Cardiac Manifestation of Rosai-Dorfman Disease: A Case Report and a Systematic Review.

BACKGROUND: Rosai-Dorfman disease is a rare condition that typically presents as a nodal disease. Cardiac involvement is extremely uncommon, occurring in 0.1-0.2% of cases, which has hindered our understanding. We report a case of Rosai-Dorfman disease (RDD) related cardiac manifestation in a patient without nodal involvement. Further, we conduct a comprehensive review of the literature to consolidate data on how patients with cardiac manifestations of RDD are typically managed and treated. METHODS: A systematic review of PubMed, Web of Science, and Embase was conducted to identify cases of RDD with cardiac involvement. Out of 464 studies identified, 42 publications encompassing 43 patients met the criteria and were incorporated in this review. We gathered data on patient demographics, as well as their management and treatment approaches. Additionally, we share our own experience with a patient who presented with a cardiac mass related to RDD. RESULTS: Out of the 43 patients, only 20.9% (n = 9) had a documented history of RDD prior to cardiac manifestations. Nodal involvement was reported in 32.6% (n = 14), while extranodal extracardiac involvement was reported in 46.5% (n = 20). Upon presentation, the most prevalent symptoms were dyspnea (48.8%, n = 21), chest discomfort (41.9%, n = 18), and lower extremity edema (16.3%, n = 7). Cardiac manifestations were most frequently found in the right atrium (41.9%, n = 18) and pericardium (18.6%, n = 8). Treatment encompassed systemic medical therapy (34.9%, n = 15) and cardiac surgery (39.5%, n = 17). The median follow-up period was 12 months (with a range of 1 to 36), and 8 patients (18.6%) experienced mortality. Our patient, who had a cardiac mass in the left atrium, underwent resection and has remained symptom-free without any recurrence for the past 5 years. CONCLUSION: The frequency of cardiac related-RDD manifestations may be greater than initially perceived. These results underscore the significance of identifying RDD and its cardiac-related presentations, facilitating timely diagnosis and treatment for affected individuals.

Vitamin C supplementation ameliorates liver function profile and antiviral treatment response in Hepatitis C patients.

An imbalance between oxidative stress and antioxidative defence mediates a variety of diseases pathogenesis. The present study aims to assess the possible outcome of supplementation of oral vitamin-C (VC), an antioxidant, in Viral Hepatitis C (HCV) treatment as an adjuvant therapy. 200 HCV-patients were selected, 100 were given Vitamin-C (1000 mg/day) along with anti HCV treatment (sofosbuvir plus daclatasvir) while the other 100 took only anti-HCV treatment for 4weeks. The serum ascorbic acid (Vitamin-C) levels and functions of the liver were tested before and after the VC supplementation. HCV patients with relatively low serum ascorbic acid showed significant improvement after the intake of vitamin C. After 4 weeks of treatment, AST, ALP, albumin, and total, direct and indirect bilirubin were improved significantly in the VC group; whereas only ALT and indirect bilirubin were improved in both groups when associated with the control subjects. Comparing the two treatment groups at 4weeks; more effective and significant improvement was observed in ALT (p<0.01), AST (p<0.001), direct (p<0.01) and indirect bilirubin (p<0.001), total proteins (p<0.001) and albumin (p<0.05) in patients with VC supplementation on anti-viral treatment compared to only anti-viral treatment group. Thus, VC supplementation improves the antiviral therapy outcome by bestowing a beneficial effect in minimizing liver damage in HCV cases.

Effects of active isolated stretching on exercise-induced muscle damage in untrained subjects: a randomized controlled trial.

Objectives: To investigate the prophylactic effect of the active isolated stretching technique on exercise-induced muscle damage of wrist flexors. METHODS: The mixed model randomised controlled interventional study was conducted at the University of Sargodha, Sargodha, Pakistan, from November 2018 to May 2019, and comprised young adults who were untrained, sedentary and healthy who were randomly divided into intervention group A and control group B. Group A participants received self-assisted active isolated stretching before inducing muscle soreness of wrist flexors by eccentric exercises. Group B did not receive any intervention. The outcome measures were pain intensity, muscle soreness, pressure pain threshold, range of motion, and grip strength. Data were collected at baseline, after one hour, and daily from day 1 to 7 after inducing muscle soreness. Data were analysed using SPSS 21. RESULTS: Of the 60 subjects, there were 30(50%) in each of the two groups. There were 14(23.3%) males and 46(76.7%) females. The overall mean age was 21.47±1.9 years. Group A showed early recovery in pain and muscle soreness compared to group B (p<0.05). Also, a limited deficit in the range of motion, grip strength, and pain pressure threshold was found in group A compared to group B (p<0.05). CONCLUSIONS: Active isolated stretching before strenuous, unaccustomed exercise was found to be useful in ameliorating the symptoms of muscle soreness.

