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Pulmonary hypertension in pregnancy has always scared the treating physician and gynecologist due to reported high mortality since ages. The upcoming therapies targeting pulmonary hypertension (calcium channel blockers, nitric oxide, endothelin receptor antagonist, phosphodiesterase type 5 inhibitors) and improvement in hemodynamic monitoring and intensive management in pulmonary arterial hypertension (PAH) specialist centers give a ray of hope to these patients. Termination of pregnancy continues to be a management modality in pregnant patients with PAH. Multidisciplinary approach targeting PAH- and pregnancy-specific therapy in this subset can prove rewarding. Larger multicentric studies in the present era of new pharmacologic agents targeting PAH are required.

Heat stress has an adverse effect on the quality and quantity of agriculturally important crops, especially wheat. The tolerance mechanism has not been explored much in wheat and very few genes/ TFs responsive to heat stress is available on public domain. Here, we identified, cloned and characterized a putative TaHSFA6e TF gene of 1.3 kb from wheat cv. HD2985. We observed an ORF of 368 aa with Hsf DNA binding signature domain in the amino acid sequence. Single copy number of TaHSFA6e was observed integrated in the genome of wheat. Expression analysis of TaHSFA6e under differential HS showed maximum transcripts in wheat cv. Halna (thermotolerant) in response to 38 °C for 2 h during pollination and grain-filling stages, as compared to PBW343, HD2329 and HD2985. Putative target genes of TaHSFA6e (HSP17, HSP70 and HSP90) showed upregulation in response to differential HS (30 & 38 °C, 2 h) during pollination and grain-filling stages. Small HSP17 was observed most triggered in Halna under HS. We observed increase in the catalase, guaiacol peroxidase, total antioxidant capacity (TAC), and decrease in the lipid peroxidation in thermotolerant cvs. (Halna, HD2985), as compared to thermosusceptible (PBW343, HD2329) under differential HS. Multiple stresses (heat - 38 °C, 2 h, and drought - 100 mL of 20% polyethylene Glycol 6000) during seedling stage of wheat showed positive correlation between the expression of TaHSFA6e, putative targets (HSP70, HSP90, HSP17) and TAC. Halna (thermotolerant) performed better, as compared to other contrasting cvs. TaHSFA6e TF can be used as promising candidate gene for manipulating the heat stress-tolerance network.

Assessment of contribution of source towards sink development is very important for deciding pruning intensity and fruit load. In the present study, 14C-sucrose was used as a tracer to study source–sink carbon flow dynamics in Kinnow, for which branches having one or two fruits were selected and leaves at the proximal or distal position, to the fruit-sink, were tagged. 14C accumulation results reveal that the sink-fruit is capable of drawing the photoassimilates from the source-leaves, irrespective of later’s position “proximal or distal” on the supporting branch and that heavy pruning is not a healthy practice for Kinnow since the main branch serves as the source of photoassimilate reserves.

RuBisCo activase modulate the activity of RuBisCo and protect the nascent proteins from aggregation under heat stress (HS). Here, we have identified and cloned a putative RuBisCo activase (Rca) gene of 1402 bp from wheat cv. HD2985 using transcriptomic approach. Evolutionary search established the presence of 63 Orthologs and 2 Paralogs of the cloned Rca gene. Sequence analysis showed significant variations in the amino acid of Rca and RuBisCo (large and small subunit) in thermotolerant and thermosusceptible wheat cvs. Heterologous expression of Rca in E. coli showed the release of ~ 47 kDa purified protein. Expression analysis of Rca at transcript and protein level showed significant up-regulation in wheat cvs. Raj3765 (thermotolerant) and HD2329 (thermosusceptible) under HS. RuBisCo enzyme present in thermosusceptible cv. showed more sensitivity to HS, as compared to thermotolerant. Rca activity was observed higher in Raj3765 during pollination and milky-ripe stages under HS (38 °C, 1 h), as compared to HD2329. The binding of Rca with the RuBisCo under HS was observed more stable in Raj3765, as compared to HD2329. The purified Rca enzyme was observed more effective in the renaturation of RuBisCo (inactive) under HS in Raj3765 than in HD2329. A positive correlation was established between the Rca enzyme activity and radical scavenging potential in the leaves of both the wheat cvs. under HS. There is a need to characterize the enzyme kinetics and functional diversity of Rca in order to exploit it in a better way to augment the carbon assimilatory processes in wheat under differential HS.

