Hyperkalemia Causing Inappropriate Subcutaneous Implantable Cardioverter Defibrillator Shocks in a Patient with End-Stage Renal Disease: A Case Report and Literature Review.

Subcutaneous implantable cardioverter-defibrillators (S-ICD) provide an effective treatment option for ventricular arrhythmias. When compared to transvenous implantable cardioverter-defibrillators (TV-ICDs), S-ICDs have a lower infection rate but a higher rate of inappropriate shocks. In patients with end-stage renal disease (ESRD), significant electrolyte disturbances are commonly seen, such as hyperkalemia, which can cause an increase in T wave amplitude. We present a patient with ESRD on hemodialysis who experienced inappropriate shocks from an S-ICD during sinus rhythm due to hyperkalemia-induced T wave oversensing and highlight related cases in the current literature.

Cryptococcal Pneumonia in an Immunocompetent Patient: A Rare Occurrence.

Cryptococcosis is an invasive yeast infection commonly found among immunosuppressed patients. Pulmonary cryptococcal infection can have variable presentations ranging from pulmonary nodules and masses to consolidation. A patient can present with shortness of breath, cough, sputum production, chest pain, fatigue, and weight loss. Diagnosis can be made using fungal culture, histology, radiographic findings, and cryptococcal antigen in serum as well as in the cerebrospinal fluid. Treatment is usually with a combination or a single antifungal agent. Few cases have been reported in immunocompetent individuals. Here we present a case of 69-year-old immunocompetent individual, who was initially seen in the outpatient clinic for dyspnea, cough, and fatigue and was treated for pneumonia. The patient remained symptomatic despite multiple courses of oral antibiotics. He was then sent for inpatient admission. CT scan was obtained that showed patchy infiltrates and consolidations, followed by bronchoscopy. The cytology confirmed adenocarcinoma. The fungal smear and culture grew Cryptococcus neoformans. The patient was treated with fluconazole with improvement of his symptoms before starting chemotherapy. We are reporting this case as clinicians usually focus on bacterial etiologies in outpatient setting. Our patient, who was immunocompetent, had a new diagnosis of cryptococcal pneumonia and was also found to have lung adenocarcinoma. This case highlights the rare occurrence of this type of pneumonia in immunocompetent patients and the importance of considering fungal causes of pneumonia in patients.

Superior Vena Cava Syndrome Due to Thrombosis: A Case Report.

Superior vena cava (SVC) syndrome is a clinical entity with signs and symptoms resulting from obstruction of blood flow through the SVC. The resulting obstruction leads to edema in the upper body, including the head, neck, and upper extremities. Clinical signs and symptoms can include plethora, cyanosis, dyspnea, stridor, cough, and hoarseness, as well as more serious complications such as cerebral edema leading to headache, confusion, and coma. Here, we present an interesting case of a 66-year-old female, with a medical history of esophageal cancer in remission and thyroid cancer currently undergoing radiation therapy, who was admitted for facial and upper extremity swelling. The initial impression was of angioedema or an allergic reaction. Imaging studies showed thrombus in the SVC resulting in SVC syndrome. The patient was treated with heparin initially, with a plan for an interventional radiologist to perform catheter-guided thrombolysis. However, the patient became unstable and ended up requiring mechanical ventilation. The patient was eventually discharged on oral anticoagulants. This case was rare as the patient developed SVC syndrome from venous thrombosis in the absence of any external tumor compression or as a result of an intravascular catheter.

Autoimmune Progesterone Dermatitis.

The condition autoimmune progesterone dermatitis (APD) is an immune disorder, observed among women, primarily due to progesterone surge during menstrual cycle. Here, we present a case of a 29-year-old female with recurrent severe skin eruptions associated with her menstrual cycle that commenced a few years ago. She presented with blistered skin lesion of the body and also blisters in oropharyngeal mucosa leading to a variety of symptoms ranging from pruritus to difficulty in swallowing. Recognition of this process is important as it can result in significant debility among women. Our patient was treated with steroids and antihistamines to provide symptomatic relief and was encouraged to resume her oral contraceptive pill, which is a more definitive therapy.

