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When operating in space, on-board Silicon Geiger-Mode Avalanche Photodiodes (GM-APDs) are exposed to radiation damage that result in an increase in dark count rates. Thermal annealing has been found to mitigate the damage, although prior studies have largely focused on annealing following a single session of proton irradiation. This work reports that thermal annealing can be performed simply with the built-in thermo-electric coolers of the GM-APDs. Annealing was also done in 10 min intervals for a clearer view of the recovery curve. Mitigation of damage from repeated γ radiation was observed from the: (1) halving of the increase in dark count rates on average and (2) outperformance of room temperature annealing ( 25 ∘ C) by 33 % . Additionally, we show that heavy doses of γ radiation (21 krad) have a probability of causing Random Telegraph Signals in GM-APDs that can be suppressed by lowering the operating temperature. [ABSTRACT FROM AUTHOR]

When operating in space, on-board Silicon Geiger-Mode Avalanche Photodiodes (GM-APDs) are exposed to radiation damage that result in an increase in dark count rates. Thermal annealing has been found to mitigate the damage, although prior studies have largely focused on annealing following a single session of proton irradiation. This work reports that thermal annealing can be performed simply with the built-in thermo-electric coolers of the GM-APDs. Annealing was also done in 10 min intervals for a clearer view of the recovery curve. Mitigation of damage from repeated γ radiation was observed from the: (1) halving of the increase in dark count rates on average and (2) outperformance of room temperature annealing ( 25 ∘ C) by 33 % . Additionally, we show that heavy doses of γ radiation (21 krad) have a probability of causing Random Telegraph Signals in GM-APDs that can be suppressed by lowering the operating temperature. [ABSTRACT FROM AUTHOR]

Introduction: Dengue is a globally prevalent mosquito-borne disease that has been endemic in Malaysia since the 1980s. Despite significant government efforts, dengue cases continue to rise. To combat this trend, fostering positive perceptions, attitudes, and practices is essential. This study aims to assess the perceptions and attitudes of undergraduate medical students in Malaysia regarding dengue prevention activities and their responses to early warnings. Methods: Participants were given online questionnaires constructed in English. Statistical tests (Unpaired t-test and chi square test) were done using Epi Info software (version 7.2.2.6). Results: Almost 100% of the students are aware of dengue fever, and 96.2% believe that it can cause mortality. Additionally, 79.5% reported having sufficient knowledge to prevent dengue infection. Furthermore, 99.4% think that an early warning system is a useful tool for the community to take preventive measures to avoid potential infection in a timely manner. However, only 23.7% of the participants checked the current dengue hotspot in their area. Regarding early warning about dengue, 95.6% reported that they would help convey this information to others, 81.4% reported that they would avoid outdoor activities, and 82.7% reported that chemical fogging is necessary. Conclusion: Most participants demonstrated a positive perception, attitude, and response regarding dengue infection and early warning systems. The study found a significant association between the participants' phases of study and their perceptions of dengue. Overall, medical students showed a favorable outlook toward dengue infection, a positive attitude toward the early warning system, and an appropriate response to it. [ABSTRACT FROM AUTHOR]

