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Background: The beta subunit of human Chorionic Gonadotropin (hCG) and TSH are very similar and hCG is known to weakly bind the TSH receptor. hCG induced hyperthyroidism has been previously reported as a rare paraneoplastic syndrome in non-seminomatous germ-cell tumors and usually presents with subclinical thyrotoxicosis. We present a noteworthy case of thyroid storm in a patient with hCG producing testicular Choriocarcinoma. Clinical case: A 19-year-old Hispanic man presented to an outside emergency department (ED) with one day of abdominal pain, nausea, recurrent emesis and subjective fever. He had presented to the same ED 9 days prior with similar symptoms which prompted contrasted CT Abdomen/Pelvis demonstrating hepatic masses and a large right testicular mass, suspicious for primary testicular malignancy. On return evaluation, he was noted to have tachycardia with HR 165, mild scleral icterus, tenderness to palpation of right upper quadrant, abdominal pain and a right scrotal mass (5x5 cm). CBC revealed; WBC 12.0 k/uL (n: 4-10.8), AST: 428 u/L (n: 3-34); ALT: 176 u/L (n: 15-41); total bilirubin: 6.3 mg/dL (n: 0.2-1.3), TSH Conclusion: A low threshold of suspicion should be maintained for the possibility of hyperthyroidism in patients with suspected testicular choriocarcinoma, particularly in the context of recent iodinated contrast imaging. If the clinical picture does not support a primary etiology of hyperthyroidism and hCG is not concordantly elevated, re-assessment of hCG by dilution should be considered as hCG assay is also subject to prozone (hook) effect. Hyperthyroidism should be actively managed and closely monitored as response to treatment can be rapid.

Premature rupture of the membranes is defined as the spontaneous rupture of the chorioamnion before the onset of uterine contractions, this is also known as Prelabour rupture of membrane. In some Indian studies the incidence of PROM is reported as 7-12% in term pregnancy. This study was conducted at Narayana Multispeciality Hospital, Jaipur, Rajasthan, for 7 months of duration (from February 2020 to August 2020). This study was Prospective, Observational and Comparative study. A total 70 term PROM patients were recruited in our study and divided into two groups randomly- 35 (Group A) patients were managed actively by induction of labour and 35 (Group B) patients underwent expectant management. Both these patient groups were studied to compare the feto-maternal outcome. Patients in Actively managed group were induced with iv oxytocin infusion. In Expectantly management group patients were observed to await the spontaneous onset of labour pains for at least 24 hours. In our study vaginal deliveries in actively managed group are 65.7% and in expectantly managed group its 54% and in 51% cases of actively managed cases PROM to delivery interval was less than 12 hours and in 88% cases of expectantly managed group PROM to delivery interval was 12 to 24 hours. APGAR score was notably higher in expectant management group. Therefore, from our study we concluded that immediate induction of labour in term PROM cases favours vaginal deliveries, shortens the PROM to delivery interval and reduces NICU admission rate.

Papillary thyroid cancer is one of the most common endocrine malignancies, and it is often associated with an excellent prognosis. However, it has been shown to recur in the lymph nodes in the neck. The management of these lymph nodes remains controversial, and current treatment strategies include observation, surgery, radioactive iodine ablation, and percutaneous ethanol injection. These various treatment modalities are discussed in this article.

In this work, the successful synthesis of ZnSe nanowires using alumina template by simple and facile electroless template technique has been reported. Morphological characterization of the synthesized nanowires has been done by X-ray diffraction (XRD) and scanning electron microscopy (SEM) measurements. The optical characterizations were conducted by UV–visible and time resolved photo-luminescence. Grain size of synthesized ZnSe nanowires was also calculated using the XRD results. The calculated crystallite size was found to be 6.80 nm. SEM analysis confirms the fabrication of nanowires successfully and it also confirms the size of the nanowires as per the template parameters. The calculated band gap value of 3.03 eV shows the origin of quantum confinement effect in ZnSe nanowires even at the 100 nm scale. The time resolved photoluminescence result indicates that the ZnSe nanowires can be a promising material for luminescent applications in micro-second time domain.

Determining the pretest probability of angiographically significant (≥50% stenosis) coronary artery disease (CAD) in symptomatic patients relies on the Diamond and Forrester (DF) classification, which was derived from a cohort referred for invasive coronary angiography. The accuracy of this approach in patients referred for noninvasive coronary angiography is not fully known. Consecutive patients without known CAD referred for coronary computed tomographic angiography (CCTA) were evaluated. Chest pain was prospectively categorized as nonanginal, atypical angina, typical angina, or asymptomatic. The pretest likelihood of angiographically significant CAD was estimated using DF classification and compared with observed rates of angiographically significant CAD on CCTA. Among 1,027 patients (41% women; mean age 50 ± 12 years), 38 (4%) had nonanginal symptoms, 643 (63%) had atypical angina, 72 (7%) had typical angina, and 274 (26%) were asymptomatic. The prevalence of angiographically significant CAD in patients with nonanginal chest pain, atypical angina, typical angina, and no symptoms was 1 (3%), 55 (9%), 14 (19%), and 25 (9%), respectively (p0.001). DF classification significantly overestimated angiographically significant CAD prevalence across all symptom classifications, genders, and ages despite adjustment for risk factors (p0.001 for all comparisons). DF classification had an area under the receiver-operating characteristic curve of 0.72 (95% confidence interval 0.66 to 0.78), which was not significantly different from age alone (0.69) or age, symptoms, and risk factors (0.68). In conclusion, in a low- to intermediate-risk cohort referred for CCTA, DF classification significantly overestimated angiographically significant CAD prevalence across all age, gender, and symptom strata. The DF classification may overestimate the pretest probability of angiographically significant CAD in contemporary patients referred for CCTA.

