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Background: Tuberculosis is a contagion from ancient times comprising around one 3rd of global population on the wedge of infection with Mycobacterium tuberculosis complex where under developed and developing countries is coping with high burden of the disease. Aim: To observe the most prevalent occupation and treatment outcome in both Genders of MDR TB patients. Methodology: Health Research Institute-National Institute of Health TB Research Centre in collaboration with Department of Pulmonology, King Edward Medical University/Mayo Hospital Lahore from january 2014 to December 2020. A pre-designed questionnaire was used to collect data from MDR Tb patients after verbal informed consent. Patients were followed to see the final outcome on completion of anti-tubercle treatment. Data was entered and analyzed by using SPSS. Results: Out of total 450 MDR TB patients analyzed in this study a higher proportion of 54.9% were males and 45.1% were females with an overall mean age of patients as 39.64±17.52 years. Most of 159(35.4%) patients had no skills and were labors whereas most of 145 (28.2%) females were house wives. Almost 71% of the patients successfully completed the treatment including 45% cured on the basis of availability of final smear and culture reports.. Conclusion: A high mortality rate of MDR TB patients was observed while most of the TB patients in this study belong to labor class while most of the women were housewives. Keywords: Tuberculosis, MDR TB, Occupation, Treatment outcome, loss to follow up.

Plasmodium vivax malaria is one of the most common vector-borne parasitic infections worldwide. P. vivax clinical manifestations include lung injury, renal dysfunction, hepatic dysfunction and extreme thrombocytopenia etc. P. vivax contributes around 70% of malaria cases in Pakistan with variable severity, but 47% of total severe vivax malaria cases have been reported in India. Elimination of P. vivax is very difficult because of its ability to form dormant stages of the liver. Insecticidetreated nets and insecticides are used to control malaria in malaria-endemic regions. Chloroquine is used as the first line of the agent in P. vivax malaria treatment. ACTs are also very effective because of their fast medical and parasitological response than that of chloroquine. Due to increasing drug resistance among P. vivax, scientists have tested with mass drug administration to eradicate malaria. In spite of all this, the P. vivax vaccine would be the last resort in the eradication of P. vivax malaria.

Hyponatremia is a very common electrolyte abnormality, associated with poor short- and long-term outcomes in patients with heart failure (HF). Two opposite processes can result in hyponatremia in this setting: Volume overload with dilutional hypervolemic hyponatremia from congestion, and hypovolemic hyponatremia from excessive use of natriuretics. These two conditions require different therapeutic approaches. While sodium in the form of normal saline can be lifesaving in the second case, the same treatment would exacerbate hyponatremia in the first case. Hypervolemic hyponatremia in HF patients is multifactorial and occurs mainly due to the persistent release of arginine vasopressin (AVP) in the setting of ineffective renal perfusion secondary to low cardiac output. Fluid restriction and loop diuretics remain mainstay treatments for hypervolemic/ dilutional hyponatremia in patients with HF. In recent years, a few strategies, such as AVP antagonists (Tolvaptan, Conivaptan, and Lixivaptan), and hypertonic saline in addition to loop diuretics, have been proposed as potentially promising treatment options for this condition. This review aimed to summarize the current literature on pathogenesis and management of hyponatremia in patients with HF.

Capsella bursa-pastoris has been analyzed for nutritional composition, antioxidant and cytotoxic potential to reveal its nutraceutical and medicinal importance. Methanol and chloroform extracts were used for preliminary phytochemical analysis following quantification of total phenolic, flavonoid, tannins, saponins, and alkaloids. Antioxidant activity was determined by using DPPH, phosphomolybdate, and reducing power assays. Proximate and elemental analysis was performed by using standard methods. Brine shrimp larvae assay was used to determine the cytotoxicity of chloroform and methanol extract. Chloroform and methanol extract of the plant indicated the presence of 1.56×10-4 mg g-1 and 1.28×10-4 mg g-1 phenolic, respectively. The plant was found to have high carbohydrate and protein contents. The high-level mineral composition was determined containing Potassium, Sodium, Iron, Zinc, and Copper. Results of antioxidant activity by the DPPH method indicated IC50 of 235.37 μg ml-1 and 552.01 μg ml-1 for chloroform and methanol extract, respectively. Brine shrimp larvae assay was used to determine the cytotoxicity resulting LD50 of 246.4469 μg ml-1 and 169.85 μg ml-1 of methanol and chloroform extract, respectively. The study inferred that C. bursa-pastoris could serve as a good source of protein and energy as well as micronutrients in the form of a leafy vegetable for human consumption.