Beat the exercise-induced muscle damage.

Eccentric exercises are being used widely as a strategy to manage sarcopenia. However, eccentric exercises are linked to increased risk of myofibre damage and delayed recovery. There is elevated muscle soreness, decrease muscle strength and increased levels of muscle-specific circulatory protein. There is a huge variation in the severity of the symptoms after eccentric exercise. Several factors affect the degree and severity of muscle soreness. It includes exercise intensity, duration, mode, muscle group, age, gender, genetics and nutritional status. Therefore, designing a specific individual exercise plan is required to overcome injuries, myofibre damage and muscle soreness. At present, we still do not have enough knowledge about the exact sources and factors that trigger muscle soreness linked with strenuous exercise. Deep insight and identification of the risk factors which predispose individuals at an increased risk of muscle soreness after unaccustomed exercises may be a key to help them by prescribing personalised exercise therapy to speed up recovery and adaptation. Non-steroidal anti-inflammatory drugs are being used widely to manage muscle soreness, pain and tenderness linked with post exercise complications. But there is more to it than just treating pain. Is there any substantive gain besides pain relief? Can they improve muscle function? Could they prevent muscle soreness or speed up recovery? The current narrative review was planned to discuss the sources and factors that trigger exercise-induced muscle damage. Furthermore, it also provides a comprehensive analysis of the literature concerning the effectiveness of non-steroidal anti-inflammatory drugs in reducing symptom and improving muscle function in exercise induced muscle soreness.

Non-pharmacological interventions to combat exercise-induced muscle damage, a little natural tax on work out.

Debilitating pain, stiffness, tenderness, fatigue, impaired muscle function, lack of strength subsequent to exercise are not welcomed by those not accustomed to it. It may discourage an individual from participating in regular exercise. Numerou s ph armacological and non - pharmacological strategies have been used to alleviate symptoms of muscle soreness, muscle pain, improving muscle function, the range of motion and recovery time. Non-steroidal anti-inflammatory drugs are suggested to have a beneficial impact on muscle soreness, but fail to rejuvenate muscle weakness and range of motion coupled with muscle soreness. Furthermore, oral antiinflammatory drugs are widely used to mitigate muscle soreness symptoms, but chronic use can lead to different side effects in terms of peptic ulcer and liver toxicity. Non-pharmacological remedies and interventions can be a better choice. This narrative review is intended to provide insight into the non-pharmacological strategies to combat exercise-induced muscle damage.

Numerical optimization and performance evaluation of ZnPC:PC70BM based dye-sensitized solar cell.

The increase in global energy consumption and the related ecological problems have generated a constant demand for alternative energy sources superior to traditional ones. This is why unlimited photon-energy harnessing is important. A notable focus to address this concern is on advancing and producing cost-effective low-loss solar cells. For efficient light energy capture and conversion, we fabricated a ZnPC:PC70BM-based dye-sensitized solar cell (DSSC) and estimated its performance using a solar cell capacitance simulator (SCAPS-1D). We evaluated the output parameters of the ZnPC:PC70BM-based DSSC with different photoactive layer thicknesses, series and shunt resistances, and back-metal work function. Our analyses show that moderate thickness, minimum series resistance, high shunt resistance, and high metal-work function are favorable for better device performance due to low recombination losses, electrical losses, and better transport of charge carriers. In addition, in-depth research for clarifying the impact of factors, such as thickness variation, defect density, and doping density of charge transport layers, has been conducted. The best efficiency value found was 10.30% after tweaking the parameters. It also provides a realistic strategy for efficiently utilizing DSSC cells by altering features that are highly dependent on DSSC performance and output.

Persistent Hypokalemia in a Patient With Ogilvie's Syndrome.