Context: Handling of electronic and electrical waste (E-waste) has adverse effects on the environment and human well-being. To address the environmental and health risks arising from improper e-waste disposal, it is crucial to foster responsible practices and enhance understanding of e-waste management. Aims: This study aimed to assess the knowledge, awareness, and practice of e-waste management and association of these factors with demographic variables among undergraduate medical students. Settings and Design: A cross-sectional study was conducted at a private medical university among medical students in Malaysia. Subjects and Methods: The selection of participants was done using purposeful sampling, and the questionnaire was distributed in the form of an online survey using Google Forms. Statistical Analysis Used: Chi-square test and multivariable logistic regression were calculated. Results: Out of the 135 medical students surveyed, 39.3% demonstrated a good knowledge and 27.4% displayed a good awareness. In terms of practice, 67.4% of respondents appropriately disposed of electronic gadgets, whereas 41.5% properly disposed of electrical appliances. Notably, no statistically significant associations were found between demographic characteristics and the knowledge, awareness, and practice in e-waste management among the participants. Conclusions: Our research emphasizes the insufficient knowledge, awareness, and inadequate implementation of proper practices concerning e-waste management among medical students. Fostering a supportive environment and emphasizing collaborative efforts are crucial steps that empower medical students to actively participate in and contribute to responsible electronic waste practices. This approach enables students to be proactive agents in promoting a greener and more environmentally conscious approach to electronic waste. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, regular teaching-learning activities have been replaced with online education strategies. This study aimed to explore undergraduate medical students' experiences in conducting research projects during the COVID-19 pandemic in Malaysia. In the study institution, undergraduate medical students had a rotation at the community medicine posting during their Semesters 6 and 7, and they needed to conduct health research projects. Upon completion of the posting, students were asked to reflect on their project using Gibbs' reflective cycle. The inclusion criteria were reflective writings of undergraduate medical students in the study institution, who conducted online research projects during the COVID-19 pandemic. The secondary qualitative data from the reflections of 40 students were included until the data were saturated and analysed with thematic analysis. The R-based Qualitative Data Analysis (RQDA) software was used for data analysis. Seven salient themes emerged from the qualitative reflections: (a) sudden changes due to the COVID-19 pandemic, (b) challenges, (c) feelings of students, (d) support, (e) adaptation to the online learning process, (f) perceived benefits of online research projects, and (g) self-reflection and way forward. Although there were various challenges, the students were able to overcome and develop adaptation to conduct health research projects. The educational sector should provide support to students in terms of technology and clear guidance on the project process and encourage communication and teamwork to overcome challenges. From a positive perspective, the COVID-19 pandemic situation could have a beneficial impact on implementing e-learning and conducting online surveys and research projects. [ABSTRACT FROM AUTHOR]

The northern Andaman Sea off Myanmar is one of the relatively high productive regions in the Indian Ocean. The abundance, biomass and species composition of mesozooplankton and their relationships with environmental variables in the epipelagic zone (∼200 m) were studied for the first time during the Sino-Myanmar joint cruise (February 2020). The mean abundance and biomass of mesozooplankton were (1 916.7±1 192.9) ind./m3 and (17.8±7.9) mg/m3, respectively. A total of 213 species (taxa) were identified from all samples. The omnivorous Cyclopoida Oncaea venusta and Oithona spp. were the top two dominant taxa. Three mesozooplankton communities were determined via cluster analysis: the open ocean in the Andaman Sea and the Bay of Bengal (Group A), the transition zone across the Preparis Channel (Group B), and nearshore water off the Ayeyarwady Delta and along the Tanintharyi Coast (Group C). Variation partitioning analysis revealed that the interaction of physical and biological factors explained 98.8% of mesozooplankton community spatial variation, and redundancy analysis revealed that column mean chlorophyll a concentration (CMCHLA) was the most important explanatory variable (43.1%). The abundance and biomass were significantly higher in Group C, the same as CMCHLA and column mean temperature (CMT) and in contrast to salinity, and CMT was the dominant factor. Significant taxon spatial variations were controlled by CMCHLA, salinity and temperature. This study suggested that mesozooplankton spatial variation was mainly regulated by physical processes through their effects on CMCHLA. The physical processes were simultaneously affected by heat loss differences, freshwater influx, eddies and depth. [ABSTRACT FROM AUTHOR]