Background and objectives This study was conducted to compare the safety and efficacy of intravenous epoetin alfa-epbx, an epoetin alfa biosimilar, to epoetin alfa in patients on hemodialysis with ESKD and anemia. Design, setting, participants, & measurements In this 24-week, multicenter, double-blind comparative efficacy and safety study, 612 patients on hemodialysis with ESKD and anemia who had stable hemoglobin and were receiving stable doses of intravenous epoetin alfa were randomized (1:1) to intravenous epoetin alfa or epoetin alfa-epbx. Dosing was adjusted according to the epoetin alfa prescribing information. The coprimary efficacy end points were the least squares mean difference between the two treatments in mean weekly hemoglobin level and mean weekly epoetin dose per kilogram of body weight during the last 4 weeks of treatment. Results The least squares mean difference between epoetin alfa-epbx and epoetin alfa in weekly hemoglobin was −0.12 g/dl and the 95% confidence interval (−0.25 to 0.01) was contained within the prespecified equivalence margin (−0.5 to 0.5 g/dl). The least squares mean difference between epoetin alfa-epbx and epoetin alfa in weekly epoetin dose per kilogram of body weight was 0.37 U/kg per week, and the 95% confidence interval (−10.40 to 11.13) was contained within the prespecified equivalence margin (−45 to 45 U/kg per week). Incidences of adverse events (77.1% versus 75.3%), serious adverse events (24.9% versus 27.0%), and deaths (n=5 versus 6) were similar between the epoetin alfa-epbx and epoetin alfa groups, respectively. Five patients tested positive for anti-recombinant human erythropoietin antibodies at baseline, and two additional patients (n=1 per group) developed anti-recombinant human erythropoietin antibodies while on study treatment. All patients tested negative for neutralizing antibodies, and no patient in either group experienced an event of pure red cell aplasia. Conclusions This 24-week, comparative, clinical trial in patients on hemodialysis with ESKD and anemia demonstrated there is no clinically meaningful difference in efficacy or safety between epoetin alfa-epbx and epoetin alfa.

Recommendations in many of the current design codes like the Eurocode and the AASHTO LRFD Bridge Design Code discount the effect of transverse reinforcement on strength of bottle shaped struts whereas the mechanics of the force system within a bottle-shaped strut suggests otherwise. In this investigation, the effect of amount of transverse reinforcement on strength of steeply inclined normal-strength and high-strength concrete bottle-shaped struts measured in terms of efficiency factors has been experimentally investigated for three transverse reinforcement ratios - 0.0031, 0.0046 and 0.0069, with the control bottle-shaped strut being transversely unreinforced. Efficiency factor increases of 31% and 25% in the normal-strength and the high-strength concrete bottle-shaped struts respectively were obtained when the transverse reinforcement ratio was increased from nil to 0.0031 whereas for the higher reinforcement ratios the increase in efficiency factor was relatively smaller. Service load crack widths in all the transversely reinforced struts were less than an upper bound value of 0.3 mm. The results of this investigation emphasise the role of transverse reinforcement in the strength of bottle-shaped struts and indicate that the 0.003 transverse reinforcement ratio recommended in the ACI 318-14 Building Code is the optimum amount of such reinforcement in normal-strength and high-strength concrete bottle-shaped struts.

Residual solid and liquid streams from the one-pot CRUDE (Conversion of Raw and Untreated Disposal into Ethanol) process were treated with two separate biochemical routes for renewable energy transformation. The solid residual stream was subjected to thermophilic anaerobic digestion (TAD), which produced 95 ± 7 L methane kg−1 volatile solid with an overall energy efficiency of 12.9 ± 1.7%. A methanotroph, Methyloferula sp., was deployed for oxidation of mixed TAD biogas into methanol. The residual liquid stream from CRUDE process was used in a Microbial Fuel Cell (MFC) to produce electricity. Material balance calculations confirmed the integration of biochemical routes (i.e. CRUDE, TAD, and MFC) for developing a sustainable approach of energy regeneration. The current work demonstrates the utilization of different residual streams originated after food waste processing to release minimal organic load to the environment.