Introduction: COVID-19 pandemic has become a major global health challenge, with more than 178 million confirmed cases and over 3.86 million deaths to date. While general and respiratory symptoms are common, it may have atypical GI involvement. We chronicle here an extremely rare case of acute acalculous cholecystitis (AAC) in a patient with COVID-19. Case Description/Methods: A previously healthy 35-year-old male presented to the emergency room with abdominal pain and non-biliary vomiting. He was nonsmoker, nonalcoholic, and drugfree. His vitals revealed: temperature 37.1°C, heart rate 82 bpm, blood pressure 114/72 mm Hg, respiratory rate 16/minute, and an oxygen saturation of 99% in room air. Physical examination revealed a positive Murphy's sign. Laboratory parameters revealed leukocytosis and high CRP level. Abdominal ultrasound showed marked gallbladder wall thickening, normal CBD, with no cholelithiasis or sludge formation. EUS also ruled out stones in the gallbladder. Therein, coronavirus rRTPCR came back positive. CT chest revealed bilateral patchy peripheral ground-glass opacities in the lungs, consistent with COVID-19. Based on these findings and exclusion of probable causes of AAC, COVID-19-related AAC was diagnosed. The patient was initiated on standard COVID-19 treatment for the mild disease and conservative treatment for AAC. His hospital course remained unremarkable, except for fever and dyspnea on day 4 of admission. He remained hemodynamically stable. On day 7 of admission, his abdominal pain, vomiting, and fever disappeared with treatment. On day 9 of admission, he was afebrile, dyspnea had resolved, and had no abdominal pain. He was then discharged home in a stable condition. He continues to do well for 2 months now. Discussion: Published medical literature is bereft of reports on the association between AAC and COVID-19. A PubMed search was conducted for all case reports of AAC amidst COVID-19 till June 2021. Search terms included ''acalculus cholecystitis'' and ''COVID-19''. The search resulted in only 4 case reports to date. This case highlights that the GI symptoms may precede the pulmonary manifestations of COVID-19. It further provides the clinical evidence behind a causal relationship between SARS-CoV-2 infection and biliary involvement. The extrapulmonary symptomology of this infection has not been extensively studied, warranting a high index of suspicion for rare manifestations like AAC. Thus, new-onset GI symptoms may indicate COVID-19, requiring prompt testing for SARSCoV- 2.

Aim: The point of this audit is to direct an individual patient information meta-examination of randomized controlled clinical preliminaries (RCTs) to assess whether benchmark downturn, persistent, and method related components could affect the accomplishment of complete root inclusion. Methods: A written search without any limitation as to status or language of distribution was carried out for MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE, CENTRAL (Cochrane Central Register of Controlled Trials), and the Cochrane Oral Wellbeing Group's specialist register databases up to and including May 2019 to April 2020. Our current research conducted at Jinnah Hospital, Lahore from May 2019 to April 2020. Only controlled trials, a length of ‡6months evaluating areas in recession (Miller's Class I or II) that were treated using root inclusion techniques have been included. Mixed-impact calculated relapse examinations conducted to assess the affiliations between five standard factors and CRC. Results: Of the 76 potentially qualified preliminaries, 24 selected for meta-examination. In total, information from 327 patients and 18 strategies were evaluated. None of the RCTs was delegated in a general manner without risk of predisposition. Of the 602 slowdowns treated, 317 (52.6%) resulted in a CCR. Sub epithelial connective tissue unit (SCTG), lattice unit and lacquer grid-subordinate protein strategies were predominant in achieving CRC when analyzed at coronary progression alone. For the modified covariates, the greater the standard depth of deceleration, the more modest the possibility of performing CRC (single method examination [odds proportion (OR) = 0.57; 96% certainty stretch (CI) = 0.45, 0. 71] and review of collection method [OR = 0.57; 96% CI = 0.46, 0.72]), as well as studies with an irreconcilable situation were more likely to achieve CRC than those without an irreconcilable situation (review of single method [OR = 6.79; 96% CI = 1.79, 26.87]). Conclusion: SCTGs, matrix unions, and EMD were better than CAF in accomplishing CRC, however SCTGs appeared the best consistency. The inconceivability of incorporation of all distinguished RCTs ought to be mulled over when deciphering the current discoveries. Keywords: PROOF BASED PERIODONTAL PLASTIC SURGERY