Preparis Channel is the very important exchange path of energy and materials between the northern Bay of Bengal and Andaman Sea (AS). A set of hydrographic measurements, a microstructure profiler, and a deep mooring were used to determine the characteristics of water masses, turbulent mixing, and flows in the Preparis Channel. The unprecedented short-term mooring data reveal that a deep current in the deep narrow passage (below 400 m) of the Preparis Channel flows toward the Bay of Bengal (BoB) with a mean along-stream velocity of 25.26 cm/s at depth of 540 m; above the deep current, there are a relatively weak current flows toward the AS with a mean along-stream velocity of 15.46 cm/s between 500 m and 520 m, and another weak current flows toward the BoB between 430 m and 500 m. Thus, a sandwiched vertical structure of deep currents (below 400 m) is present in the Preparis Channel. The volume transport below 400 m is 0.06 Sv (1 Sv = 106 m3/s) from the AS to the BoB. In the upper layer (shallower than 300 m), the sea water of the AS is relatively warmer and fresher than that in the BoB, indicating a strong exchange through the channel. Microstructure profiler observations reveal that the turbulent diffusivity in the upper layer of the Preparis Channel reaches O(10−4 m2/s), one order larger than that in the interior of the BoB and over the continental slope of the northern AS. We speculate that energetic high-mode internal tides in the Preparis Channel contribute to elevated turbulent mixing. In addition, a local "hotspot" of turbidity is identified at the deep mooring site, at depth of about 100 m, which corresponds to the location of elevated turbulent mixing in the Preparis Channel. [ABSTRACT FROM AUTHOR]

Background: Hepatitis B infection is a major health concern in Myanmar. Hepatitis B birth dose vaccination to prevent mother-to-child transmission is not universal, especially in births outside of health care facilities. Little is documented about delivery of immunization programs in rural Myanmar or in conflict-affected regions. To address this gap, this study describes the implementation of a novel community delivered neonatal hepatitis B immunization program in rural Karenni State, Myanmar. Methods: A mixed-methods study assessed the effectiveness and feasibility of hepatitis B birth dose immunization program. 1000 pregnant women were screened for hepatitis B virus (HBV) infection using point of care testing. Neonates of HBV positive mothers were immunized with a three dose HBV vaccine schedule at birth, 1, and 6 months of age. HBV testing was completed for children at 9 months to assess for infection. Descriptive statistics were collected including demographic data of mothers, neonatal vaccination schedule completion, and child HBV positivity at 9 months. Qualitative data examining barriers to implementation were collected through semi-structured interviews, participant-observation, and analysis of program documents. Themes were codified and mapped onto the Consolidated Framework for Implementation Research. Results: 46 pregnant women tested HBV positive leading to 40 live births. 39 women-child dyads were followed until the 9-month age mark. With the exception of two neonates who received their birth dose past 24 hours, all children received their vaccines on time. None of the 39 children tested positive for HBV at nine months. Themes regarding barriers included adaptability of the program to the rural setting, friction with other stakeholders and not meeting all needs of the community. Identified strengths included good communication and leadership within the implementing ethnic health organization. Conclusion: A community delivered neonatal HBV vaccination program by ethnic health organizations is feasible and effective in rural Myanmar. [ABSTRACT FROM AUTHOR]

A large-scale land reclamation project was carried out in the eastern part of Singapore involving 2000 hectares of land at a foreshore location from 1991 to 2005. The land was reclaimed, by placing sand hydraulically on the seabed comprising soft marine clay. Prefabricated vertical drains with surcharge preloading and deep compaction techniques, were used to improve the soft marine clay and reclaimed sand fill. Several specialist in situ tests were conducted during the project, such as with the cone penetration test (CPT), cone pressuremeter test (CPMT), dilatometer test and self-boring pressuremeter tests. The CPMT is an in situ testing method used to measure both the soil strength and stiffness parameters. The CPMT combines the advantages of a conventional pressuremeter test and a CPT. The CPT provides a continuous profile of the soil by measuring the stress on the cone tip, the sleeve friction and the pore-water pressure. The CPMT enables the assessment of the soil strength and stiffness at selected depths. CPMT tests were conducted on both the reclaimed sand and underlying soft marine clay layers during the Changi East reclamation project. [ABSTRACT FROM AUTHOR]

