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Background: The Electrocardiogram (ECG) can be visualised either in a scalar form, as waves in the standard 12‑lead ECG, or vectorially, as vector loops in different planes in the Vectorcardiogram (VCG). An Electro-Vectorcardiogram (ECG-VCG) is a graphic visualization combining scalar and vector ECGs. We aimed to assess if integrating the scalar 12‑lead ECG and vector ECG makes ECG interpretation by medical students more accurate, faster, and easier than using 12‑lead ECG alone., Methods: Undergraduate medical students were randomised into ECG group and ECG-VCG group. The students received a web-based tutorial followed by a test. The ECG group were taught with and had to interpret standard 12‑lead ECG images, while the ECG-VCG group were taught and had to interpret ECG-VCG images with two-dimensional VCG panels (frontal and horizontal) of the same diagnosis. On completion, participants reported their ease of interpretation as grades. Test scores, time taken and ease were compared between the groups., Results: The study included 296 medical students. The primary outcome, interpretation accuracy (test score out of 10), was significantly greater in the ECG-VCG group (7.34 ± 2.13 vs 6.09 ± 2.34, p < 0.001). The time taken for interpretation was significantly lower and ease of interpretation was significantly greater in the ECG-VCG group., Conclusion: The use of ECG-VCG to teach undergraduate medical students can outperform the 12‑lead ECG in terms of accuracy, speed and ease., Competing Interests: Declaration of competing interest This manuscript, in part or in full, has not been submitted or published anywhere. No authors have any relevant conflict of interest disclosures., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: In male congenital hypogonadotropic hypogonadism (CHH), it was observed that lower dose human gonadotropic hormone (hCG) can maintain normal intratesticular testosterone levels. We propose this study to compare the low-dose hCG, follicle stimulating hormone (FSH), and Testosterone (T) [LFT Regimen] to conventional treatment to induce virilization and fertility., Design: This open-label randomized pilot study was conducted from June 2020 to December 2021., Subjects and Outcome Measures: CHH were randomly assigned to either the LFT regimen (Group A)-low-dose hCG (500U thrice per week), FSH (150U thrice per week), and T(100 mg biweekly) or conventional therapy(GroupB) with high hCG dose(2000U thrice per week) and the same FSH dose. The hCG dosage was titrated to reduce anti-mullerian hormone (AMH) by 50% and normalization of plasma T in groups A and B, respectively. The primary objective was to compare the percentage of individuals who achieved spermatogenesis between the two groups., Results: Out of 30 patients, 23 (76·7%) subjects achieved spermatogenesis, and the median time was 12 (9-14·9) months. There was no difference in achieving spermatogenesis between the two groups (64·3% vs 7·5%,P = 0·204), and even the median time for spermatogenesis was similar (15months vs 12months,P = 0·248). Both groups had nonsignificant median plasma AMH at spermatogenesis, [6·6 ng/ml (3·3-9·76) vs4·41 ng/ml (2·3-6·47), P = 0·298]. Similarly, the median plasma Inhibin B at spermatogenesis between groups were comparable [152·4 pg/ml (101·7-198·0) vs49·1 pg/ml (128·7-237·3), P = 0·488]., Conclusions: A reasonable approach to induce fertility in male CHH is to initiate combination therapy using FSH, low-dose hCG targeting AMH <6·9 ng/ml, along with T to achieve normal range. Monitoring AMH could serve as a proxy indicator of spermatogenesis., Competing Interests: Disclosure The authors have no conflicts of interest to disclose., (Copyright © 2024 AACE. Published by Elsevier Inc. All rights reserved.)

A woman in her early fifties with a known case of severe rheumatic mitral stenosis presented to the out-patient department with increasing breathlessness.