Aim: Screw-held reclamations supported in some clinical circumstances, for example, restricted between occlusal spaces. This study was intended to think about burdens created in the peri-embed bone in two distinct sorts of screw-held rebuilding efforts (portioned versus non-fragmented projection) utilizing a limited component model. Methods: An embed, 6.3 mm in width and 14 mm long, was set in the main molar site of a mandibular model with 1 mm of cortical bone on the buccal and lingual sides. Our current research conducted at Sir Ganga Ram Hospital, Lahore from March 2019 to February 2020. Fragmented and non-sectioned screw projections with their crowns were set on the mimicked embed in each model. Subsequent to stacking (100 N, pivotal and 45° non-hub), von Mises stress was recorded utilizing ANSYS programming, variant 13.0.1. Results. The greatest concerns with the fragmented projection screw were not exactly those of the fragmented projection (89 vs. 100, and 379 vs. 435 MPa under the pivot and non-pivot stacking, individually). The greatest loads in the peri-nesting bone for the fragmented projection model were not exactly those of the undivided (22 vs. 24 MPa, and 33 vs. 126 MPa under vertical and precise vertical stacking, individually). Similarly, the miniature stress of the peri-embedded bone for the recovery of the fragmented projection was not as great as that of the fragmented projection. Conclusion: Under pivotal and non-hub loadings, non-portioned projection demonstrated less pressure fixation in the screw, while there was less anxiety in the peri-embed bone in the fragmented projection. Keywords: Peri-Implant Bone, Screw-Retained, Finite Element Model.

Introduction: Chronic liver disease is known to be an important prognostic factor in determining morbidity and mortality in preoperative risk assessment and mortality in general. Data are limited on outcomes in patients with infective endocarditis (IE) and comorbid concurrent liver cirrhosis. Objective of our study is to evaluate the clinical outcomes of patient with IE with and without underlying liver cirrhosis and determining in-hospital mortality and outcomes of interest i.e. renal failure, cardiogenic shock, hematologic (coagulopathy/thrombocytopenia) and hepatic complications (hepatic encephalopathy/hepatitis). Hypothesis: Liver Cirrhosis worsen clinical outcomes in patients with IE. Methods: Patients with principle diagnosis of IE with and without liver cirrhosis were identified by querying the Healthcare Cost and Utilization (HCUP) database, specifically, National Inpatient Sample for year 2013 and 2014 based on ICD9 codes. Results: During 2013 and 2014, a total of 17, 952 patients were admitted with diagnosis of IE, out of whom 780 had concurrent liver cirrhosis. There was an increased in-hospital mortality [15.6% vs 10.2%, aOR 1.57(1.27-1.93)], acute kidney injury [41.4% vs 32.6%, aOR 1.45(1.24-1.69)], coagulopathy/thrombocytopenia [32.1 vs 14.7%, aOR 2.87(2.44-3.37)] in patients with IE with liver cirrhosis when compared to patients with IE without liver cirrhosis. IE without liver cirrhosis underwent increased number of interventions i.e. aortic (7.2 vs 3.7%, 0.51(0.34-0.76)] and mitral (4.9% vs 3.4%, aOR 0.39(0.23-0.69)] valvular replacements as compared to without liver cirrhosis. Conclusions: Liver cirrhosis is an important prognostic marker of in-hospital mortality in patients with concurrent IE. High risk surgical state with coagulopathy, bleeding complications, worsening hepatic complications and renal dysfunction lead to higher mortality.