Demographics, Biochemical Characteristics, and Phases of Chronic Hepatitis B Virus Infection: Retrospective Analysis From a Secondary Care Setup.

Introduction Hepatitis B virus (HBV) is the leading cause of cirrhosis in the developing world. Despite the development of effective vaccine(s) and direct-acting antivirals (DAAs) such as tenofovir and entecavir, the eradication of chronic HBV remains a distant dream in endemic regions. Factors such as treatment naivety, longer duration of disease, late diagnosis, family history of liver disorders and hepatocellular carcinoma, fatty liver disease, multiple comorbidities, alcoholism, use of tobacco products, noncompliance to drugs, and loss to follow-up all contribute to disease progression and development of complications. In order to promote a better understanding of the treatment initiation, duration, and eventual outcomes, the European Association for the Study of the Liver (EASL) updated its guidelines in 2017 and introduced a new staging system for chronic HBV. Since these guidelines are relatively recent, data regarding the new staging is virtually absent in local/regional settings. Moreover, it has been observed that patients presenting to secondary care setups at major urban centers have disease characteristics quite distinct from those of their rural counterparts or patients presenting to tertiary care setups, even in the same cities. Additionally, there is scarce published data with regard to this aspect. With this study, we hope to make progress on all of those fronts. Objective We aimed to evaluate the demographics, biochemical characteristics, and phases of chronic HBV at the secondary care level. Methods This was a retrospective observational cohort conducted at the Sindh Government Hospital, Liaquatabad from January to December 2020. Patients of either gender who were aged ≥12 years, and diagnosed as a case of chronic HBV were eligible to be enrolled in the study. Only treatment-naive patients were enrolled in the study. Demographics, biochemical characteristics, and phases of HBV (in light of the updated guidelines issued by EASL in 2017 with respect to HBV) were recorded and analyzed. Patient confidentiality was ensured at all times. Results A total of 102 patients were enrolled in the study. The mean age of our cohort was 34.31 ±12.42 years, and the male-to-female ratio was 3:2. All referrals were made from within the city district. Housewives and laborers made up the majority of our patients. The mean alanine transaminase (ALT) levels were 39.83 ±21.33 IU/L; otherwise, the biochemical profile of the patients was unremarkable. Phase III was the most frequently recorded stage of chronic HBV; 41 (40.19%) of the patients were diagnosed with it. However, nearly half of the patients had chronic active hepatitis (phases II and IV). Only a single case each of hepatitis Delta virus and decompensated liver disease (DCLD) was recorded. Conclusions All patients of chronic HBV presenting at the secondary care level were referred locally, were relatively older, and exhibited a higher frequency of chronic active hepatitis (phases II and IV). This corresponded to borderline elevations of ALT. But the remainder of the biochemical profile was largely unremarkable due to the very low prevalence of cirrhosis among these patients.

Water productivity, yield and agronomic attributes of maize crop in response to varied irrigation levels and biochar-compost application.

BACKGROUND: Due to the rapid increase in world population, the demand for freshwater is increasing day by day. There is also immense pressure on the agriculture sector to produce more food with limited supplies of water. About 75% of freshwater is used in crop production out of which 63% is lost due to poor farm practices and evapotranspiration. Enhancement of crop water productivity for sustainable agriculture production especially in areas having water scarcity plausibly contributes towards the solution of water scarcity. RESULTS: The combined application of biochar and compost has a highly significant impact on maize yield with increased grain production, i.e. 6.44 and 6.52 t ha-1 at 60% irrigation level with combined application of biochar and compost as compared with control at 6.39 and 6.44 t ha-1 at 100% irrigation level in autumn and spring seasons, respectively, by saving 40% of water. Furthermore, the highest value of water productivity (1.51 and 1.16 kg m-3 ) was achieved at 60% irrigation level with combined application of soil amendments. Also, cost-benefit analysis has shown highest values of net benefit with soil organic amendments. CONCLUSIONS: It is concluded that addition of biochar and compost to soil has the potential to increase crop yield and growth even at low irrigation levels by enhancing water use efficiency. © 2021 Society of Chemical Industry.