Background From the past few decades, remarkable awareness has laid on the use of herbal medicines in pharmaceutical research. Thymoquinone (TQ), the main chemical constituent of Nigella Sativa (NS) plant, has been extensively explored, and revealed an array of therapeutic benefits, in different in vitro, and in vivo conditions. This review provides brief outline of the diverse therapeutics actions of TQ, and NS, viz. anti-oxidant, anti-inflammatory, anti-cancer, anti-diabetic, gastroprotective, hepato-protective, anti-microbial and anti-histaminic. Besides, a special emphasis has given on the use of colloidal drug delivery systems exploited hitherto, for the effective delivery of TQ and NS. Objective The main objective of the review was to include an intensive patent literature, available on TQ and NS, for its usefulness in different therapeutic conditions. Methods We embarked an organized search of bibliographic databases for peer-reviewed research literature and patent databases. The characteristics of screened papers were described, and a rational qualitative content analysis approach was applied to analyze the interventions and findings of included studies using a theoretical framework. Results In the past, various studies have carried out which undoubtedly vouch for the multifarious therapeutic roles of TQ in an array of different diseases. More than 670 research papers and around 50 review articles are available on TQ and NS in PubMed database until now, suggesting its high significance. Around 12 review articles published only on the anticancer potential, while the others on its anti- inflammatory and anti-oxidant potential. Around 120 papers included in the review revealed the therapeutic benefits of TQ. In addition to this, an intensive patent literature is also available on TQ and NS, for its usefulness in different therapeutic conditions. Conclusion The findings of this review confirm the effectiveness of TQ in various pathologies viz. inflammation, cancer, diabetes, gastric, hepatic, microbial and allergies. However, the complete clinical benefit of TQ has not yet been realized, owing to its poor biopharmaceutical properties. Nevertheless, colloidal drug delivery carrier systems, could be impending in bringing forth this potential molecule to reality.

Diabetes mellitus (DM) is a chronic metabolic condition and a major public health problem. It is associated with many musculoskeletal manifestations which are usually under-recognized and poorly treated, as compared to other complications like neuropathy, nephropathy and retinopathy. These manifestations affect the joints, soft tissues and the bones leading to alterations in musculoskeletal system of the patient. This article reviews the major rheumatological problems of diabetes mellitus including their management.J Enam Med Col 2018; 8(2): 94-100

Galactosylated nanocarriers have recently emerged as viable and versatile tools to deliver drugs at an optimal rate specifically to their target tissues or cells, thus maximizing their therapeutic benefits while circumventing off-target effects. The abundance of lectin receptors on cell surfaces makes the galactosylated carriers suitable for the targeted delivery of bioactives. Additionally, tethering of galactose (GAL) to various carriers, including micelles, liposomes, and nanoparticles (NPs), might also be appropriate for drug delivery. Here, we review recent advances in the development of galactosylated nanocarriers for active tumor targeting. We also provide a brief overview of the targeting mechanisms and cell receptor theory involved in the ligand-receptor-mediated delivery of drug carriers.

Objective: There are no community based, longitudinal, intra individual epidemiological studies on effect of weather and season on blood pressure (BP). We evaluated the effect of season and temperature on prevalence and epidemiology of BP in tropical climate. Methods and results: It was a longitudinal cross sectional survey of rural and urban subjects in their native surroundings. BP was measured in four different seasons in same subjects. A total of 978 subjects (452 rural and 521 urban) were included in the current analysis. Demographic characteristics such as age, gender, education, occupational based physical activity and body mass index (BMI) were recorded. Mean BP, both systolic and diastolic were significantly higher in winter season as compared to summer season. Mean difference between winter and summer was 9.01 (95% CI: 7.74–10.28, p

In the present study, water-soluble lysine-based C60-fullerene nanoconjugates (CF-LYS-TEG-MMF) were synthesized using a biodegradable linker for the better delivery of monomethyl fumarate (MMF) employing Prato reaction. CF-LYS-TEG-MMF resulted in enhanced cytotoxicity on neuroblastoma cells, meanwhile found to be substantially biocompatible to erythrocytes. The designed nanoconjugate exhibited a pH-based drug release pattern, minimizing the leaching of drug at plasma pH. However, the carrier offered maximum drug release at cancer cell pH, indicating huge promise in internalization of drug molecules at the site of target. The pharmacokinetics of MMF in rodents was significantly improved in terms of enhanced bioavailable drug fraction in the central compartment, reduced drug clearance, elevated plasma concentrations and prolonged biological residence of drug. Enhanced in vitro efficacy in SH-SY5Y neuroblastoma cells, improved erythrocyte compatibility, high drug loading, and conducive pharmacokinetic profil...

