioactivity profile of resultant ginger extracts also revealed higher total phenolic contents (1875.87 ± 31.40 mg GAE/100 g) and DPPH radical scavenging activity (18.2 ± 0.9 mg TE/kg) in 50 °C treated ginger samples. Meanwhile, the hydroethanolic mixture (70% ethanol) was also reorganized with better extraction efficiency than water and MWF (a ternary blend of methanol, water, and formic acid) solution. The promising outcomes of this study endorse the influence of drying temperature on the quality characteristics and bioactive profile of ginger and the selection of suitable extraction solvents to acquire phenolic-rich extract.

Clinical impact of preemptive pharmacogenomic testing on antiplatelet therapy in a real-world setting.

CYP2C19 genotyping to guide antiplatelet therapy after patients develop acute coronary syndromes (ACS) or require percutaneous coronary interventions (PCIs) reduces the likelihood of major adverse cardiovascular events (MACE). Evidence about the impact of preemptive testing, where genotyping occurs while patients are healthy, is lacking. In patients initiating antiplatelet therapy for ACS or PCI, we compared medical records data from 67 patients who received CYP2C19 genotyping preemptively (results >7 days before need), against medical records data from 67 propensity score-matched patients who received early genotyping (results within 7 days of need). We also examined data from 140 patients who received late genotyping (results >7 days after need). We compared the impact of genotyping approaches on medication selections, specialty visits, MACE and bleeding events over 1 year. Patients with CYP2C19 loss-of-function alleles were less likely to be initiated on clopidogrel if they received preemptive rather than early or late genotyping (18.2%, 66.7%, and 73.2% respectively, p = 0.001). No differences were observed by genotyping approach in the number of specialty visits or likelihood of MACE or bleeding events (all p > 0.21). Preemptive genotyping had a strong impact on initial antiplatelet selection and a comparable impact on patient outcomes and healthcare utilization, compared to genotyping ordered after a need for antiplatelet therapy had been identified.

Oro-Anal Transit Time and Colon Manometry: Predictability and Outcomes in Children With Functional Constipation.

OBJECTIVES: The primary objective of the study was to evaluate the correlation of oro-anal transit time (OTT) using SITZMARKS® (Konsyl Pharmaceuticals Inc., Easton, MD, USA) with colonic manometry (CM) in children with chronic idiopathic constipation (CIC). The secondary objective was to determine the clinical utility of these studies in directing treatment strategies. METHODS: A retrospective chart review of 44 children with CIC was evaluated with both OTT and CM. The median follow-up was one year (0.3 to 7). RESULTS: Seventeen children had normal OTT, and 27 had abnormal OTT (slow-transit constipation (STC)). There was no statistical difference between the percentage of children with abnormal CM (13) test results categorized by OTT (23.5% normal OTT vs. 33% abnormal OTT, p = 0.73). A change in therapy was accepted by all 13 children with abnormal CM, but only 26/31 (84%) of the children had normal CM. The CM test results prompted acceptance of treatment change (appendicectomy or medication escalation) in 89% of children. Overall, 31/44 (70%) of children undergoing CM testing had improvement in clinical symptoms. More children with abnormal CM testing improved vs. normal CM but did not reach significance (85% vs. 65%, p = 0.28). CONCLUSION: Contrary to previous studies, OTT results did not predict the presence of colonic dysmotility based on colon motility testing. Colonic manometry testing resulted in the acceptance of a change in therapy in approximately 90% of children. More children with colonic dysmotility improved versus those with normal CM studies. Other interventions beyond stimulant laxatives should be considered in children with refractory constipation.

Novel breath biomarkers identification for early detection of hepatocellular carcinoma and cirrhosis using ML tools and GCMS.