Ogilvie's syndrome, also known as acute colonic pseudo-obstruction (ACPO), is a rare disease characterized by acute dilatation of the colon in the absence of anatomic intestinal obstruction. It is of clinical importance because of its preponderance in elderly males in the seventh decade of life who may present with constipation or diarrhea. We present an 80-year-old male who presented with diarrhea, with laboratory investigations showing hypokalemia and a CT abdomen revealing colonic distension. The patient was wasting potassium both from colon and renal losses, despite low aldosterone levels. The patient was treated with Neostigmine, which helped relieve abdominal distention. Subsequently, potassium was corrected with aggressive replacement. This case sheds light on newer modalities of treatment such as neostigmine, as in this case.

Warfarin Failure in a Patient With Chronic Thromboembolic Pulmonary Hypertension: A Case Report and Literature Review.

Chronic thromboembolic pulmonary hypertension (CTEPH) is a form of pulmonary hypertension caused by chronic venous thromboembolism (VTE). Venous thromboembolism (VTE) manifests as deep vein thrombosis (DVT), progressing to pulmonary embolism (PE). Pulmonary endarterectomy (PEA) is the preferred therapeutic option as it provides vascular disobliteration. Long-term anticoagulation with warfarin or direct oral anticoagulants (DOACs) is recommended for patients at risk for recurrent DVT in poor surgical candidates. However, treatment failure remains a concern. We present a patient who had VTE despite long-term anticoagulation with warfarin who had failed treatment and developed VTE with a therapeutic dilemma to continue anticoagulation despite supratherapeutic international normalized ratio (INR).

Painless Subacute Thyroiditis in a Patient With Acute COVID-19 Infection: A Transient Event.

Coronavirus 2019 disease (COVID-19) is a highly contagious infectious disease caused by severe acute respiratory coronavirus 2 (SARS-CoV-2). Although several articles have described the non-respiratory effects of COVID-19 in the past two years, there are few reports of COVID-19 associated with thyroiditis. We present a case of a middle-aged female patient with positive COVID-19 PCR associated with acute pulmonary embolism and thyroiditis. Three months ago, her baseline thyroid profile was normal. Thyroiditis induced elevated free thyroxine (FT4) and decreased thyroid-stimulating hormone (TSH) levels resolved with conservative management within six days.

Acute COVID-19-Associated Cardiac Arrhythmia: A Case Series and Literature Review.

Coronavirus disease 2019 (COVID-19) is a highly contagious infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report two cases of COVID-19-associated atrial fibrillation (AF) in two elderly females and a case of atrial flutter (AFlutter) in a middle-aged male patient. We believe this case series will contribute to the literature on new-onset AF and AFlutter in patients with acute COVID-19 infection. This case series illustrates various case scenarios of patients developing cardiac arrhythmia with acute COVID-19 infection without any prior history or other explicable cause of AF/AFlutter. The exact mechanism behind COVID-19 infection leading to AF or AFlutter is still unknown. Of the three patients reported, two converted to sinus rhythm following medical management, and one did not convert to sinus rhythm despite medical treatment.

Dysregulated Autophagy Leads to Oxidative Stress and Aberrant Expression of ABC Transporters in Women with Early Miscarriage.

Early miscarriage (EMC) is a devastating obstetrical complication. ATP-binding cassette (ABC) transporters mediate cholesterol transfer across the placenta and enhance cell survival by effluxing substrates from target cells in the presence of stressors. Recent evidence reports an intricate interplay between autophagy and ABC transporters. We hypothesized that dysregulated autophagy and oxidative stress (OS) in the placenta leads to abnormal expression of membrane transporters contributing to poor pregnancy survival in EMC. We determined mRNA and protein expression of autophagy genes (Beclin-1/Bcl-2/LC3I/LC3II/p62) and ABC transporters (ABCA1/ABCG1/ABCG2) in placentae from EMC patients (n = 20), term controls (n = 19), first trimester (n = 6), and term controls (n = 5) controls. Oxidative/antioxidant status and biomarkers of oxidative damage were evaluated in maternal serum and placentae from EMC and healthy controls. In EMC, placental expression of LC3II/LC3I as well as of the key autophagy regulatory proteins Beclin-1 and Bcl-2 were reduced, whereas p62 was increased. Both in the serum and placentae of EMC patients, total OS was elevated reflected by increased oxidative damage markers (8-OHdG/malondialdehyde/carbonyl formation) accompanied by diminished levels of total antioxidant status, catalase, and total glutathione. Furthermore, we found reduced ABCG1 and increased ABCG2 expression. These findings suggest that a decreased autophagy status triggers Bcl-2-dependent OS leading to macromolecule damage in EMC placentae. The decreased expression of ABCG1 contributes to reduced cholesterol export to the growing fetus. Increasing ABCG2 expression could represent a protective feedback mechanism under inhibited autophagy conditions. In conclusion, dysregulated autophagy combined with increased oxidative toxicity and aberrant expression of placental ABC transporters affects materno-fetal health in EMC.

