Anomalous origin of the right coronary artery

Coronary artery anomalies are congenital variations of the origin(s), course(s), and terminations(s) of the 3 main epicardial coronary arteries that make up less than 1% of cases. Clinically, coronary artery anomalies can be asymptomatic or present with dyspnea, chest pain, and even sudden cardiac death. In this report, we discuss the case of a patient who was found to have a rare presentation of an anomalous right coronary artery originating from the anterior ascending aorta 20.9 mm above the sino-tubular junction that was discovered on coronary CT angiography.

Pulmonary Cement Embolism After Vertebroplasty

Pulmonary cement embolism (PCE) is a known complication that can occur in the setting of vertebroplasty. The majority of these cases are asymptomatic and found incidentally on imaging. There are no current management recommendations regarding PCE. We present a case of a patient who underwent vertebroplasty complicated by a symptomatic sub-massive PCE.

Guided waves-based damage identification in plates through an inverse Bayesian process

The use of guided waves to identify damage has become a popular method due to its robustness and fast execution, as well as the advantage of being able to inspect large areas and detect minor structural defects. When a travelling wave on a plate interacts with a defect, it generates a scattered field that will depend on the defects geometry. By analysing the scattered field, one can thus characterize the type and size of the plate damage. A Bayesian framework based on a guided waves interaction model for damage identification of infinite plate for the first time is presented here. A semi-analytical approach based on the lowest order plate theories is adopted to obtain the scattering features for damage geometries with circular symmetry, resulting in an efficient inversion procedure. Subsequently, ultrasound experiments are performed on a large aluminium plate with a circular indentation to generate wave reflection and transmission coefficients. With the aid of signal processing techniques, the effectiveness and efficiency of the proposed approach are verified. A full finite element model is used to test the damage identification scheme. Finally, the scattering coefficients are reconstructed, reliably matching the experimental results. The framework supports digital twin technology of structural health monitoring.

Presentation and outcome of Middle East respiratory syndrome in Saudi intensive care unit patients

BACKGROUND

Middle East respiratory syndrome coronavirus infection is associated with high mortality rates but limited clinical data have been reported. We describe the clinical features and outcomes of patients admitted to an intensive care unit (ICU) with Middle East respiratory syndrome coronavirus (MERS-CoV) infection.

METHODS

Retrospective analysis of data from all adult (>18 years old) patients admitted to our 20-bed mixed ICU with Middle East respiratory syndrome coronavirus infection between October 1, 2012 and May 31, 2014. Diagnosis was confirmed in all patients using real-time reverse transcription polymerase chain reaction on respiratory samples.

RESULTS

During the observation period, 31 patients were admitted with MERS-CoV infection (mean age 59 ± 20 years, 22 [71 %] males). Cough and tachypnea were reported in all patients; 22 (77.4 %) patients had bilateral pulmonary infiltrates. Invasive mechanical ventilation was applied in 27 (87.1 %) and vasopressor therapy in 25 (80.6 %) patients during the intensive care unit stay. Twenty-three (74.2 %) patients died in the ICU. Nonsurvivors were older, had greater APACHE II and SOFA scores on admission, and were more likely to have received invasive mechanical ventilation and vasopressor therapy. After adjustment for the severity of illness and the degree of organ dysfunction, the need for vasopressors was an independent risk factor for death in the ICU (odds ratio = 18.33, 95 % confidence interval: 1.11-302.1, P = 0.04).

CONCLUSIONS

MERS-CoV infection requiring admission to the ICU is associated with high morbidity and mortality. The need for vasopressor therapy is the main risk factor for death in these patients.

Modified expression of a carrot small heat shock protein gene, hsp17. 7, results in increased or decreased thermotolerancedouble dagger

We have determined that one small heat shock protein gene, encoding Hsp17.7, plays an important role in the ability of carrot cells and plants to survive thermal stress. Transgenic cells and regenerated plants were generated in which the carrot Hsp17.7 gene was either constitutively expressed (denoted CaS lines) or expressed as a heat inducible antisense RNA (denoted AH lines). Thermotolerance measurements demonstrated that CaS lines were more thermotolerant than vector controls and AH antisense lines were less thermo- tolerant than vector controls. RNA analysis demonstrated that Hsp17. 7 mRNA was detectable, but not abundant, prior to heat shock in CaS cells, but not in vector control cells. Conversely, RNA analysis of antisense cells showed that, after heat shock, the amounts of mRNA for Hsp17.7 was moderately less abundant in AH cells than in vector controls. Analysis of protein synthesis in CaS cells did not indicate substantial synthesis or accumulation of Hsp17.7, or any small Hsp, at 23 degrees C. However, in the most thermotolerant line, protein synthesis was maintained at a higher rate than in other cell lines at a more extreme heat shock (42 degrees C). In contrast, antisense AH cells showed reduced synthesis of many Hsp, large and small. These results suggest that the Hsp17.7 gene plays a critical, although as yet not understood, role in thermotolerance in carrot. This represents the first demonstration of the ability to both increase and decrease thermotolerance by the manipulation of expression of a single gene.

Fracture of tracheostomy tubes--report of 3 cases

Fracture of the tubes appears to be caused by their prolonged use and defective fusion at the junction of cannula and phalange. We report here three cases of fractured polyvinyl chloride tracheostomy tube, an unusual complication of tracheostomy, presenting as foreign body in the trachea.

Juvenile nasopharyngeal angiofibroma

A total of 27 cases of nasopharyngeal angiofibroma were treated in this series. All were males and age ranged between 9 and 24 years. Predominant symptoms were epistaxis and nasal obstruction. Nasopharyngeal mass was present in all cases. Cheek extensions were observed in 6. Surgery was done in 25 cases. Transpalatal excision was done in all cases. Cheek extensions were removed through separate sublabial incisions. Additional lateral rhinotomy was required in one case. Death occurred in one case during surgery due to excessive haemorrhage. Out of 25 cases, 21 were followed up for periods ranging from 2-5 years. Complete cure was observed in 16 cases. Recurrence occurred in 5 cases, who were operated upon again. Out of 5 recurrence operated cases, 2 cases showed a second recurrence.

In vitro and in vivo evaluation of change of local pH on bacteria in C.S.O.M

An in vitro study has shown a high bactericidal activity of 2 per cent acetic acid. An in vitro study in 400 cases of C.S.O.M. has shown that conservative treatment of C.S.O.M. by pH change with 2 per cent acetic acid is better than antibiotic ear drops alone. However, combined therapy (pH change plus antibiotic ear drops) is definitely superior to single treatment by either of the two methods. Two per cent acetic acid is well tolerated by the middle ear mucosa except in 1 per cent cases, where its use had to be discontinued because of irritation. The use of 2 per cent acetic acid is highly recommended, particularly for poor nations, because of its negligible cost as compared to antibiotic ear drops.

Propranolol in the control of schizophrenic symptoms

All schizophrenic symptoms remitted completely in six out of 14 adults who had not responded to phenothiazine drugs and who were then given propranolol. Another patient improved markedly and four improved moderately. Two had minimal or transient improvement, and one left hospital unchanged after a short, severe, toxic reaction. The six with complete remissions all began to improve within a few days of starting propranolol and the florid symptoms remitted completely after three to 26 days. They were stabilized on a daily dose of 500-3,500 mg of propranolol and at the time of writing had remained well for up to six months. Two patients who stopped propranolol after their symptoms remitted relapsed severely within a few days. Toxic effects (ataxia, visual hallucinations, and confusional states) were related to the rate of increase rather than to the absolute dose of propranolol. After the procedure was modified unwanted effects were usually mild or absent.