The motivations that drive customers towards purchasing luxury brands have complex psychological underpinnings that warrant careful examination. This research paper examines the effect of brand image (BdI), brand trust (BdT) and brand affect (BdA) on luxury brand buying behavior with an aim to understand consumer motivations towards luxury brands. A structured questionnaire consisting of validated scales for the said constructs was administered to a sample of 390 consumers outside luxury brand stores within the Punjab province of Pakistan. For the data analysis, Partial Least Squares structural equation modeling (PLS-SEM) was used. We assessed the three correlations revealing significant relationships between the constructs. The empirical study makes an important contribution to the luxury brand management literature along with providing productive implications to academicians and experts.

Dieulafoy’s lesion is an abnormally large, tortuous, submucosal vessel that erodes the overlying mucosa, without primary ulceration or erosion. Although these lesions predominantly involve the stomach and upper small intestine, they are being detected with increasing frequency in the rectum. We conducted a systematic literature search of MEDLINE, Cochrane, Embase, and Scopus databases for adult rectal Dieulafoy’s lesion. After careful review of the search results, a total of 101 cases were identified. The data on patient characteristics, clinical features, colonoscopy findings, diagnosis, treatment, and clinical outcomes were collected and analyzed. The mean age of presentation was 66±17 years (range, 18–94 years), with 54% of cases reported in males. Clinical presentation was dominated by acute lower gastrointestinal bleeding in the form of bright-red blood per rectum 47% and hematochezia 36%, whereas 16% of patients were admitted with symptoms related to other medical conditions. Major underlying disorders were hypertension 29%, diabetes mellitus 21%, and chronic kidney disease 16%. The average number of colonoscopies required for the diagnosis of rectal Dieulafoy’s lesion was 1.5±0.7. In regard to treatment, endoscopic therapy was applied in 80%, direct surgical suturing in 12%, angiographic embolization in 4%, and endoscopic therapy followed by surgical ligation was performed in 4% of patients. The endoscopic treatment was a feasible choice for rectal disease, with a primary hemostasis rate of 88%. Although the overall mortality rate was 6%, the causes of death were unrelated to this entity. This review illustrates that patients with rectal Dieulafoy’s lesion can have a favorable clinical outcome. Prompt diagnosis and appropriate management are of paramount importance to prevent serious hemodynamic complications. The best therapeutic modality remains to be determined but the data presented here support the use of mechanical endoscopic methods as safe and effective.

In 2014, the World Health Organization was notified of an outbreak of a communicable disease characterized by fever, severe diarrhea, vomiting, and a high fatality rate in Guinea. Virologic investigation identified Zaire ebolavirus (EBOV) as the causative agent. Approximately 30 years after the first epidemic, there is no vaccine or therapeutic medication approved to counter the Ebola virus. In this review, it emphasized that plant based antibodies can be an effective cure to Ebola hemorrhagic fever. Genetically modified Nicotiana benthamiana is used to manufacture ZMapp drug by Kentucky BioProcessing. ZMapp three-antibody cocktail binds to the Ebola virus to deactivate it and provides simulated immune response against sugar-tagged proteins on the outside of the Ebola virus, which had verified efficacy against Ebola infection in nonhuman primates and also successfully treated two American medical workers infected with Ebola virus disease.