Ocean Sensitivity to Periodic and Constant Volcanism.

It is strongly believed that the explosive eruptions produce negative radiative forcing that causes long-term perturbations in the ocean. Moreover, it is anticipated that a sporadic strong cooling should initiate more vigorous vertical mixing of the upper ocean, and therefore cools the ocean more effectively than a uniform radiative forcing. However, the long-term simulations show that on average the ocean heat content responses to periodic and constant forcings are comparable. To better understand this controversy and to better quantify the post-eruption oceanic response, we conducted two sets of parallel simulations, the first with a uniform/constant volcanic forcing and the second one with a periodic volcanic forcing of magnitude 1×, 5×, 10× and 30× of Pinatubo size eruption using Geophysical Fluid Dynamics Laboratory's coupled model, CM2.1. We systematically compared the effect of periodic volcanic forcing with an equivalent time-average volcanic cooling. Our results reveal that on average, volcanic-induced perturbations in Ocean Heat Content (OHC), and sea-level rise (SLR) following uniform and periodic eruptions are almost identical. It further emphasizes that the strength of ocean heat uptake at different ocean depths is mainly driven by the strength of the Atlantic Meridional Overturning Circulation (AMOC). These findings are important for ocean initialization in long-term climate studies, and geoengineering applications. It would help to unfold uncertainties related to ocean relaxation process, heat storage, and redistribution.

Occult Nodal Metastasis in Oral Cavity Cancers.

INTRODUCTION:  In squamous cell carcinoma (SCC) of the oral cavity, there is always a risk of occult metastasis to neck nodes in the clinically and radiologically negative neck (N0). Therefore, elective neck dissection (END) has ever been under discussion since the beginning of their routine use for the management of neck for oral carcinomas. The purpose of the current study is to identify the percentage of occult nodal metastasis to neck levels I-V in the cases of oral carcinoma who were treated for the N0 with END. METHODS:  Patients who were treated between June 2005 and May 2010 with END from neck levels I to V for the management of N0 with oral SCC had been identified from the database of Aga Khan University Hospital. Those who met the inclusion and exclusion criteria were included in the study. Data were analyzed using SPSS 16 software. Using descriptive statistics, the mean was computed for the quantitative variable (age). Frequencies and percentages were calculated for gender, site, tumor grade, and lymph node involvement for each neck level. RESULTS:  A total of 50 patients were included in the study. There were 38 males and 12 females. The mean age was 47 (range 25-72). The most common site of the tumor was buccal mucosa in 50% of the cases followed by tongue 20%, then floor of mouth 14%, dentoalveolar ridge 8%, retromolar area 4%, lip 2%, and hard palate 2%. Histopathological grading of tumors showed well-differentiated 28%, moderately differentiated 33%, and poorly differentiated 6%. Twenty-seven out of 50 patients were found positive for nodal metastasis on final postoperative histopathology. Neck node metastasis at level I was found in 22 patients, at level II in 16 patients, at level III in seven patients, and at level IV in two patients. The level V was found free of metastasis in all of the cases. CONCLUSION:  The rate of occult metastatic disease to the neck nodes was similar to that found in the literature. Both early and advanced local disease is associated with a risk of occult metastasis. END for neck levels I-V is, therefore, recommended for the management of the N0 in all cases of oral SCCs. Spread to levels IV and V is rare and these levels should not be a part of routine END.

Screening Programs for Hearing Assessment in Newborns and Children.