According to WHO 2019, Hepatocellular carcinoma (HCC) is the fourth highest cause of cancer death worldwide. More precise diagnostic models are needed to enhance early HCC and cirrhosis quick diagnosis, treatment, and survival. Breath biomarkers known as volatile organic compounds (VOCs) in exhaled air can be used to make rapid, precise, and painless diagnoses. Gas chromatography and mass spectrometry (GCMS) are utilized to diagnose HCC and cirrhosis VOCs. In this investigation, metabolically generated VOCs in breath samples (n = 35) of HCC, (n = 35) cirrhotic, and (n = 30) controls were detected via GCMS and SPME. Moreover, this study also aims to identify diagnostic VOCs for distinction among HCC and cirrhosis liver conditions, which are most closely related, and cause misleading during diagnosis. However, using gas chromatography-mass spectrometry (GC-MS) to quantify volatile organic compounds (VOCs) is time-consuming and error-prone since it requires an expert. To verify GC-MS data analysis, we present an in-house R-based array of machine learning models that applies deep learning pattern recognition to automatically discover VOCs from raw data, without human intervention. All-machine learning diagnostic model offers 80% sensitivity, 90% specificity, and 95% accuracy, with an AUC of 0.9586. Our results demonstrated the validity and utility of GCMS-SMPE in combination with innovative ML models for early detection of HCC and cirrhosis-specific VOCs considered as potential diagnostic breath biomarkers and showed differentiation among HCC and cirrhosis. With these useful insights, we can build handheld e-nose sensors to detect HCC and cirrhosis through breath analysis and this unique approach can help in diagnosis by reducing integration time and costs without compromising accuracy or consistency.

Comparative study of encoded and alignment-based methods for virus taxonomy classification.

The emergence of viruses and their variants has made virus taxonomy more important than ever before in controlling the spread of diseases. The creation of efficient treatments and cures that target particular virus properties can be aided by understanding virus taxonomy. Alignment-based methods are commonly used for this task, but are computationally expensive and time-consuming, especially when dealing with large datasets or when detecting new virus variants is time sensitive. An alternative approach, the encoded method, has been developed that does not require prior sequence alignment and provides faster results. However, each encoded method has its own claimed accuracy. Therefore, careful evaluation and comparison of the performance of different encoded methods are essential to identify the most accurate and reliable approach for virus taxonomy classification. This study aims to address this issue by providing a comprehensive and comparative analysis of the potential of encoded methods for virus classification and phylogenetics. We compared the vectors generated for each encoded method using distance metrics to determine their similarity to alignment-based methods. The results and their validation show that K-merNV followed by CgrDft encoded methods, perform similarly to state-of-the-art multi-sequence alignment methods. This is the first study to incorporate and compare encoded methods that will facilitate future research in making more informed decisions regarding selection of a suitable method for virus taxonomy.

Ginger Bioactives: A Comprehensive Review of Health Benefits and Potential Food Applications.

Ginger is an herbaceous and flowering plant renowned for its rhizome, which is widely employed as both a spice and an herb. Since ancient times, ginger has been consumed in folk medicine and traditional cuisines for its favorable health effects. Different in vitro and in vivo studies have disclosed the advantageous physiological aspects of ginger, primarily due to its antioxidant, anti-inflammatory, antimicrobial, and anti-carcinogenic properties. These health-promoting features are linked to the variety of bioactive compounds that are present in ginger. Following the advancement in consumer awareness and the industrial demand for organic antioxidants and functional ingredients, the application of ginger and its derivatives has been broadly investigated in a wide range of food products. The prominent features transmitted by ginger into different food areas are antioxidant and nutraceutical values (bakery); flavor, acceptability, and techno-functional characteristics (dairy); hedonic and antimicrobial properties (beverages); oxidative stability, tenderization, and sensorial attributes (meat); and shelf life and sensorial properties (film, coating, and packaging). This review is focused on providing a comprehensive overview of the tendencies in the application of ginger and its derivatives in the food industry and concurrently briefly discusses the beneficial aspects and processing of ginger.

A Hybrid Approach for Alluring Ads Phishing Attack Detection Using Machine Learning.