Renin-angiotensin-aldosterone system (RAAS) inhibitors are the key medications for patients with heart failure and chronic kidney disease. Multiple randomized controlled trials have demonstrated their benefits in an outpatient setting for the treatment of chronic heart failure. Additional advantages in acute heart failure treatment during inpatient hospitalization are less clear but a small number of non-randomized studies have favored their use. Conditions that result in stoppage of RAAS inhibitors during inpatient stay are an increase in serum creatinine, hyperkalemia, and hemodynamic instability such as hypotension. The role of RAAS inhibitors in chronic kidney disease has also been documented in multiple randomized controlled trials, with their use in hypertension and proteinuria being unambiguous. This narrative review summarizes the role of RAAS inhibitors in acute and chronic heart failure and chronic kidney disease., Competing Interests: Disclosure and potential conflicts of interest: The authors declare that they have no conflicts of interest relevant to this manuscript. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2020/09/dic.2020-7-3-COI.pdf, (Copyright © 2020 Singhania N, Bansal S, Mohandas S, Nimmatoori DP, Ejaz AA, Singhania G.)

The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has brought many unique pathologies, such as coagulopathy, prompting a desperate need for effective management. COVID-19-associated coagulopathy (CAC) can cause various thromboembolic complications, especially in critically ill patients. The pathogenesis is likely due to endothelial injury, immobilization, and an increase in circulating prothrombotic factors. Data on treatment are limited, although prophylactic anticoagulation is advised in all hospitalized patients. Herein, we have comprehensively reviewed the current literature available on CAC and highlight the pathogenesis, clinical features, and management of CAC.

Several antibiotics, proton pump inhibitors, and nonsteroidal anti-inflammatory drugs can cause acute interstitial nephritis. This is not dose-dependent, and recurrence can occur with a second exposure of the same drug. Stopping the culprit is critical for successful management., Competing Interests: None declared., (© 2020 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

Atrial fibrillation (Afib) is associated with 15%-25% of strokes. Wearable devices like Apple watch can generate an electrocardiogram and can increase detection of Afib in general population. Early diagnosis and treatment can decrease the risk of strokes., Competing Interests: Authors do not have any conflict of interest to disclose., (© 2020 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

Bartonella infection has been associated with culture negative endocarditis and in rare cases immune complex medicated rapidly progressive glomerulonephritis (RPGN). Most of the previously reported cases of RPGN are associated with endocarditis. We report a case of RPGN with no endocarditis secondary to Bartonella infection. Good social history, high index of suspicion, diagnosis with polymerase chain reaction and treatment with antibiotics is the key for treatment.

Randomized controlled trials have demonstrated the benefits of guideline-directed medical therapy in the outpatient setting for treatment of chronic heart failure. However, the benefits of continuation (or discontinuation) of major chronic heart failure therapies when treating acute heart failure during hospitalization are less clear. Real and anticipated worsening renal function, hyperkalemia and hypotension are the three major reasons for discontinuation of renin-angiotensin-aldosterone system inhibitors during hospitalization, and a failure to resume renin-angiotensin-aldosterone system inhibitors before discharge could worsen cardiovascular outcomes. Available data, mostly observational, shows that continuation or initiation of renin-angiotensin-aldosterone system inhibitors appears efficacious, safe, and well tolerated in majority of acute heart failure patients during hospitalization. Worsening renal function portends poor prognosis only if associated with congestion in acute heart failure, and clinicians should not de-escalate diuretic therapy routinely for worsening renal function., Competing Interests: All the authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript., (©2019 Singhania et al. Published by IMR press. All rights reserved.)

To evaluate the efficacy of combined procedure of Descemet's membrane endothelial keratoplasty (DMEK) and posterior iris-claw-fixated intra ocular lens (IOL) implantation in the management of aphakic bullous keratopathy (ABK). Sankara eye centre, a tertiary eye care centre. A prospective case series analysis. A prospective study comprised ten eyes of ten patients who underwent DMEK and posterior iris-claw-fixated IOL. Mean follow-up period was 12-36 months. Pre-operative and post-operative best corrected visual acuity (BCVA), endothelial cell density (ECD) and complications were noted. A total ten eyes of ten patients underwent DMEK. Out of ten patients BCVA improved from 1.00 to 1.60 LogMAR with mean and SD of 1.40 ± 0.20 to +0.20-0.40 LogMAR with mean and SD of 0.30 ± 0.07, with a significant p value of <0.001, Mean ECD of the donor tissue pre-operatively was 2367 cells, whereas 24 months post-operatively it was reduced to 1798 cells. Mean reduction in ECD pre procedure and post procedure was 569 (24 %). Iris-fixated IOL appears to offer simplicity in implantation and may be combined with DMEK in ABK. This procedure provides a faster visual recovery than other endothelial keratoplasties with iris-fixated IOL.