Background The Klotho gene, described as an 'aging suppressor' gene, encodes a single-pass transmembrane protein. The extracellular part of Klotho is cleaved and released into the circulation where it may function as a vasculoprotective hormone. Coronary flow reserve ( CFR) is accepted as a marker of coronary microvascular dysfunction when epicardial coronary stenosis is absent. There are no data regarding the relationship between serum Klotho levels and disorders in coronary microcirculation in healthy adults. We aimed to investigate the association between serum Klotho levels and alterations in coronary microcirculation in healthy adults using echocardiographic measurements of CFR. Methods Thirty-four healthy volunteers (median age: 34 [27-39], 14 males) were enrolled in this study. The study population was divided into two subgroups according to the median value of serum Klotho levels: a high Klotho ( HK) group (n = 17, median age: 34 [30-38]; 6 males) and a low Klotho ( LK) group (n = 17, median age: 32 [26-39]; 8 males). The analysis of coronary flow velocities was performed by transthoracic Doppler echocardiography. Results Hyperemic diastolic peak flow velocities and CFR were significantly higher in the HK group than in the LK group (70 [66-92] versus 61 [47-66], P = 0.003 and 3.0 [2.6-3.8] versus 2.2 [1.7-2.8], respectively, P = 0.001). Serum Klotho levels were positively correlated with CFR (P < 0.001). Conclusion Serum Klotho levels correlate with CFR in a healthy population. Low serum Klotho levels may potentially identify patients with impaired CFR. [ABSTRACT FROM AUTHOR]

Background: Artemisinin resistance in Plasmodium falciparum extends across Southeast Asia where it is associated with worsening partner drug resistance and a decline in the efficacy of frontline artemisinin-based combination therapy. Dihydroartemisinin-piperaquine (DP) is an essential component of preventive and curative treatment in the region, but its therapeutic efficacy has fallen in Cambodia. Methods: A prospective clinical and parasitological evaluation of DP was conducted at two sites in Upper Myanmar between August 2013 and December 2014, enrolling 116 patients with acute uncomplicated falciparum malaria. Patients received DP orally for 3 days together with primaquine 0.25 mg/kg on admission. Parasite clearance half-lives based on 6 hourly blood smears, and day 42 therapeutic responses were assessed as well as parasite K13 genotypes. Results: Median parasite clearance half-life was prolonged, and clearance half-life was greater than 5 h in 21 % of patients. Delayed parasite clearance was significantly associated with mutations in the propeller region of the parasite k13 gene. The k13 F446I mutation was found in 25.4 % of infections and was associated with a median clearance halflife of 4.7 h compared with 2.7 h for infections without k13 mutations (p < 0.001). There were no failures after 42 days of follow-up, although 18 % of patients had persistent parasitaemia on day 3. Conclusion: The dominant k13 mutation observed in Upper Myanmar, F446I, appears to be associated with an intermediate rate of parasite clearance compared to other common mutations described elsewhere in the Greater Mekong Subregion. Discerning this phenotype requires relatively detailed clearance measurements, highlighting the importance of methodology in assessing artemisinin resistance. [ABSTRACT FROM AUTHOR]

Objective: AA amyloidosis occurs in the setting of longstanding inflammation. An increased incidence of coronary artery disease (CAD) was noted in patients with chronic inflammatory disease (CID). Retrobulbar blood flow predicts future macrovascular events including CAD. Increase in carotid artery intima–media thickness is regarded as a marker for early atherosclerosis. The relationship between chronic inflammation and atherosclerosis is well known; however, the connection between amyloidosis-advanced CIDs and retrobulbar microvascular function and carotid intima–media thickness (CIMT) is unidentified. We aimed to investigate whether retrobulbar microcirculation and CIMT were impaired or not in amyloidosis-advanced CID patients compared to normal subjects.Methods: Fourteen patients with renal AA amyloidosis and a group of healthy volunteers were included in the study. Measurement of CIMT and retrobulbar blood flow velocities was performed with ultrasound scanner and color Doppler ultrasonography.Results: The CIMT of patients with renal amyloidosis was significantly thicker than that of the normal population (p < 0.001). The resistivity index of the ophthalmic artery (OA) of patients with renal amyloidosis was significantly higher than the study group (p < 0.001).Conclusion: This study demonstrates that accelerated atherosclerosis which can be shown by increased OA resistivity index and CIMT are found in amyloidal-related CID patients. [ABSTRACT FROM PUBLISHER]