In terrestrial landscape architecture, land surface temperature (LST) is a key estimator of local climate, vegetation growth, and urban transition. It also represents the environmental factors that influence the land cover patterns using temperature variation over land use land cover (LULC) classes. In the present study, various geospatial techniques have been implemented to analyze the spatio-temporal trends in temperature among different LULC of an arid Potohar region of Pakistan using Landsat 7 (ETM+) and 8 (OLI & TIRS) and the relationship between different normalized satellite indices and LST. Results of the seasonal fluctuation in winter showed temperature range of 0–57, 0–50, 04–31 and 7–39 °C for the year 2000, 2005, 2010, and 2015, respectively, while the summer exhibited the temperature range of 24–48, 27–57, 22–48, and 12–41 °C for the year 2000, 2005, 2010, and 2015, respectively. The analysis established a direct correlation between LST and normalized difference vegetation index and normalized difference water index, and an indirect correlation among LST and normalized difference soil index, normalized difference built-up index and built-up index. The findings are critically important for planning and development division for sustainable use of land resources for urbanization extension projects. Future research will highlight the change in the area occupied by different land featured classes and their impacts on LST over a specified period.

The main objective of the study is to analyze the gestational weight gain among women with gestational diabetes mellitus in local population of Pakistan. This cross sectional study was conducted in Allama Iqbal Memorial Teaching Hospital, Sialkot during January 2019 to July 2019. The data was collected from 100 female patients according to the ethical committee of hospital during the time period of December 2016 to April 2017. According to the pre-pregnancy BMI, 96 women (11.5%) were underweight, 558 (67.1%) were of normal weight, 134 (16.1%) were overweight and 44 (5.3%) were obese (Table1). The level of glycated hemoglobin was significantly higher in the overweight and obese groups than in normal weight and underweight groups (P&thinsp

The plants provide medicinally valuable substances since ancient time and are the cheapest, oldest, as well as imperative source of pharmacologically active chemical compounds used for the treatment of several diseases. Medicinally, Otostegia limbata (O. limbata) is very imperative species of genus Otostegia which are extensively utilized by traditional practitioners against several ailments and its chemical constituents possess antispasmodic, antiulcer, antidepressant, sedative, anxiolytic, anti-inflammatory for eyes inflammation, antibacterial, antioxidant, haemagglutination activity, cholinesterase inhibition for Alzheimer's treatment, antitussive potential, anti-aphids and larvicidal potential aptitude. The pharmacological impact of O. limbata and their diverse biological activities along with its active constituent are complied in this review. This species provide rich variety of biologically active secondary metabolites. Quite large number of active compounds isolated from O. limbata is the evidence to have considerable potential making them competent candidate for critically required novel drugs.

Viola canescens Wall. ex Roxb. is a perennial herb belonging to family Violaceae, and it is almost cosmopolitan in distribution. This plant is widely used in Ayurveda and Unani medicinal systems for curing various ailments, most commonly for cough and cold. Phytochemical studies releaved that this plant is rich in secondary metabolites. This plant revealed significant antimicrobial, anti-inflamatory, antioxidant, hepatoprotective, laxative, analgesic as well as antitumor activities. Due to all these important pharmacological activities, market demand of Viola canescens is increasing day by day and this plant is facing tremendous over exploitation and becomes a threatened plant according to International Union for Conservation of Nature and Natural Resources. The present review compiles that the ethnobotanical, phytochemical and pharmacological aspects of the plant need to be conserved.

Land use land cover (LULC) patterns are significantly effecting the urban/rural spaces in the encompassing areas. Murree being tourist resort is always under pressure of tourists from all over the country. The population increase in peak season of tourism in summer season and extreme winter, causes a tremendous growth and expansion of urban area of Murree. So a relic of blue pine forest and Chir pine forest is expected to undergo tremendous change and to undergo expansion or degradation depending upon the tourist’s behavior. The present study uses Multi-Temporal Landsat (TM and ETM+ for year 1998, 2003, 2005, 2010) images to detect LULC change in Murree due to the enhanced activities of ecotourism. Change detection of three tourist hotspots of Murree region including Murree Mall, Bhurban and Patriata was evaluated through Maximum Likelihood Classification (MLC) algorithm. The urban expansion has impacted the land use, as it has increased from 57.37% to 69.10%. Result indicates that the Built-up area have increased by 11.73%, reserve forest by 8.11% while grassland and dense natural forest decreases by 7.50 and 12.37 percent respectively. The results provided the better knowledge and understanding of former and current spatial dynamics of LULC change in Murree region along with its ecotourism hotspots.