Phishing attacks are evolving with more sophisticated techniques, posing significant threats. Considering the potential of machine-learning-based approaches, our research presents a similar modern approach for web phishing detection by applying powerful machine learning algorithms. An efficient layered classification model is proposed to detect websites based on their URL structure, text, and image features. Previously, similar studies have used machine learning techniques for URL features with a limited dataset. In our research, we have used a large dataset of 20,000 website URLs, and 22 salient features from each URL are extracted to prepare a comprehensive dataset. Along with this, another dataset containing website text is also prepared for NLP-based text evaluation. It is seen that many phishing websites contain text as images, and to handle this, the text from images is extracted to classify it as spam or legitimate. The experimental evaluation demonstrated efficient and accurate phishing detection. Our layered classification model uses support vector machine (SVM), XGBoost, random forest, multilayer perceptron, linear regression, decision tree, naïve Bayes, and SVC algorithms. The performance evaluation revealed that the XGBoost algorithm outperformed other applied models with maximum accuracy and precision of 94% in the training phase and 91% in the testing phase. Multilayer perceptron also worked well with an accuracy of 91% in the testing phase. The accuracy results for random forest and decision tree were 91% and 90%, respectively. Logistic regression and SVM algorithms were used in the text-based classification, and the accuracy was found to be 87% and 88%, respectively. With these precision values, the models classified phishing and legitimate websites very well, based on URL, text, and image features. This research contributes to early detection of sophisticated phishing attacks, enhancing internet user security.

Compost and humic acid amendments are a practicable solution to rehabilitate weak arid soil for higher winter field pea production.

Arid soils are often weak, low in fertility, and lack essential plant nutrients. Organic amendments might be a feasible solution to counter the detrimental impact and rehabilitate weak arid soil for the growth of legumes. The study aimed to investigate how organic amendments of compost and humic acid may affect winter field pea productivity in arid soil. Over 2 years of field experiments, a range of treatments were applied, including different amounts of compost and humic acid. The results showed higher microbial carbon (C), and nitrogen (N) biomass, root length, shoot length, grains pod-1, and grain yield of pea, gained from the collective application of 8 Mg ha-1 compost and 15 kg ha-1 humic acid compared to all other treatments. Organic amendments increased soil microbial C density by 67.0 to 83.0% and N biomass by 46.0 to 88.0% compared with the control. The combined application of compost and humic acid increased soil microbial N biomass by 57.0 to 60.0% compared to the sole applications of compost-only and humic acid-only. It was concluded that organic amendments of 8 Mg ha-1 compost and 15 kg ha-1 humic acid in arid soil modulated microbial density, resulting in improved winter field pea productivity. This study suggests organic amendments of compost and humic acid might be a practicable solution to rehabilitate weak arid soil to grow legumes.

Relapse of colchicine-intolerant, corticosteroid-dependent recurrent idiopathic pericarditis after perigestational discontinuation of anakinra: uncertain safety of anakinra in pregnancy and the need for shared decision-making.

A nulligravid woman in her mid-20s with colchicine-intolerant, steroid-dependent recurrent idiopathic pericarditis was in remission for 2 years on anakinra monotherapy when she had an unplanned pregnancy. Due to very limited and conflicting data, European Alliance of Associations for Rheumatology and American College of Rheumatology guidelines are equivocal on the use of anakinra in pregnancy, emphasising an individualised approach. Anakinra was discontinued but a month later, in the second month of gestation, the patient had an acute pericarditis flare. A multidisciplinary, patient-centred discussion about the competing risks of infection, obstetric complications and fetal malformations with anakinra versus suboptimally managed recurrent acute pericarditis guided the patient to choosing improved symptom control. Chest pain resolved and CRP normalised after daily anakinra injections were resumed. In the second trimester, the patient had mild COVID-19 infection and streptococcal pharyngitis on anakinra. At 34 weeks gestation, the patient went into preterm labour and had a spontaneous vaginal delivery of a healthy neonate.

Right Atrial and Endocardial Lead Mass Secondary to Anterior Mediastinal Mass Encasing Left Subclavian Vein.

