Electrocardiographic Features in SCN5A Mutation-Positive Patients with Brugada and Early Repolarization Syndromes: A Systematic Review and Meta-Analysis

Background: Early repolarization syndrome (ERS) and Brugada syndrome (BrS) are both J-wave syndromes. Both can involve mutations in the SCN5A gene but may exhibit distinct electrocardiographic (ECG) differences. The aim of this systematic review and meta-analysis is to investigate possible differences in ECG markers between SCN5A positive patients with ERS and BrS. Methods: PubMed and Embase, were searched from their inception to October 20th, 2021 for human studies containing the search terms “SCN5A” and “variant” and “early reporlarization” or “Brugada”, with no language restrictions. Results: A total of 328 studies were identified. After full text screening, 12 studies met our inclusion criteria and were included in this present study. 104 ERS patients (mean age: 30.86 ±14.45) and 2000 BrS patients (mean age: 36.17 ±11.39) were studied. Our meta-analysis found that ERS patients had a significantly lower heart rate (standardized mean difference [SMD]a= 14.69, 95% confidence interval [CI] = 21.43, 7.94, P = 0.0001), shorter QRS duration (SMD = 13.90, 95% CI = 17.16, 10.65, P = 0.0001) and shorter QTc [corrected QT interval] (SDM = 21.52, 95% CI = 33.77, 9.26, P = 0.0006) than BrS patients. Conclusion: BrS patients with positive SCN5A mutations exhibited prolonged QRS, indicating conduction abnormalities, whereas ERS patients with positive SCN5A mutations showed normal QRS. By contrast, whilst QTc intervals were longer in BrS than in ERS SCN5A positive patients, they were within normal limits. Further studies are needed to examine the implications of these findings for arrhythmic risk stratification.

Curious case of Retrosternal Colloid Goitre

Background: Retrosternal goitre is considered to be a rare entity. It is a slow growing enlargement of the thyroid gland which remains asymptomatic for many years. Symptoms are mainly due to compression of airways and oesophagus. Surgical management with the removal of the involved lobe is considered sufficient. Summary: Here we report a case of a 33 yrs. old lady who presented to us with complaints of neck pain, facial flushing, difficulty in breathing and vague body ache. Clinical examination was within normal limits. The patient was referred to orthopedician for further evaluation. MRI cervical spine was done which was suggestive of large swelling in left lobe of thyroid with retrosternal extension causing deviation of trachea to opposite side. FNAC was done which was inconclusive. The involved lobe was removed surgically with frozen section suggestive of Colloid goitre. Conclusion: Retrosternal goitre are slow growing enlargement of thyroid gland which may present with vague symptoms, best managed surgically often followed relief from the symptoms post-surgery.

Is Elevation of Alkaline Phosphatase a Predictive Factor of Response to Alectinib in NSCLC?

In the following report, we describe a case of alkaline phosphatase (ALP) elevation occurring during treatment with alectinib (Alecensa™), which was administered for anaplastic lymphoma kinase (ALK) mutated metastatic non-small cell lung cancer (mNSCLC). A 51 year-old female with widespread metastatic disease exhibited a rapid and significant response within a very short period to alectinib therapy, accompanied by a rapid increase of ALP to more than six times the upper limit of normal (grade 3) ALP, decreasing to within normal limits within 3 weeks after initiation of therapy without any dose modification.

The effect of toxic metal As on the Matricaria Chamomilla L. medicinal plant

The paper presents an experimental laboratory study of the bioaccumulation of the toxic metal arsenic in the medicinal plant chamomile (Matricaria Chamomilla L.). The study makes a comparison regarding the bioaccumulation capacity of the chamomile plant in which arsenic is found as a unique contaminant, as well as in mixtures of 2, 3, or 4 toxic metals (Cd, Ni and Pb) on a natural soil enriched with metals, compared to the chamomile plant developed on an unpolluted substrate. The tests followed the effects of soil pollution with metals on the germination and development of chamomile. The experimental results indicated that arsenic does not bioaccumulate in the chamomile plant, remaining in the soil. The experiment that was an exception is the one with arsenic as the only contaminant (E1) in which at 90 days, the arsenic content in the chamomile plant was 3.58 mg/kg arsenic, the value that is within normal limits, below the phytotoxic value of 5 mg/kg, but was higher than that determined in the plant from the control test experiment (<0.75 mg/kg). The bioaccumulation factor (BCF) after 90 days, in all experiments, either by a combination of metals or a single contaminant had values lower than 1, indicating that the plant does not accumulate arsenic. The total chlorophyll from the results obtained indicates that the toxicity in the E1 experiment is higher than in the metal mixture.

Reference Ranges of Left Ventricular Hemodynamic Forces in Healthy Adults: A Speckle-Tracking Echocardiographic Study

Background: The normal limits of left ventricular (LV) hemodynamic forces (HDFs) are not exactly known. The aim of this study was to explore the full spectrum of HDF parameters in healthy subjects and determine their physiologic correlates. Methods: 269 healthy subjects were enrolled (mean age: 43 ± 14 years; 123 (45.7%) men). All participants underwent an echo-Doppler examination. Tri-plane tissue tracking from apical views was used to measure 2D global endocardial longitudinal strain (GLS), circumferential strain (GCS), and LV HDFs. HDFs were normalized with LV volume and divided by specific weight. Results: LV systolic longitudinal HDFs (%) were higher in men (20.8 ± 6.5 vs. 18.9 ± 5.6, p = 0.009; 22.0 ± 6.7 vs. 19.8 ± 5.6, p = 0.004, respectively). There was a significant correlation between GCS (increased) (r = −0.240, p < 0.001) and LV longitudinal HDFs (reduced) (r = −0.155, p = 0.01) with age. In a multivariable analysis age, BSA, pulse pressure, heart rate and GCS were the only independent variables associated with LV HDFs (β coefficient = −0.232, p < 0.001; 0.149, p = 0.003; 0.186, p < 0.001; 0.396, p < 0.001; −0.328, p < 0.001; respectively). Conclusion: We report on the physiologic range of LV HDFs. Knowledge of reference values of HDFs may prompt their implementation into clinical routine and allow a more comprehensive assessment of the LV function.

