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A 68-year-old man with a severe ischemic cardiomyopathy underwent left ventricular assist device (LVAD) implantation (Heart Mate II device) for destination therapy. He presented 49 months after LVAD implantation with worsening heart failure symptoms and new severe aortic regurgitation. Given high risk for both surgical and transcatheter aortic valve replacement, he was admitted for transcatheter closure of the aortic valve under transesophageal echocardiographic (TEE) guidance. TEE imaging revealed severe aortic regurgitation (Fig. 1A and B and Videos 1 and 2). Under TEE and fluoroscopic guidance, a 25 mm Amplatzer cribriform atrial septal defect closure device was advanced across the aortic valve (Fig. 1C and D and Videos 3 and 4). Immediately after device deployment, TEE revealed a well-seated device with complete aortic valve closure and trivial aortic regurgitation (Fig. 2A, B, C and D and Videos 5, 6, 7 and 8). Subsequent transthoracic echocardiograms obtained from 74 to 172 days after the procedure revealed no residual aortic regurgitation. The patient awoke with diffuse urticaria 244 days after the procedure and died en route to the emergency department, presumably secondary to a systemic allergic reaction. De novo aortic regurgitation is increasingly recognized in patients with LVADs (1). TEE-guided transcatheter aortic valve closure is an option in these high-risk patients (2).

An 84-year-old man presented 5 years after bioprosthetic mitral valve replacement with three months of worsening dyspnea on exertion. A new mitral stenosis murmur was noted on physical examination, and an electrocardiogram revealed newly recognized atrial fibrillation. Severe mitral stenosis (mean gradient = 13 mmHg) was confirmed by transthoracic echocardiography. Transesophageal echocardiography revealed markedly thickened mitral bioprosthetic leaflets with limited mobility, and a massive left atrial thrombus (>4 cm in diameter) (Fig. 1A, B, C, D and Videos 1, 2, 3 and 4). Intravenous heparin was initiated, and 5 days later, he was taken to the operating room for planned redo mitral valve replacement and left atrial thrombus extraction. Intraoperative transesophageal echocardiography revealed near-complete resolution of the bioprosthetic leaflet thickening, and a mean mitral gradient of only 3 mmHg (Fig. 2A, B, C and Videos 5, 6 and 7). The patient underwent resection of the massive left atrial thrombus (Fig. 2D) but did not require redo mitral valve replacement. He was initiated on heparin (and transitioned to warfarin) early in the post-operative period, with complete resolution of dyspnea on exertion at 3-month follow-up. Bioprosthetic valve thrombosis is increasingly recognized as a cause of early prosthetic valve dysfunction (1, 2). This case illustrates that bioprosthetic valve thrombosis may occur years after valve replacement; therefore, any deterioration in a patient’s clinical status (new-onset dyspnea, heart failure or atrial fibrillation) warrants a thorough evaluation of the bioprosthetic valve with transesophageal echocardiography. In this case, initiation of anticoagulation obviated the need for redo mitral valve replacement.

The field experiments were conducted in semi-arid region during rabi seasons of 2015-16 and 2016-17 to study the effect of integrated nutrient management practices on water productivity and profitability of hyacinth in baby corn - hyacinth bean cropping system. Experiment was laid in Randomized Block Design for baby corn during kharif 2015 with seven treatments comprised of 100% recommended dose of fertilizers (RDF 150:27:50 N, P and K kg ha-1), 25% N supplemented through farm yard manure or vermicompost+75% RDF with or without bio-fertilizers Azospirillum and Bacillus megaterium @ 5 kg ha-1 each in addition to control and replicated thrice. Each main treatment was divided into four subplots and the treatments of 100% RDF (20-22 N, P kg ha-1) and 75% RDF with or without Bradyrhizobium @ 500 g ha-1 (seed treatment) were imposed for hyacinth bean in rabi seasons and data was analyzed in split plot design. Integration of 100% RDF in conjunction with Bradyrhizobium seed treatment to hyacinth bean resulted in significantly higher water productivity, gross and net returns and maximum B:C during rabicompared to 100% RDF, 75% RDF with or without seed treatment. Integration of 75% RDF with 25% N through FYM along with biofertilizers to kharif baby corn showed significantly higher water productivity, gross and net returns of hyacinth bean during rabiover rest of the treatments of 100% RDF with or without biofertilizers and un-fertilized control but was at par with other organic treatments with or without biofertilizers due to residual effect. [ABSTRACT FROM AUTHOR]