Postoperative atrial fibrillation ( POAF) is common after cardiac surgery and is associated with increased morbidity, mortality, and prolonged hospital stay. Speckle tracking echocardiography ( STE) has been applied recently for evaluation of LA function. The purpose of this study was to examine whether left atrial longitudinal strain measured by STE is a predictor for the development of POAF following mitral valve surgery for severe mitral regurgitation. We studied 53 patients undergoing mitral valve surgery in sinus rhythm at the time of surgery. Echocardiography with evaluation of LA strain by STE was performed. Detection of POAF was based on documentation of AF episodes by continuous telemetry throughout hospitalization. Patients who did not develop POAF were taken as group 1 and those who had POAF constituted group 2. The echocardiographic and clinical predictors of POAF were investigated. POAF occurred in 28.3% of subjects. Mean age, LAVi and BNP were found higher in group 2 while peak atrial longitudinal strain ( PALS) (13.9 ± 3.8% vs. 24.8 ± 7.3%; P < 0.001), peak atrial contraction strain ( PACS) (7.6 ± 1.95% vs. 11.3 ± 3.5%; P < 0.001) were significantly lower. By multivariate logistic regression analysis, PALS and LAVi were independent predictor of POAF development. LA longitudinal strain was found to predict POAF in patients undergoing mitral valve surgery. It could be used to better identify patients at greater risk of developing POAF, and thus to guide in risk stratification and to take appropriate intensive prophylactic therapy. [ABSTRACT FROM AUTHOR]

Aim: To present the long-term results of our 158 endovenous laser ablation (EVLA) procedures. Materials and methods: From June 2008 to December 2011, 158 patients (89 women, 69 men; mean age: 38.2 years, range: 27-65) were treated with EVLA for venous insufficiency in 192 lower limbs. All patients were symptomatic and the majority had a class 4 or higher clinical disease (CEAP classification). A 980-nm diode laser was used under general anesthesia combined with local tumescent anesthesia to deliver 100 to 140 laser applications along the course of the vein. Compression bandages were applied for 2 weeks postoperatively. Follow-up exams were done by Doppler ultrasound exam at 4 weeks, 6 months, 1 year, and 2 years. Results: A total of 192 great saphenous veins were ablated, achieving a 99% clinical success rate. Postoperative complications were mild and well tolerated. Of the 2 (1.0%) recanalized target veins, 2 were successfully treated with a second EVLA procedure. After 3 to 6 months of EVLA treatment, 99% of the patients had significant relief of their symptoms. All patients returned to normal activity within 2 days. Conclusion: EVLA for symptomatic saphenous vein incompetence is a minimally invasive and successful technique in resolving varicose veins and reducing symptoms. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate left atrial deformations using speckle tracking echocardiography for predicting left atrial appendage ( LAA) thrombus in patients with suspected cardioembolic stroke who were in normal sinus rhythm. A total of 153 ischemic stroke patients (89 males, 64 females) in sinus rhythm who were suspected of having cardioembolism were included in the study. The patients underwent conventional two-dimensional (2 D) echocardiogram and 2 D speckle tracking echocardiogram of the left atrium. Left atrial peak strain ( LA-4 C- RES) and left atrial precontraction strain ( LA-4 C- PUMP) were measured. Patients were divided into 2 groups according to the presence of thrombus in the LAA in transesophageal echocardiography. Both LA-4 C- RES and LA-4 C- PUMP values were found to be significantly lower in patients with LAA thrombus (11.8 ± 1.4% vs. 33 ± 12%, P < 0.001 and 5.8 ± 1.3% vs. 14.2 ± 5.3%, P < 0.001, respectively). A good inverse correlation was present between LA-4 C- RES values and LAA morphologic parameters (with LAA area: r = −0.70, P < 0.001, with LAA length: r = −0.60, P < 0.001), and a good positive correlation was present with LAA emptying velocity with pulse Doppler (r = 0.74, P < 0.001). The area under the receiver-operating characteristic curve of the LA-4 C- RES was 0.94 (0.90-0.98, P < 0.001), for the LA-4 C- PUMP, the area was 0.92 (0.87-0.96, P < 0.001) to predict LAA thrombus. Left atrial deformation parameters measured by 2 D speckle tracking method was found to predict impaired LAA functions and the presence of LAA thrombus in ischemic stroke patients with suspected cardioembolism, but who are in sinus rhythm. [ABSTRACT FROM AUTHOR]