Patient: Female, 26., Final Diagnosis: Endosalpingiosis., Symptoms: Chronic pelvic pain., Medication: -., Clinical Procedure: Diagnostic laproscopy (conservative management)., Specialty: Obstetrics and Gynecology., Objective: Challenging differential diagnosis., Background: Interesting and unusual case of endosalpingiosis mimicking ovarian malignancy presentation., Case Report: A 26-year-old G0P0 white female presented to our office with chronic pelvic pain. On vaginal examination, a nontender mass in left the adnexal region was palpable. Transvaginal ultrasound showed a left ovarian cyst. Laparoscopy was performed, which revealed diffuse bilateral ovarian excrescences with unusual multiple studdings throughout the peritoneum and abdominal cavity. Due to a suspicion of malignancy, a biopsy specimen was obtained for frozen sectioning. The specimen proved to be consistent with benign papillary serous cystadenofibroma. Gross appearance was still suspicious for malignancy and therefore left paraovarian cystectomy was performed. Additional specimens showed ovarian adenofibroma and endosalpingiosis. The patient's complaint of pelvic pain improved after laparoscopy. Due to diffuse presentation of endosalpingiosis in the peritoneum, serial CT scan of abdomen and pelvis at 6-month intervals was recommended., Conclusions: To our knowledge, this is an unusual case of a young, nulliparous female presenting with diffuse-presentation endosalpingiosis in the abdomen and peritoneum, which on gross examination was suspicious for malignancy. By following a conservative approach and performing serial CT scans, the patient will be clinically monitored.

Ceria, because of its excellent redox behavior and oxygen storage capacity, is used as a catalyst for several technologically important reactions. In the present study, different morphologies of nano-CeO2 (rods, cubes, octahedra) were synthesized using the hydrothermal route. An ultrafast microwave-assisted method was used to efficiently attach Pt particles to the CeO2 polyhedra. These nanohybrids were tested as catalysts for the CO oxidation reaction. The CeO2/Pt catalyst with nanorods as the support was found to be the most active catalyst. XPS and IR spectroscopy measurements were carried out in order to obtain a mechanistic understanding and it was observed that the adsorbed carbonates with lower stability on the reactive planes of nanorods and cubes are the major contributor to this enhanced catalytic activity.

We present a green method for the synthesis of ZnO-Au hybrids using an ultrafast microwave-based technique. This method provides good control over the nucleation of the metal nanoparticles on the oxide support, which governs the morphology and microstructure of the hybrids. The hybrids exhibit good catalytic activity for CO oxidation compared to similar hybrids reported in the literature. Detailed XPS investigation reveals the presence of Au-Zn and Au-O bonds at the interface. This surface doping leads to the formation of anionic and cationic Au sites that contribute to the enhanced activity. Our method is general and can be applied for designing other supported catalysts with controlled interfaces.

We conducted this double blind randomized controlled trial to compare the rapid bronchodilator effect of salmeterol and formoterol in 60 children with stable asthma. Participants were randomized to receive either salmeterol (50 microg) (n=31) or formoterol (24 microg) (n=29) by metered dose inhaler and spacer. Spirometry was performed at baseline, at 30 minutes, and at 60 minutes. Bronchodilatation was assessed by changes in FEV(1) at 30 and 60 minutes. Baseline parameters were comparable in the two groups. There was no significant difference in the FEV(1) at 30 and 60 minutes between two groups. We conclude that salmeterol and formoterol both cause bronchodilator response at end of 60 minutes and are not different with regards to their rapid bronchodilator response.