A 57-year-old obese man presented to our medical centre with abdominal pain for 12 hours. The pain was severe, diffuse, crampy in nature, marked in the lower left abdomen, non-radiating and aggravated after eating and drinking. It was associated with diaphoresis and one episode of non-bloody, non

Hypertriglyceridemic pancreatitis (HTGP) is an uncommon but well-established clinical entity. Although the initial clinical features are similar to pancreatitis due to other etiologies, the severity of the disease and the risk of complications are higher in these patients. Prompt diagnosis and appropriate treatment are crucial in patients with hypertriglyceridemia-induced pancreatitis to avoid life-threatening complications. The initial conservative treatment is applied followed by additional specific therapies tailored to decrease serum triglyceride levels. This includes plasmapheresis, insulin, heparin infusion, and hemofiltration. After the acute episode, lifestyle modifications along with hypolipidemic medications should be initiated to prevent further events. Currently, there is paucity of the medical literature directly comparing different treatment modalities. This article illustrates the use of insulin therapy for HTGP as a feasible therapeutic choice. Randomized controlled trials are warranted to outline a generalized and efficient treatment for this serious disorder.

Ovarian cancer is one of the leading causes of death from gynecologic cancers. In this present era of cancer treatment, therapeutic options for patients with advanced or recurrent ovarian cancer are limited. The present standard of care treatment for advanced ovarian cancer is a platinum-based doublet chemotherapy (paclitaxel and carboplatin with or without bevacizumab) after a maximum attempt of surgical cytoreduction. However, there are no promising options for the management of patients with ovarian cancer refractory to the platinum-based chemotherapy. Therefore, newer, safe, and more effective treatment modalities are required for patients with advanced or recurrent ovarian cancer. Poly(adenosine diphosphate [ADP]-ribose) polymerase (PARP) inhibitors have shown an impressive safety profile and anti-tumor efficacy in patients with breast cancer 1 and 2 (BRCA1 and BRCA2) gene-mutated ovarian cancer who were previously treated with the standard of care chemotherapy. We have done a detailed review of the literature to emphasize the role of PARP inhibitors in the treatment of advanced or relapsed ovarian cancer.

Context: Drug-induced pancreatitis (DIP) is rare, but as there are no systematic data on it, the true incidence is not known. Although numerous and varied drugs have been associated with DIP, the clinical evidence on doxycycline-induced pancreatitis is sparse. Case Report: We present the case of a 58-year-old female who presented with complaints of nausea and severe epigastric pain. Her medications included doxycycline which she had been on for only 2 days. Computed tomography of her abdomen showed mild enlargement of body of the pancreas with peripancreatic fatty infiltration, along with lipase level suggestive of acute pancreatitis. In the absence of classical risk factors for acute pancreatitis, a diagnosis of DIP secondary to doxycycline therapy was made. Immediate withdrawal of the drug was accompanied by relief of symptoms and resolution of pancreatitis. Conclusion: This report implicates doxycycline as an etiological factor for acute pancreatitis. Knowledge regarding doxycycline related pancreatitis is of paramount importance in order to diagnose cases early and institute effective treatment in patients who are undergoing therapy with this drug.

Crotalaria burhia Buch.-Ham. (C. burhia) (Fabaceae), is an undershurb found distributed in arid parts of the world. It extensively grows in Pakistan, India and Afghanistan. It is a highly medicinal plant. The leaves, branches and roots can be used as a cooling medicine. Plant juice is useful for treatments of gout, eczema, hydrophobia, pain and swellings, wounds and cuts, infection, kidney pain, abdominal problems, rheumatism and joint pain in traditional medicine system. The medicinal activity is the result of the presence of various important phytochemicals like alkaloids, flavonoids, phenols, polyphenols, tannins, steroids, triterpenoids, anthraquinones, crotalarine, monocrotaline, croburhine, crosemperine, quercetins and β-sitosterol. C. burhia is also known to possess antimicrobial, anti-inflammatory and antinociceptive activities, which supports its traditional uses. In this article, a comprehensive account of phytochemical constituents and pharmacological activities is presented along with traditional uses of C. burhia.