Since the introduction of immunemodulators in the treatment of rheumatoid arthritis (RA), there has been hope that orally effective biologic agents would be developed. Tofacitinib, a Janus kinase inhibitor, has become the first oral biologic to receive approval for use in active RA patients. This paper reviews the efficacy and safety profile of Tofacitinib at dosages of 5mg and 10mg twice daily. Remarkable improvement in terms of ACR 20 response and HAQ-DI score was noted at month 3 and month 6. DAS 28-4 ESR < 2.6 achievement was noticeably obvious at month 6 for both dosages. No significant serious adverse events, serious infections, neutropenia, or anaemia were observed compared to placebo. In fact, Tofacitinib 5mg was even found to have significant protective effect of anaemia in the meta-analysis (P = 0.004). Tofacitinib has a noticeable efficacy in controlling disease activity in RA with a manageable safety profile. However, longer studies are needed for its long-term safety profile. [ABSTRACT FROM AUTHOR]

Since the introduction of immunemodulators in the treatment of rheumatoid arthritis (RA), there has been hope that orally effective biologic agents would be developed. Tofacitinib, a Janus kinase inhibitor, has become the first oral biologic to receive approval for use in active RA patients. This paper reviews the efficacy and safety profile of Tofacitinib at dosages of 5mg and 10mg twice daily. Remarkable improvement in terms of ACR 20 response and HAQ-DI score was noted at month 3 and month 6. DAS 28-4 ESR < 2.6 achievement was noticeably obvious at month 6 for both dosages. No significant serious adverse events, serious infections, neutropenia, or anaemia were observed compared to placebo. In fact, Tofacitinib 5mg was even found to have significant protective effect of anaemia in the meta-analysis (P = 0.004). Tofacitinib has a noticeable efficacy in controlling disease activity in RA with a manageable safety profile. However, longer studies are needed for its long-term safety profile. [ABSTRACT FROM AUTHOR]

Background: Previous studies have demonstrated an increased risk for cardiovascular events and pulmonary disease in patients with biomass fuel exposure (BFE). However, biventricular heart function has yet to be investigated in these patients. Left ventricular (LV) myocardial performance index (LVMPI), which is an index of global ventricular function, incorporates ejection, isovolumic relaxation, and contraction times. In this study, pulmonary function and biventricular heart function were investigated in nonsmoking female patients with BFE. Methods: Our study population consisted of 46 female patients with BFE (group 1) and 31 control subjects (group 2). Pulmonary function tests and transthoracic echocardiographic examination were performed. Right ventricular myocardial performance index (RVMPI) and LVMPI were obtained by tissue Doppler imaging echocardiography (TDI). Results: BFE caused obstructive and restrictive spirometric impairments. RVMPI was higher in group 1 (0.55 ± 0.07) than group 2 (0.46 ± 0.06) (P = 0.042) and LVMPI was higher in group 1 (0.54 ± 0.08) than group 2 (0.47 ± 0.05) (P = 0.032). Also, pulmonary artery systolic pressure was higher in group 1 than group 2 (P = 0.02). Conclusions: BFE causes both obstructive and/or restrictive lung disease and systolic and diastolic biventricular dysfunction. Nonetheless, long-term studies are needed to understand on BFE-related ventricular dysfunctions and to document subsequent cardiovascular events. (Echocardiography 2011;28:52-61) [ABSTRACT FROM AUTHOR]