Objective In this study, we aimed to assess the incidence of hearing loss in the pediatric population through otoacoustic emission (OAE) and brainstem evoked response audiometry (BERA) and to analyze the possible etiological factors responsible for it. Material and methods A retrospective observational study was conducted in the Otolaryngology (ENT) and Gynecology and Obstetrics Departments at the Jinnah Postgraduate Medical Centre and National Institute of Child Health in Karachi, Pakistan between July 2019 and October 2019. The convenient sampling technique was used to select the patients. The final sample size consisting of newborns and children was 108. Initially, screening procedures were undertaken for newborns to detect permanent or fluctuating, bilateral or unilateral, and sensory or conductive hearing loss, averaging 30-40 dB or more in the frequency region, which indicated potential issues related to speech recognition (approximately 500-4,000 Hz). The screening of newborns involved the use of non-invasive, objective physiologic measures that included OAEs and/or auditory brainstem response (ABR). The children with hearing impairment then underwent BERA; thereafter, further investigations were performed to confirm the defects found on BERA testing. Results Of the 108 cases, 96 had normal hearing on OAE screening, and 12 were found to have hearing loss on the OAE test. Further testing was carried out on BERA for 12 cases that had been detected to have hearing loss on OAE, and BERA showed normal hearing for five cases whereas seven were found to have hearing loss. Of the seven patients with hearing loss on the BERA test, five were diagnosed with cochlear deafness, and two had retrocochlear deafness. Conclusion Our present study concludes that in order to avoid any hearing problems in infants, OAE hearing screening and diagnostic BERA screening programs should be carried out in all the hospitals of Pakistan to assess newborn hearing at an early age.

Galactin-3 and soluble ST2 as complementary tools to cardiac MRI for sudden cardiac death risk stratification in heart failure: A review.

Heart failure (HF) is recognized as one of the leading causes of morbidity and mortality worldwide. Every year about 500,000 new cases of HF are diagnosed in the United States. The predominant etiology of death in HF patients include sudden cardiac death (SCD) and pump failure. Prediction of mode of death may help in devising management decisions. In patients with HF, the presence of myocardial fibrosis has been a known risk factor for SCD and thus it could be used as a criterion in risk stratification for SCD. However, the underlying pathophysiology of SCD is uncertain and controversial, which makes it necessary to develop newer tools to enhance SCD risk stratification. The newer tools should be innovative enough either to complement or to replace the currently available tools. In this scoping review, we highlighted the utilization of novel biomarkers galectin-3 (gal-3) and soluble ST2 (sST2) and discussed that how they might complement currently available tools such as, cardiac MRI (CMR) for SCD risk stratification in HF patients.

A perspective on diuretic resistance in chronic congestive heart failure.

Chronic congestive heart failure (CHF) is a complex disorder characterized by inability of the heart to keep up the demands on it, followed by the progressive pump failure and fluid accumulation. Although the loop diuretics are widely used in heart failure (HF) patients, both pharmacodynamic and pharmacokinetic alterations are thought to be responsible for diuretic resistance in these patients. Strategies to overcome diuretic resistance include sodium intake restriction, changes in diuretic dose and route of administration and sequential nephron diuretic therapy. In this review, we discuss the definition, prevalence, mechanism of development and management strategies of diuretic resistance in HF patients.

Regenerative Stem Cell Therapy Optimization via Tissue Engineering in Heart Failure with Reduced Ejection Fraction.

The prevalence of heart failure (HF) is continuously rising in both the industrialized and non-industrialized nations. Despite current therapeutic advances, prognosis of HF patients remains poor. Presently, therapeutic pharmacological and device strategies for HF with reduced ejection fraction (HFrEF) are mostly palliative and do not induce regeneration of lost myocardial tissue. Stem cell therapy has demonstrated promising results in clinical studies by promoting myocardial restoration in HFrEF subjects. Despite decades of investigation, many challenges remain unanswered to the widespread clinical application of stem cell therapy for HFrEF. This review will describe the foundational work already accomplished in cardiac stem cell therapy, advantages and limitations of the various candidates for tissue restoration, their presumed mechanisms of action, the role of scaffolding materials as well as the challenges that exist for widespread clinical application.

Type 1 Brugada pattern electrocardiogram induced by hypokalemia.

Coved-type ST-segment elevation in the right precordial leads are the characteristics of Brugada syndrome, an inherited arrhythmogenic ion channel disease, which could lead to ventricular arrhythmia and sudden death. Hypokalemia alone may induce Type 1 Brugada pattern electrocardiogram (EKG), and the association has rarely been reported. We describe a patient with hypokalemia 2.9 mmol/L and the appearance of new right bundle branch block pattern with coved ST-segment elevations with inverted T wave in leads V1-V2. Serum potassium was corrected and repeated EKG 6 h later revealed disappearance of Type 1 Brugada pattern. Although there is no definite value of serum potassium level that can induce Brugada pattern EKG, hypokalemia may unmask Type 1 Brugada EKG pattern. Awareness of its appearance should be made by all physicians since patients with a family history of arrhythmia or sudden cardiac death (SCD) are at the high risk of developing SCD.