Objectives The purpose of this study was to describe the prevalence and severity of coronary artery disease (CAD) in relation to prognosis in symptomatic patients without coronary artery calcification (CAC) undergoing coronary computed tomography angiography (CCTA). Background The frequency and clinical relevance of CAD in patients without CAC are unclear. Methods We identified 10,037 symptomatic patients without CAD who underwent concomitant CCTA and CAC scoring. CAD was assessed as Results Mean age was 57 years, 56% were men, and 51% had a CAC score of 0. Among patients with a CAC score of 0, 84% had no CAD, 13% had nonobstructive stenosis, and 3.5% had ≥50% stenosis (1.4% had ≥70% stenosis) on CCTA. A CAC score >0 had a sensitivity, specificity, and negative and positive predictive values for stenosis ≥50% of 89%, 59%, 96%, and 29%, respectively. During a median of 2.1 years, there was no difference in mortality among patients with a CAC score of 0 irrespective of obstructive CAD. Among 8,907 patients with follow-up for the composite endpoint, 3.9% with a CAC score of 0 and ≥50% stenosis experienced an event (hazard ratio: 5.7; 95% confidence interval: 2.5 to 13.1; p Conclusions In symptomatic patients with a CAC score of 0, obstructive CAD is possible and is associated with increased cardiovascular events. CAC scoring did not add incremental prognostic information to CCTA.

Trimethylsilyl-substituted N-arylsalicylaldiminates Me3Si (OC6H4CH═NAr) [Ar═C6H5 (1), C6H3Me2-2,6 (2), C6H2Me3-2,4,6 (3), C6H3Et2-2,6 (4), and C6H3(Pr-i)2-2,6 (5)] have been prepared by the equimolar reactions of Me3SiCl with N-arylsalicylaldimines (LH) in benzene using Et3N as a base. Reactions in the desired molar ratios (1:1 or 2:1) of Me3Si(OC6H4CH═NAr) with TiCl4 and ZrCl4 afford a convenient and clean synthetic procedure for the preparation of chloride-salicylaldiminate derivatives of early transition metals. Characterisations of all these new derivatives have been carried out by elemental analyses, molecular weight determinations and spectroscopic [IR, NMR (1H, 13C and 29Si)] studies.

We sought to assess the prognostic value of coronary computed tomography angiography (CCTA) among military health care system beneficiaries. We identified 1,125 consecutive symptomatic patients without known coronary artery disease (CAD) referred for 64-slice CCTA (2006-2010) at a single center. CAD was assessed as none,50%, oror = 50% (obstructive) coronary stenosis. A combined endpoint of major adverse events (death, myocardial infarction [MI], coronary revascularization90 days after CCTA) was assessed by Kaplan-Meier and Cox proportional hazards. The mean age was 50 +/- 12 years, 59% were male, and 617 (55%) had no CAD, 411 (37%) nonobstructive CAD, and 97 (9%) obstructive CAD on CCTA. During 2.0 +/- 1.1-year follow-up, there were 6 deaths, 3 MIs, and 6 revascularizations. There was 1 event in the no-CAD group (0.08%/year), 4 events in the nonobstructive group (0.5%/year), and 9 events in patients with obstructive CAD (4.5%/year) (p0.001). Patients with obstructive CAD had significantly increased combined adverse events. Increasing angina typicality and risk factors (hazard ratio [HR] 1.24, 95% confidence interval [CI] 1.05-1.46; p = 0.01) and obstructive CAD (HR 12.1, 95% CI 3.99-36.9; p0.001) were independently predictive of events. Absence of CAD was associated with very low event rates, providing military health care system patients and providers confidence in regards to cardiovascular risk, future deployments, and occupational assignments.

Reactions of MeSiC13 in 1:1, 1:2, and 1:3 molar ratios with HOC6H4CH=NAr (Ar = C6H3Me2-2,6; C6H2Me3-2,4,6; and C6H3Et2-2,6) in the presence of Et3N or C5H5N as a base afford compounds of the type MeSiCl3-x(OC6H4CH=N Ar)x (X = 1, 2, and 3). Characterization of all these species have been carried out by elemental analysis, molecular weight determinations, and spectroscopic [IR, NMR (1H, 13C and “Si)] studies.

In dimethyl sulphoxide the dianions derived from 2,3- or 3,4-dihydroxybenzaldehydes and 4-methylesculetin afford products corresponding to alkylation at the less acidic site while the monoanions give the isomeric phenols.