INTRODUCTION: Multimodality cardiac imaging is a valuable tool for the noninvasive evaluation of right atrial masses (tumor, vegetation, or thrombus). CASE PRESENTATION: We report a case of right atrial mass that was discovered on a transthoracic echocardiogram ordered for pacemaker-pocket erythema in a 101-year-old man with heart failure/reduced left-ventricular ejection fraction and a dual-chamber pacemaker. Transthoracic and transesophageal echocardiogram showed a large hypoechoic mobile RA mass extending from the superior vena cava, with pacemaker device lead attachment. Infective endocarditis was excluded (no symptoms of systemic infection; negative blood cultures). CT angiography of the chest revealed an anterior mediastinal mass, highly suspicious for malignancy, encasing the left subclavian vein. The patient chose not to pursue invasive assessment of the mediastinal mass. Role of anticoagulation is unclear. CONCLUSION: Computed tomography complemented echocardiographic assessment and management of a right atrial mobile echo density due to a large anterior mediastinal mass.

Transient Complete Atrioventricular Block Associated With Herbal Supplement Use.

INTRODUCTION: Increasing and easy availability of so-called natural/herbal supplements pose the unique challenge of identifying associated side effects, including arrhythmias in otherwise-healthy individuals. CASE PRESENTATION: A 25-year-old female patient presented to the emergency department with fatigue and lightheadedness. The electrocardiogram showed complete AV block with a junctional escape rhythm at 55 beats per minute with QT prolongation (542ms). One week ago, she started to use a herbal medication (Muscle Eze Advanced) for muscle cramps after workouts. Extensive cardiac testing, including complete blood count, complete metabolic panel, TSH, transthoracic echocardiography, urine drug analysis, Lyme antibody were negative. Normal sinus rhythm was restored spontaneously within 1 day of discontinuing the herbal medication. PR and corrected QT intervals returned to baseline over the next two weeks. CONCLUSION: Muscle Eze Advanced consists of seven ingredients, including Melissa officinalis and Valeriana officinalis that have negative chronotropic, negative dromotrophic and QT prolonging effects. Recognizing the association between certain over-the-counter supplements and brady-arrhythmias may circumvent need for permanent pacemakers - an important consideration especially in the young.

Bedside Carotid Sinus Massage for Syncope Evaluation With Bifascicular Block and First-Degree Atrioventricular Block.

Symptomatic bifascicular block (BFB) with a reversible high-grade atrioventricular block (AVB) is an overlooked cause of syncope with differing diagnostic and therapeutic approaches. We present a case of a 79-year-old gentleman with multiple episodes of cardiac syncope. Initial electrocardiogram revealed a left bundle branch block and first-degree AVB worsened by bedside carotid sinus massage (CSM) obviating the need for electrophysiologic (EP) studies or continuous electrocardiographic monitoring for further evaluation. This case highlights the importance of CSM as a useful clinical tool in addition to EP studies and internal loop recorder (ILR) placement for assessment and appropriateness of permanent pacemaker (PPM) implantation. It also sheds light on the differing management protocols between EP studies and ILR evaluation versus empiric PPM implantation for patients with cardiac syncope secondary to BFB and AVB.

SVR achievement in triple therapy treated hepatitis C induced cirrhosis: A dual center retrospective cohort study.

Background and objective: Multiple prospective and retrospective cohort studies from the West have demonstrated the conflicting results about the efficacy of direct-acting antivirals (DAAs) by sustained virologic response (SVR) achievement rate in hepatitis C virus (HCV) infected patients. But there is limited to no data about the effectiveness of triple therapy ribavirin-sofosbuvir-daclatasvir in cirrhotic hepatitis C infected patients from Pakistan. Methods: We conducted a retrospective cohort study by retrieving records of 359 hepatitis C infected patients treated with triple therapy from two tertiary care hospitals in Pakistan [Cirrhotic = 187 (53%); non-cirrhotic = 172 (47%)] from February 18, 2018, to June 29, 2019. We lost the follow-up of 158 (44.1%) patients due to death (n = 24, 6.68%), non-responding/wrong contact number (n = 43, 9.63%), and whom consented to study but didn't complete follow-up/refused to participate in the study (n = 91, 25.34%). Only 201 (45.9%) completed follow up, and of these 87 (43.2%) were cirrhotic patients based on Liver Stiffness Index. Analysis was run by dividing groups into subgroups; who achieved SVR/who didn't achieve SVR. Results: We analyzed the data of 201 (45.9%) who completed follow-up including cirrhotic patients (n = 87, 43.2%). Mean age was 50.6 + 10.65 years. 81 (94.18%) did achieve SVR while 5 (5.81%) did not achieve SVR. Achievement of SVR was statistically associated with low platelet count, higher total bilirubin, and lower albumin (p < 0.05) while other demographic and disease-related characteristics of patients were not statistically significant (p > 0.05). Conclusion: Triple therapy (ribavirin-sofosbuvir-daclatasvir) achieves over 94% SVR in the Pakistani population, so proved to be highly effective against hepatitis C infection.