Background: Pseudoexfoliation syndrome (PEX) is recognised by chronic deposition of abnormal pseudoexfoliation material on anterior segment structures of the eye, especially the anterior lens capsule. In recent years, several studies have shown the presence of vascular, cardiac and other organ pseudoexfoliative material in patients with ocular pseudoexfoliation. Aims: The purpose of this study is to determine whether an association exists between ocular pseudoexfoliation and coronary artery disease, aortic aneurysms and peripheric vascular disease. Patients and Methods: 490 patients who underwent coronary angiography (CAG) at Kosuyolu Cardiovascula Research and Training Hospital were included in the study. Patients were evaluated for conventional risk factors such as age, sex, family history, hypertension, diabetes, dislipidemia and smoking. Detailed eye examinations including evaluation of lens were done in all patients. The presence of PEX material in the anterior segment was best appreciated by slit lamp after pupillary dilation. The patients were divided into two groups according to the presence of PEX, and compared for the presence of CAD and other risk factors. Results: CAD was present in 387 patients. 103 patients had normal coronary angiography. 20 (5.2 %) of CAD patients and 4 (3.9%) of normal CAG patients were found to have PEX (p>0.05). There was no significant relationship between CAD and the presence of PEX (p>0.05). When patients were grouped according to the presence of PEX, only age was significantly different between the two groups (r: 0.25, p<0.001). Conclusion: There is no significant relationship between the presence of PEX and CAD. Further studies in larger scales with elderly population may be more valuable. [ABSTRACT FROM AUTHOR]

Background: Elevated Gamma-glutamyltransferase (GGT) level is independently correlated with conditions associatedwith increased atherosclerosis, such as obesity, elevated serum cholesterol, high blood pressure and myocardial infarction. It is also demonstrated that serum gamma-glutamyltransferase activity is an independent risk factor for myocardial infarction and cardiac death in patients with coronary artery disease. Although the relationship between gamma-glutamyltransferase and coronary artery disease has been reported, not many studies have shown the relationship between changes ofgamma-glutamyltransferase in acute coronary syndromes and a well established coronary risk factor high sensitive C-reactive protein. (hs-CRP). Aims: In this study, how gamma-glutamyltransferase levels changed in acute coronary syndromes and its relationship with high sensitive C-reactive protein if any were studied. Patients & Methods:This trial was carried out at Kosuyolu Cardiovascular Training and Research Hospital and Van Yuksek Ihtisas Hospital, Turkey. 219 patients (177 males and 42 females) presenting with acute coronary syndrome, and 51 control subjects between September 2007 and September 2008 were included in the study. Serum gamma-glutamyltransferase, high sensitive C-reactive protein, serum lipoprotein levels and troponin I were determined. Results: Serum gamma-glutamyltransferase and high sensitive C-reactive protein levels were higher in acute coronary syndrome patients compared to control. There was also correlation between gamma-glutamyltransferase and high sensitive C-reactive protein levels. Conclusion: Serum gamma-glutamyltransferase and high sensitive C-reactive protein levels were higher in acute coronary syndrome patients. In subgroup analyses, the higher difference with Non-ST elevation myocardial infarction and ST elevation myocardial infarction groups than unstable angina oectoris group proposes a relationship between gamma-glutamyltransferase and severity of acute coronary syndromes. [ABSTRACT FROM AUTHOR]