Comprehensive RNA-seq analysis revealed molecular pathways and genes associated with drought tolerance in wild soybean (Glycine soja Sieb. and Zucc.).

Drought stress at the germination stage is an important environmental stress limiting crop yield. Hence, our study investigated comparative root transcriptome profiles of four contrasting soybean genotypes viz., drought-tolerant (PI342618B/DTP and A214/DTL) and drought-sensitive (NN86-4/DSP and A195/DSL) under drought stress using RNA-Seq approach. A total of 4850 and 6272 differentially expressed genes (DEGs) were identified in tolerant (DTP and DTL) and sensitive (DSP and DSL) genotypes, respectively. Principle component analysis (PCA) and correlation analysis revealed higher correlation between DTP and DTL. Both gene ontology (GO) and MapMan analyses showed that the drought response was enriched in DEGs associated with water and auxin transport, cell wall/membrane, antioxidant activity, catalytic activity, secondary metabolism, signaling and transcription factor (TF) activities. Out of 981 DEGs screened from above terms, only 547 showed consistent opposite expression between contrasting genotypes. Twenty-eight DEGs of 547 were located on Chr.08 rich in QTLs and "Hotspot regions" associated with drought stress, and eight of them showed non-synonymous single nucleotide polymorphism. Hence, 10 genes (including above eight genes plus two hub genes) were predicated as possible candidates regulating drought tolerance, which needs further functional validation. Overall, the transcriptome profiling provided in-depth understanding about the genetic mechanism and candidate genes underlying drought tolerance in soybean.

Brassinosteroid Regulates 3-Hydroxy-3-methylglutaryl CoA Reductase to Promote Grape Fruit Development.

Brassinosteroids (BRs) are known to regulate plant growth and development. However, only little is known about their mechanism in the regulation of berry development in grapes. This study demonstrates that BR treatment enhances the accumulation of fruit sugar components, reduces the content of organic acids (e.g., tartaric acid), promotes coloration, and increases the anthocyanin content in grape berries at the onset of the veraison, half veraison, and full veraison stages at the rate of 0.0998, 0.0560, and 0.0281 mg·g-1, respectively. In addition, BR treatment was also found to accelerate the biosynthesis of terpenoid aroma components, such as α-pinene, d-limonene, and γ-terpinene, which influence the aromatic composition of grapes. BRs can negatively regulate the expression of VvHMGR, a key gene involved in the mevalonate (MVA) pathway, and reduce the activity of 3-hydroxy-3-methylglutaryl CoA reductase (HMGR). Inhibiting the expression of HMGR promoted the accumulation of anthocyanins and fruit coloration. Meanwhile, after the inhibition, the contents of auxin indole-3-acetic acid (IAA), abscisic acid (ABA), and brassinosteroid (BR) increased, while gibberellin (GA3) and zeatin riboside (ZR) decreased, and its aromatic composition also changed. Therefore, it may be concluded that BRs inhibited HMGR activity and cooperated with VvHMGR to regulate the formation of color, aroma, and other quality characteristics in fruits.

Grapevine immune signaling network in response to drought stress as revealed by transcriptomic analysis.