An analytical formulation based on the truss analogy has been used for prediction of shear capacity in uncracked ‘push-off’ specimens made with natural concrete and with recycled aggregate concrete. The analytical model shows that shear capacity is a function of tie force across the shear plane. This tie force is reckoned to consist of the tensile capacity of concrete in the shear plane and the tensile force resisted by the clamping reinforcement bridging the shear plane. It is shown that if the ‘concrete contribution’ to this tie force can be estimated, then the amount of clamping reinforcement required to furnish the balance of the force in the tie can be determined for the condition of yielding of this reinforcement. The proposed methodology has been validated by comparing the predicted amounts of clamping reinforcement required to resist reported shear capacities in the literature with the provided values. Based on the shear friction theory, design for push-off shear capacity using strut-and-tie models has been proposed.

Radiation processing of soybean, varying in seed coat colour, was carried out at dose levels of 0.25, 0.5 and 1 kGy to evaluate their potential anti-proliferative and cytoprotective effects in an in vitro cell culture system. Irradiated and control black (Kalitur) and yellow (DS9712) soybean extracts were characterized in terms of total phenolics, flavonoids and anthocyanins, especially cyanidin-3-glucoside (C3G). Using an epithelial cell line, BEAS-2B the potential cytoprotective effects of soybean extracts were evaluated in terms of intracellular ROS levels and cell viability. The most relevant scavenging effect was found in Kalitur, with 78% decrease in ROS, which well correlated with a 33% increase in C3G after a 1 kGy dose. Results evidenced a correspondence between in vitro antioxidant activity and a potential health property of black soybean extracts, exemplifying the nutraceutical role of C3G. To our knowledge this study is the first report validating the cytoprotective effects of irradiated black soybean extracts.

Objectives: To develop mathematical model for prediction of impact toughness of friction stir welded ZE-41 magnesium alloy joints. Methods/Analysis: Friction stir welded joints were fabricated using five different tool geometries. Total 31 experiments as dictated by central composite design technique with 4 factors, 5 levels were conducted. Model was developed using data obtained from this investigation. F-Test and Student’s t-test were conducted to investigate the adequacy of model. It was found that developed model is adequate. Findings: It can be concluded from the present research that taper cylindrical tool pin produced highest impact toughness as compared with other tool pins used. Threaded cylindrical pin yielded lowest impact toughness of the joint. It was further observed that welding speed have a profound effect on impact toughness. With increment in weld speed impact toughness increased to 4.5J then decreased with further increase in welding speed. Similar trend had been followed when tool rotational speed was varied. Micrographs of stir zone also support above results. Optimum parameters for obtaining maximum toughness had been presented. Application/Improvement: A novel mathematical model useful for prediction of impact toughness for improving the weld quality, commercially useful in aircraft, automotive and consumer electronic sectors. Keywords: Friction Stir Welding, Impact Toughness, Rare Earth, Response Surface Methodology, ZE-41 Magnesium Alloy

Aim: The aim of the current study was to investigate the therapeutic efficacy of cationic-charged bilayered nanoemulsion for topical delivery of fusidic acid in eradicating methicillin-resistant Staphylococcus aureus (MRSA) bacterial burn wound infection. Materials & methods: The developed carriers were characterized for particle size, antibacterial activity, cell viability assay in HaCat cell lines, rheological profile, ex vivo and in vivo studies, namely, full thickness MRSA 33591 murine burn wound infection via topical route. Results: The developed cationic bilayered nanogel offered enhanced drug permeation, reduction in bacterial load and enhanced wound contraction along with faster re-epithelialization in burn wounds. Conclusion: The results encourage the exploration of the potential of cationic nanogel in treating resistant microorganisms such as MRSA, especially for application in burn wound infection.

The work describes systematic development of nanomicellar cationic supersaturable self-nanoemulsifying drug delivery systems (CS-SNEDDS) for augmenting oral biopharmaceutical performance of raloxifene hydrochloride. Plain SNEDDS formulation containing Capryol 90, Cremophor RH 40, and Transcutol HP was optimized using D-optimal mixture design. SNEDDS were characterized for emulsification time, globule size, in vitro drug release, and ex vivo permeation. The CS-SNEDDS formulation was prepared from the optimized SNEDDS by adding oleylamine as the cationic charge inducer and HPMC as the polymeric precipitation inhibitor. Evaluation of CS-SNEDDS was carried out through in vitro cell line studies on Caco-2 and MCF-7 cells, in situ perfusion, and in vivo pharmacokinetic studies, which indicated significant improvement in biopharmaceutical attributes of the drug from CS-SNEDDS over plain drug.