Left atrial appendage inversion is a very rare cause of left atrial mass that usually occur after cardiac surgery. Its echocardiographic appearance often misleads clinicians to the diagnosis of thrombus or cardiac neoplasms. Unfortunately, misdiagnosed patients often undergo unnecessary anticoagulation or surgical treatment. We are presenting a case of left atrial appendage inversion caused by massive pericardial effusion in a patient with no previous history of cardiac surgery together with demonstrative images of transesophageal echocardiography and magnetic resonance imaging. (Echocardiography 2011;28:E134-E136) [ABSTRACT FROM AUTHOR]

It is well-known that collateral circulation is important in preserving ventricular functions, especially in coronary artery disease with total occlusion. The conus branch is distinct in having notable capacity of angiogenesis and arteriogenesis. We intend to emphasize the clinical importance of the conus branch by presenting two cases in which it supplied the distal regions of total occlusion. [ABSTRACT FROM PUBLISHER]

A 46-year-old man presented with a complaint of effort dyspnea. On transthoracic echocardiography a circle appeared in LVOT. It was seen freely floating, disappearing in every systole and appearing again in diastole. Turbulence was seen inside the circle with color Doppler. Transesophageal echocardiography showed aortic cusps and their coaptation to be normal. Aortic root diameters were normal at the annulus, sinus of Valsalva, and sinotubular junction. There were no signs of dissection, infective endocarditis or abscess. But as the probe was advanced, left sinus of Valsalva was found to be prolapsed, and ruptured into LVOT. (Echocardiography 2011;28:E9-E11) A 46-year-old man presented with a complaint of effort dyspnea. On transthoracic echocardiography a circle appeared in LVOT. It was seen freely fl oating, disappearing in every systole and appearing again in diastole. Turbulence was seen inside the circle with color Doppler. Transesophageal echocardiography showed aortic cusps and their coaptation to be normal. Aortic root diameters were normal at the annulus, sinus of Valsalva, and sinotubular junction. There were no signs of dissection, infective endocarditis or abscess. But as the probe was advanced, left sinus of Valsalva was found to be prolapsed, and ruptured into LVOT. [ABSTRACT FROM AUTHOR]

The article explores primary percutaneous revascularization using coronary stent as treatment in A patient with acute mesenteric ischemia (AMI) or acute obstruction of intestinal vessels like superior mesenteric artery. Obstruction is reportedly due to cardiac thromboembolism or thrombosis on an atherosclerotic plaque. Though surgical revascularization is treatment of choice, it is stated that primary angioplasty and stenting before intestinal necrosis may be life saving in high risk patients.

The article presents a case study of a 31 year old male who was brought to the hospital after 15 minutes of cardiac arrest. He was defibrillated after the diagnosis of ventricular fibrillation. He was then transferred to intensive care unit. After his discharge transthoracic echocardiography showed normal findings. Patient was a case of Brugada syndrome (BS). Further information on the treatment procedure done on patient and BS is also presented.

This article describes the case of a 34-year-old male patient with congenital aortic and pulmonary stenoses. The patient experienced 3-4/6 systolic murmurs on pulmonary and aortic areas. He underwent electrocardiography to examine his case. Multislice computed tomography was also performed to evaluate the right ventricular outflow tract (RVOT) and pulmonary artery.

A rarely reported complication of pacemaker lead extraction is embolization of the pulmonary vasculature by a fragmented lead tip. The tip fractured and migrated to the right pulmonary artery during the extraction, and it was successfully retrieved percutaneously. Percutaneous retrieval is an important treatment option of an embolized fragmented lead tip as it could sometimes lead to disastrous complications. [ABSTRACT FROM PUBLISHER]

Several diagnostic images which shows the cystic mass with smooth border next to the right ventricular outflow tract are presented.

The article presents a case study of a 37-year-old man who was diagnosed with aortic valve aneurysm after he had a cerebrovascular accident.