Drought is a ubiquitous abiotic factor that severely impedes growth and development of horticulture crops. The challenge postured by global climate change is the evolution of drought-tolerant cultivars that could cope with concurrent stress. Hence, in this study, biochemical, physiological and transcriptome analysis were investigated in drought-treated grapevine leaves. The results revealed that photosynthetic activity and reducing sugars were significantly diminished which were positively correlated with low stomatal conductance and CO2 exchange in drought-stressed leaves. Further, the activities of superoxide dismutase, peroxidase, and catalase were significantly actuated in the drought-responsive grapevine leaves. Similarly, the levels of abscisic acid and jasmonic acid were also significantly increased in the drought-stressed leaves. In transcriptome analysis, 12,451 differentially-expressed genes (DEGs) were annotated, out of which 8021 DEGs were up-regulated and 4430 DEGs were down-regulated in response to drought stress. In addition, the genes encoding pathogen-associated molecular pattern (PAMP) triggered immunity (PTI), including calcium signals, protein phosphatase 2C, calcineurin B-like proteins, MAPKs, and phosphorylation (FLS2 and MEKK1) cascades were up-regulated in response to drought stress. Several genes related to plant-pathogen interaction pathway (RPM1, PBS1, RPS5, RIN4, MIN7, PR1, and WRKYs) were also found up-regulated in response to drought stress. Overall the results of present study showed the dynamic interaction of DEG in grapevine physiology which provides the premise for selection of defense-related genes against drought stress for subsequent grapevine breeding programs.

Comparative Study on Reagents Involved in Grape Bud Break and Their Effects on Different Metabolites and Related Gene Expression during Winter.

To elucidate promoting and inhibiting effects of hydrogen cynamide (HC) and abscisic acid (ABA) on quiescence release of grape buds, physiological and molecular approaches were used to explore the mechanisms of quiescence based on metabolic and gene expression analysis. Physiological and molecular mechanisms involved in bud quiescence of grape were studied before and after application of HC, ABA, and ABA-HC. The data showed that ABA inhibited proclamation of quiescence in grape buds and attenuated the influence of HC. Bud quiescence was promoted and regulated by HC and ABA pre-treatment on buds of grape cultivar "Shine Muscat" with 5% HC, 100 µM ABA and combination of ABA-HC (5% HC+100 µM ABA) during quiescence under forcing condition. Exogenous application of ABA elevated superoxide dismutase (SOD), peroxidase (POD) and ascorbate peroxidase (APX) related specific activities, while catalase (CAT) activity was increased during initial period of forcing and then decreased. The concentration of plant growth hormones including gibberellins (GA) and indole acetic acid increased by HC application but decreased the ABA contents under forcing condition. ABA increased the fructose content during quiescence under forcing condition while sucrose and total soluble sugars peaked in HC treated buds as compared to control. Genes related to ABA pathway, protein phosphatase 2C (PP2C family) were down regulated in the buds treated with HC, ABA and ABA-HC as compared to control while two genes related to GA pathway (GID1 family), out of which one gene showed down regulation during initial period of forcing while other gene was up regulated in response to HC and ABA-HC treatments as compared to control. Exogenous ABA application up regulated genes related to antioxidant enzymes as compared to control. The gene probable fructose-bisphosphate aldolase 1, chloroplastic-like, was up regulated in response to ABA treatment as compared to control. Analysis of metabolites and related gene expression pattern would provide a comprehensive view of quiescence after HC, ABA, and ABA-HC treatments in grape buds which may helpful for ultimate improvement in table grape production.

Genome-Wide Identification and Analysis of the Type-B Authentic Response Regulator Gene Family in Peach (Prunus persica).

The type-B authentic response regulator (ARR-B) family members serve as DNA-binding transcriptional regulators, whose activities are probably regulated by phosphorylation/dephosphorylation, resulting in the rapid induction of type-A ARR genes. Type-B ARRs are believed to be involved in many biological processes, including cytokinin signaling, plant growth, and stress responses through a chaperone or by isomerization of proline residues during protein folding. The public availability of complete peach genome sequences allows the identification of 23 ARR-B genes by HMMER and blast analysis. Scaffold locations of these genes in the peach genome were determined, and the protein domain and motif organization of peach type-B ARRs were analyzed. The phylogenetic relationships between peach type-B ARRs were also assessed. The expression profiles of peach ARR-B genes revealed that most of the type-B ARRs showed high expression levels in tissues undergoing rapid cell division and may engage more cytokinins, like half-opened flowers, fruits at expansion stages, and young leaves. These findings not only contribute to a better understanding of the complex regulation of the peach ARR-B gene family, but also provide valuable information for future research in peach functional genomics.