X-ray photoelectron spectroscopy (XPS) and time-of-flight secondary ion mass spectrometry (ToF-SIMS) are much used analytical techniques that provide information about the outermost atomic and molecular layers of materials. In this work, we discuss the application of multivariate spectral techniques, including principal component analysis (PCA) and multivariate curve resolution (MCR), to the analysis of XPS and ToF-SIMS depth profiles. Multivariate analyses often provide insight into data sets that is not easily obtained in a univariate fashion. Pattern recognition entropy (PRE), which has its roots in Shannon’s information theory, is also introduced. This approach is not the same as the mutual information/entropy approaches sometimes used in data processing. A discussion of the theory of each technique is presented. PCA, MCR, and PRE are applied to four different data sets obtained from: a ToF-SIMS depth profile through ca. 100 nm of plasma polymerized C3F6 on Si, a ToF-SIMS depth profile through ca. 100 nm of plasma polymerized PNIPAM (poly (N-isopropylacrylamide)) on Si, an XPS depth profile through a film of SiO2 on Si, and an XPS depth profile through a film of Ta2O5 on Ta. PCA, MCR, and PRE reveal the presence of interfaces in the films, and often indicate that the first few scans in the depth profiles are different from those that follow. PRE and backward difference PRE provide this information in a straightforward fashion. Rises in the PRE signals at interfaces suggest greater complexity to the corresponding spectra. Results from PCA, especially for the higher principal components, were sometimes difficult to understand. MCR analyses were generally more interpretable.

The problem of data truncation in Computed Tomography (CT) is caused by the missing data when the patient exceeds the Scan Field of View (SFOV) of a CT scanner. The reconstruction of a truncated scan produces severe truncation artifacts both inside and outside the SFOV. We have employed a deep learning-based approach to extend the field of view and suppress truncation artifacts. Thereby, our aim is to generate a good estimate of the real patient data and not to provide a perfect and diagnostic image even in regions beyond the SFOV of the CT scanner. This estimate could then be used as an input to higher order reconstruction algorithms [1]. To evaluate the influence of the network structure and layout on the results, three convolutional neural networks (CNNs), in particular a general CNN called ConvNet, an autoencoder, and the U-Net architecture have been investigated in this paper. Additionally, the impact of L1, L2, structural dissimilarity and perceptual loss functions on the neural network’s learning have been assessed and evaluated. The evaluation of data set comprising 12 truncated test patients demonstrated that the U-Net in combination with the structural dissimilarity loss showed the best performance in terms of image restoration in regions beyond the SFOV of the CT scanner. Moreover, this network produced the best mean absolute error, L1, L2, and structural dissimilarity evaluation measures on the test set compared to other applied networks. Therefore, it is possible to achieve truncation artifact removal using deep learning techniques.

An increase in technological interventions and ruthless urbanization in the name of development has deteriorated our environment over time and caused the buildup of heavy metals (HMs) in the soil and water resources. These heavy metals are gaining increased access into our food chain through the plant and/or animal-based products, to adversely impact human health. The issue of how to restrict the entry of HMs or modulate their response in event of their ingress into the plant system is worrisome. The current knowledge on the interactive-regulatory role and contribution of different physical, biophysical, biochemical, physiological, and molecular factors that determine the heavy metal availability-uptake-partitioning dynamics in the soil-plant-environment needs to be updated. The present review critically analyses the interactive overlaps between different adaptation and tolerance strategies that may be causally related to their cellular localization, conjugation and homeostasis, a relative affinity for the transporters, rhizosphere modifications, activation of efflux pumps and vacuolar sequestration that singly or collectively determine a plant's response to HM stress. Recently postulated role of gaseous pollutants such as SO2 and other secondary metabolites in heavy metal tolerance, which may be regulated at the whole plant and/or tissue/cell is discussed to delineate and work towards a “not so heavy” response of plants to heavy metals present in the contaminated soils.

The aim of this study is to find out whether ultrasonic nanocrystal surface modification (UNSM) is capable of having a considerable impact on dry tribological and slurry erosion performance of Ni-based microwave clads. The non-reinforced and Cr7C3 reinforced Ni-based clads were produced using a microwave cladding method. The application of UNSM treatment reduced the surface roughness of the clads. The UNSM-induced effective depth of 200–350 μm refines the grain structure that influences the hardness. Interestingly, the effectiveness of UNSM treatment was weakened for the non-reinforced clad in dry tribology, whereas similar results were obtained for the reinforced clad in slurry erosion testing. Wear and slurry erosion mechanisms were comprehensively discussed based on the worn-out surface characterizations.