The field experiments were conducted at Horticultural Research Station, SKLTSHU, Adilabad, Telangana State, India during rabi seasons (October-February) of 2015-16 and 2016-17 to study the effect of Integrated Nutrient Management practices on dry matter production and nutrient uptake of hyacinth bean in baby corn-hyacinth bean cropping system. Experiment was laid in Randomized Block Design for baby corn during kharif 2015 with seven treatments comprised of 100% recommended dose of fertilizers (RDF 150:60:60 N, P2O5 and K2O kg ha-1), 25% N supplemented through farm yard manure or vermicompost+75% RDF with or without bio-fertilizers Azospirillum and Bacillus megaterium @ 5 kg ha-1 each in addition to control and replicated thrice. Each main treatment was divided into four subplots and the treatments of 100% RDF (20-50 N, P2O5 kg ha-1) and 75% RDF with or without Bradyrhizobium @ 500 g ha-1 (seed treatment) were imposed for hyacinth bean in rabi season and data of rabi 2015-16 and 2016-17 was analyzed in split plot design. Application of 25% N through FYM in conjunction with 75% RDF and bio-fertilizer to baby corn during kharif and 100% RDF along with seed treatment with Bradyrhizobium to hyacinth bean during rabi resulted in significantly higher dry matter production at various growth stages and nutrient uptake (nitrogen, phosphorus and potassium) over rest of the treatments. [ABSTRACT FROM AUTHOR]

Household products with potentially harmful effects are common constituent of each household. Abuse or accidental exposure to large quantities of these household products can lead to serious outcomes. Thus, knowledge of the poisonous effects of common household products is essential to both general public and physicians. Dettol is one such common household product, which is freely available in India as an effective antiseptic liquid. In cases of Dettol consumption, gastric lavage should be avoided. If required, it should be performed using a wide bore gastric lavage tube only after the airways are adequately protected. The physicians should be well aware of the risks of aspiration and airway obstruction in Dettol poisoning. [ABSTRACT FROM AUTHOR]

Background: Morbidity and mortality related to acute poisoning is a serious health concern worldwide. Paraquat is known to be responsible for a number of acute poisonings in south India., Aim: The study aims at presenting the various aspects of paraquat poisoning that include patient profile, clinical presentation, end-organ complications, and observations at autopsy., Materials and Methods: The present registry-based retrospective research was conducted in a tertiary care teaching hospital in south India. All the confirmed cases of paraquat poisoning were included in the present study. The postmortem and hospital records of these patients were retrieved and relevant information was collected and analyzed., Results: Paraquat poisonings constituted 14.4% of the total poisoning fatalities during the study period. Equal number of males and females were observed in the present study. The victims were aged between 17 and 65 years (mean ± SD = 30.2 ± 13.1 years). Manner of death was suicidal in 92.9% cases. Common presenting symptoms after ingestion of paraquat included vomiting, followed by difficulty in breathing. In the present series, overall survival post paraquat consumption ranged between 10 h and 25 days. Half of the victims died within 2 days of consumption of poison. The underlying cause of death included acute renal failure (ARF), adult respiratory distress syndrome (ARDS), multiorgan failure (MOF), acute liver failure, etc., In all the cases, brain was congested and edematous, and visceral organs showed marked congestion at autopsy. Lungs were congested with marked edema in 10 cases., Conclusion: It is recommended that the availability of this highly toxic substance be restricted so as to prevent its misuse as a method of suicide.