Transcatheter tricuspid valve-in-valve implantation for very early bioprosthetic tricuspid stenosis secondary to pacemaker lead entrapment: a case report.

Background: Tricuspid stenosis (native and prosthetic) is rare. Redo-sternotomy for isolated tricuspid replacement is associated with a higher risk. The efficacy and durability of transcatheter valve implantation for severe tricuspid stenosis are unclear. Case summary: Successful tricuspid valve-in-valve implantation (Edwards 26 mm Ultra) was performed to exteriorize a retained, unextractable pacemaker lead causing very early surgical bioprosthetic valve dysfunction in a 66-year-old Caucasian woman. The original indication for surgical replacement was pacemaker lead-related severe tricuspid regurgitation. History of CABG and subsequent surgical replacement rendered the risk of a third sternotomy and open-heart surgery prohibitive. Conclusion: Successful reduction in the severity of bioprosthetic tricuspid stenosis and improvement of right heart failure with transcatheter valve-in-valve implantation was observed. Percutaneous tricuspid valve implantation could be considered an alternative to redo-sternotomy for severe bioprosthetic tricuspid stenosis.

Post COVID-19 Large Atrial Thrombus Found Incidentally.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has become a leading cause of morbidity and mortality worldwide. One of the major complications of COVID-19 infection is the hypercoagulability state. Cardiac thrombi and venous thromboembolism (VTE) have been documented with severe COVID-19 infection. We present a case of large right atrial (RA) thrombus in transit incidentally diagnosed following a mild COVID-19 in a previously vaccinated patient. CASE SUMMARY: An 85-year-old male presented to the emergency department two weeks following resolution of a mild COVID-19 infection due to an incidentally discovered large RA thrombus. Computed tomography with angiography of the chest was positive for acute pulmonary thromboembolic disease with large clot burden and findings consistent with right heart strain. The patient remained hemodynamically stable and was successfully managed with anticoagulation. CONCLUSION: RA thrombi and VTE can occur in patients with mild COVID-19 infection and in the setting of full COVID-19 vaccination. Echocardiography is a useful imaging modality in this patient population.

Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA) in a Patient Taking Lisdexamfetamine.

Stimulant medications like amphetamines have been associated with various cardiovascular complications like coronary artery spasm, coronary dissections and thrombus formation, the pathophysiology of which is theorized to be the endothelial damage induced by the medication and the inflammatory cascade that follows. We report a case of 52-year-old male on lisdexamfetamine, a newer stimulant agent used for attention deficit hyperactivity disorder (ADHD) who presented with sudden chest pain and ECG changes concerning for myocardial infarction and mildly elevated troponins. However, coronary angiogram showed no obstructive coronary artery disease and there was spontaneous resolution of his symptoms and ECG changes.

Complete Heart Block Causing Takotsubo Syndrome: A Case Report.

The association of complete atrioventricular (AV) block with Takotsubo syndrome (TTS) is well known, but the cause-and-effect relationship has not been determined. We present the case of a 91-year-old female with complete AV block who went untreated for over a year and later developed Takotsubo syndrome. Reversal of wall movement defects was seen after a permanent pacemaker was implanted, and routine follow-up showed that the implanted pacemaker worked normally.