Cerebral malaria (CM) is a deadly neural disease caused by Plasmodium falciparum, affecting predominantly the immunosuppressed people. A combination of artemether (AM) and lumefantrine (LMF) is indicated as the first-line therapy in CM. Being a UV-inactive molecule, AM is difficult to analyse in large set of samples using a routine approach. Wide usage and analytical challenges with AM-LMF call for developing a simple, robust and economical method for simultaneous estimation of AM and LMF. The current studies endeavour to develop and validate a derivatization-based HPTLC densitometry methodology, wherein the influence of various derivatization parameters on the sensitivity and assay of both the drug(s) has been studied and optimized too. Effective chromatographic separation of AM and LMF was achieved with mobile phase, consisting of n-hexane: ethyl acetate (8:2 v/v), with good linearity in the concentration range 25–800 ng/spot and 10-800ng/spot for AM and LMF, respectively. High degree of accuracy, precision, robustness, ruggedness, and sensitivity were observed during validation studies. Well-resolved peaks along with high recovery of both the molecules were attained from biological and formulation matrices. The aforesaid method was subsequently employed to evaluate the brain biodistribution of the drugs following intranasal administration of their co-loaded lipid-based nanoformulation in C57BL/6 mice. In a nutshell, the developed method showed immense utility in the simultaneous estimation AM and LMF for analysis of large number of in-process samples, lipid-based nanoformulations and biological matrices.

Metabolism of polyunsaturated fatty acids results in the formation of hydroxylated fatty acids that can be further oxidized by dehydrogenases, often resulting in the formation of electrophilic, α,β-unsaturated ketone containing fatty acids. As electrophiles are associated with redox signaling, we sought to investigate the metabolism of the oxo-fatty acid products in relation to their double bond architecture. Using an untargeted liquid chromatography mass spectrometry approach, we identified mono- and di-saturated products of the arachidonic acid-derived 11-oxoeicosatetraenoic acid (11-oxoETE) and mono-saturated metabolites of 15-oxoETE and docosahexaenoic acid-derived 17-oxodocosahexaenoinc acid (17-oxoDHA) in both human A549 lung carcinoma and umbilical vein endothelial cells. Notably, mono-saturated oxo-fatty acids maintained their electrophilicity as determined by nucleophilic conjugation to glutathione while a second saturation of 11-oxoETE resulted in a loss of electrophilicity. These results would suggest that prostaglandin reductase (PTGR1), known for its reduction of the α,β-unsaturated double bond, was not responsible for the saturation of oxo-fatty acids. Surprisingly, knockdown of PTGR1 expression by shRNA confirmed its participation in the formation of 15-oxoETE and 17-oxoDHA mono-saturated metabolites. Furthermore, overexpression of PTGR1 in A549 cells increased the rate and total amount of oxo-fatty acid saturation. These findings will further facilitate the study of electrophilic fatty acid metabolism and signaling in the context of inflammatory diseases and cancer where they have been shown to have anti-inflammatory and anti-proliferative signaling properties.HighlightsPrimary saturation of electrophilic fatty acids does not abolish biological activity.Prostaglandin reductase 1 reduces double bonds in fatty acids that are structurally similar to 15-keto-prostaglandin E2.Prostaglandin reductase 1 reduces non-carbonyl adjacent double bonds.

A 78-year-old man with hypertension presented with dry cough and gradually progressive dyspnoea for 3 months. The patient had an audible stridor. Cardiovascular examination was unremarkable. Respiratory system examination revealed both inspiratory and expiratory grunting sound. Laboratory investigations were normal. Electrocardiography showed sinus rhythm with left ventricular hypertrophy (LVH). Chest X-ray showed superior mediastinal widening. Transthoracic echocardiography showed preserved LV functions and dilated aortic arch. Contrast-enhanced computed tomography of the thorax showed a huge aortic arch aneurysm compressing the adjacent trachea. The patient was planned for hybrid aortic arch repair but the patient refused and was discharged on antihypertensive, antiplatelet and statin therapy. The patient continued to have limiting cough, dyspnoea and stridor for 4 months of follow-up until he suddenly died while at home. This case highlights an unusual presentation of a potentially lethal disease. Evaluation of patients presenting with cough and dyspnoea should not be restricted to respiratory diseases. The critical observations made from history.