Unc119 is an adaptor protein that is involved in the development of the vertebrate nervous system. We have shown that Unc119 stimulates the induction of alpha-smooth muscle actin (alpha-SMA) and myofibroblast differentiation by TGF-beta in human lung fibroblasts. Unc119 increases the kinase activity of Fyn and associates with it in coprecipitation and colocalization studies. Phosphorylation and activation of Fyn in response to TGF-beta and platelet-derived growth factor is delayed in Unc119-deficient cells. This delay translates into suppressed cell proliferation. In Src family kinase-deficient (SYF) cells, Unc119 knockdown does not affect cell proliferation. The result suggests that Unc119 interacts with Fyn in the early stages of signal generation and its presence is essential for conducive signal transduction. Unc119 overexpression does not stimulate alpha-SMA in SYF cells and this defect is restored upon reconstitution with Fyn indicating that Unc119 stimulation of alpha-SMA requires at least Fyn. Unc119 overexpression stimulated p38, but not JNK, phosphorylation. Blocking p38 MAPK resulted in reduced alpha-SMA expression by Unc119 suggesting that the p38 pathway regulates Unc119-induced myofibroblast differentiation. Unc119 stimulates the production of TGF-beta and IL-6, known inducers of myofibroblast differentiation. Thus, Unc119 regulates receptor-mediated signal transduction and myofibroblast differentiation by activating Fyn and the p38 MAPK pathway. Using primary lung fibroblasts from patients with fibrotic lung diseases and control subjects, we show that the expression of alpha-smooth muscle actin is highly correlated with that of Unc119. Taken together, our results suggest that Unc119 plays an important role in fibrotic processes through myofibroblast differentiation.

R115777 is a potent farnesyltransferase (FTase) inhibitor with substantial antitumor activity in preclinical models. We conducted a phase 1 study (3 + 3 design) of R115777 in patients with myelodysplastic syndrome (MDS). R115777 was administered twice daily (3-weeks-on/1-week-off schedule for 8 weeks) (starting dosage, 300 mg by mouth twice daily; total, 600 mg). Maintenance therapy at the dose/schedule tolerated during induction could be continued until toxicity or lack of benefit. Twenty-one patients with MDS were treated (median age, 66 years). Four (19%) patients had ras mutations (n-ras,3; k-ras, 1). Objective responses (hematologic improvement, 3; partial remission, 2; or complete remission, 1) were seen in 6 of 20 (30%) evaluable patients, only 2 of whom had ras mutations. Response sequences were unusual in some patients who had increases in platelet counts without intervening aplasia. Other responders demonstrated an initial, albeit modest, myelosuppressive effect. The maximum tolerated dose was 400 mg by mouth twice a day. The most frequent side effect was myelosuppression. Dose-limiting toxicities (fatigue and confusion) occurred at 900 mg by mouth total daily dose. R115777 inhibited HDJ-2 prenylation and suppressed the activity of FTase, but not of the related geranylgeranyltransferase I enzyme, in peripheral blood mononuclear cells. Modulation of Akt, Erk, and signal transducer and activator of transcription 3 (STAT3) phosphorylation was variable, and responses occurred even without their down-regulation. Reductions in serum tumor necrosis factor-alpha (TNF-alpha) levels by day 7 showed a trend toward correlation with response (P =.09). We conclude that, at doses that are well tolerated, R115777 markedly inhibits the FTase target and has antitumor activity in MDS.

The two eosinophil ribonucleases, eosinophil-derived neurotoxin (EDN/RNase 2) and eosinophil cationic protein (ECP/RNase 3), are among the most rapidly evolving coding sequences known among primates. The eight mouse genes identified as orthologs of EDN and ECP form a highly divergent, species-limited cluster. We present here the rat ribonuclease cluster, a group of eight distinct ribonuclease A superfamily genes that are more closely related to one another than they are to their murine counterparts. The existence of independent gene clusters suggests that numerous duplications and diversification events have occurred at these loci recently, sometime after the divergence of these two rodent species ( approximately 10-15 million years ago). Nonsynonymous substitutions per site (d(N)) calculated for the 64 mouse/rat gene pairs indicate that these ribonucleases are incorporating nonsilent mutations at accelerated rates, and comparisons of nonsynonymous to synonymous substitution (d(N) / d(S)) suggest that diversity in the mouse ribonuclease cluster is promoted by positive (Darwinian) selection. Although the pressures promoting similar but clearly independent styles of rapid diversification among these primate and rodent genes remain uncertain, our recent findings regarding the function of human EDN suggest a role for these ribonucleases in antiviral host defense.