Background: Leptadenia pyrotechnica is traditionally used for treating various diseases. This species holds variety of bioactive constituents that trigger healing properties. The present review was aimed to analyze nutritional, phytochemical and pharmacological activities of L. pyrotechnica. Materials and Methods: The present review regarding Leptadenia pyrotechnica (Forssk.) Decne. Is the compilation of data from the previous research works conducted by various scientists across the world. Various published papers, medicinal plant databases, etc were utilized to compile the information. Results: L. pyrotechnica is a wonderful desert plant belongs to the family Asclepiadaceae This plant possesses antifungal, antibacterial, anticancer, antioxidant, wound healing, anthelmintic, antiatheroscloretic, hypolipidemic, antdiabetic and hepatoprotective activities coupled with other multifarious uses. Almost all plant parts are used in the traditional medicinal system to treat various disorders. Conclusion: This review includes the substance of different ethnobotanical uses, phytochemistry and exclusive capability of this plant in the field of anti-microbial and human disease activities.

Takotsubo cardiomyopathy (TCM) is a relatively recently recognised clinical entity. It frequently mimics acute coronary syndrome and is accompanied by reversible left ventricular apical ballooning in the absence of angiographically significant coronary artery stenosis. TCM is a reversible condition, and the prognosis is usually well. However, in rare instances, it can be associated with life-threatening arrhythmic complications. Herein, we report the case of a patient with TCM who developed complete atrioventricular block followed by QT prolongation and torsades de pointes. Furthermore, we undertook a literature review of this rare complication of TCM and discussed the formidable therapeutic challenge encountered in such patients.

Campylobacter jejuni enteritis is the most common enteric infection in the developed world. Although rare, pericarditis and myopericarditis have been increasingly documented as complications following campylobacteriosis. The present paper implicates that myopericarditis and non-ischemic cardiomyopathy following Campylobacter jejuni infection might be more prevalent than initially thought and perhaps underreported so far. Therefore, it is imperative to perform the appropriate initial diagnostic testing, including stool cultures, in order to make an accurate diagnosis early in the course of the disease. Identifying the etiology of myopericarditis as bacterial will ensure appropriate treatment with antibiotics in addition to the cardiac medications needed for supportive care.

Infective endocarditis (IE) is a life threatening disease requiring lengthy hospitalizations, complex multidisciplinary management and high health care costs. In this study, we analyzed the National Readmissions' Database (NRD) to identify infective endocarditis cases and the causative organisms, clinical determinants, length of stay, in-hospital mortality, and 30-day hospital readmission rates. The study cohort was derived from Healthcare Cost and Utilization Project's National Readmission Database between 2010-15. We queried the National Readmissions' Database using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic code for infective endocarditis (421.0) and identified a total of 187,438 index admissions. SAS 9.4 (SAS Institute Inc., Cary, NC) was utilized for statistical analyses. A total of 187,438 patients with a primary diagnosis of IE were identified over 6 years (2010-2015). Twenty-four percent (44,151 patients) were readmitted within 30 days. Most common etiologies for readmission included sepsis (14%), acute heart failure (8%), acute kidney injury (6%), intracardiac device infection (5.6%) and recurrence of IE (2.7%). Predictors of increased readmissions included female sex, staphylococcus aureus infection, diabetes, chronic lung disease, chronic liver disease, acute kidney injury, acute heart failure and anemia. In-hospital mortality for the readmission of IE was 13%, and average length of stay during the re-admission was 12 days. IE is associated with high rates of index admission mortality and for 30-day readmissions of which are associated with a substantial risk of death.