Literature Riview : Penerapan Kompres Air Hangat Untuk Menurunkan Suhu Tubuh Pada Pasien Demam Thypoid

Typhoid fever is a systemic infection caused by salmonella enterica bacteria, especially its derivative variants, namely salmonella typhi, paratyphi A, paratyphi B, paratyphi C. These germs attack the digestive tract, especially in the stomach and intestines, nursing problems that often occur in patients with typhoid fever, namely hyperthermia. Hyperthermia is a condition in which an individual has an increase in body temperature above 37.8 C parrectal due to external factors. A warm compress is a procedure used to improve control of body heat loss through evaporation and conduction which is usually performed on patients who have a high fever. The purpose of scientific papers is to see an overview of the application of warm compresses to reduce body temperature in typhoid fever patients. The method is carried out by searching several research journals entitled about the application of warm water compresses to reduce body temperature in typhoid fever patients. The results obtained after the action of warm water compresses, body temperature decreased within normal limits. The conclusion of this scientific paper is that the action of warm water compresses can reduce body temperature in patients with typhoid fever. Suggestions for nurses are expected to apply warm compresses to reduce body temperature in typhoid fever patients.Keywords: Key words: typhoid fever, hyperthermia, warm water compress AbstrakDemam typhoid adalah infeksi sistemik yang di sebabkan oleh bakteri salmonella enterika, khususnya varian-varian turunannya, yaitu salmonella typhi, paratyphi A, paratyphi B, paratyphi C. Kuman-kuman tersebut menyerang saluran pencernaan, terutatama di perut dan usus masalah keperawatan yang sering terjadi pada pasien demam tifoid yaitu hipertermia . Hipertermi adalah suatu keadaan dimana seorang individu mengalami peningkatan suhu tubuh di atas 37,8⁰C parrektal karena factor eksternal. Kompres air hangat adalah prosedur yang di gunakan untuk meningkatkan control kehilangan panas tubuh melalui evaporasi dan konduksi yang biasanya di lakukan pada pasien yang mengalami demam tinggi. Tujuan dari karya tulis ilmiah adalah untuk mengetahui gambaran tentang penerapan kompres air hangat untuk menurunkan suhu tubuh pada pasien demam thypoid. Metode yang dilakukan dengan mencari beberapa jurnal penelitian berjudul tentang penerapan kompres air hangat untuk menurunkan suhu tubuh pada pasien demam thypoid. Hasil yang didapatkan setelah dilakukan tindakan kompres air hangat suhu tubuh mengalami penurunan dalam batas normal. Kesimpulan karya tulis ilmiah ini bahwa tindakan kompres air hangat dapat menurunkan suhu tubuh pada pasien demam thypoid. Saran bagi perawat diharapkan dapat menerapkan tindakan kompres air hangat untuk menurunkan suhu tubuh pada pasien demam thypoid.Kata kunci: Demam Thypoid, Hipertermi, Kompres air hangat

Case Report: Vasculitis Triggered by SIRT in a Patient With Previously Untreated Cholangiocarcinoma

Arising from the biliary tract, cholangiocarcinoma is a rare and aggressive epithelial cancer. According to the primary site, it can be further classified into intrahepatic, perihilar and distal types. Due to the lack of symptoms early in the disease course, most patients are diagnosed at advanced stages. Being not candidates for curative surgical management, these patients are treated with palliative systemic chemotherapy, and their prognosis remains poor. Using radioisotopes like yttrium-90 -labeled microspheres (90Y), radioembolization represents a local approach to treat primary and secondary liver tumors. In the case of intrahepatic cholangiocarcinoma, radioembolization can be used as a primary treatment, as an adjunct to chemotherapy or after failing chemotherapy. An 88-year-old man underwent radioembolization for a previously untreated stage II intrahepatic cholangiocarcinoma. One week later, he presented to our clinic with a non-pruritic maculopapular rash of the lower extremities and abdomen, worsening fatigue and low-grade fever. Laboratory exams, including hepatitis screening, were within normal limits. Showing positive immunofluorescence staining for immunoglobulin M (IgM) and complement 3 (C3) in vessel walls without IgA involvement, the skin biopsy results were compatible with leukocytoclastic vasculitis. Apart from the anticancer intervention, there have been no recent medication changes which could explain this complication. Notably, we did not observe any side effects during or after the perfusion scan with technetium-99m macroaggregated albumin (MAA) performed prior to radioembolization. The symptoms resolved quickly after a short course of colchicine and did not reappear at cholangiocarcinoma progression. In the absence of other evident causes, we conclude that the onset of leukocytoclastic vasculitis in our patient was directly linked to the administration of yttrium-90 -labeled microspheres. Our report therefore demonstrates that this condition can be a rare but manageable complication of 90Y liver radioembolization.

Assessment of the quality of the southern Bug waters within the Khmelnytsky region and biotechnological ways to solve their purification

Water resources are the national wealth of each state, an important natural resource, and determine the development opportunities of most sectors of the economic complex of Ukraine. The Southern Bug River is the largest river, the basin of which is completely located in Ukraine. Due to the intensive growth of anthropogenic impact on the studied reservoir and the economic use of its resources, the quality of water in it has significantly decreased. To improve the quality of water in rivers, it is optimal to use biotechnological methods, which provide many opportunities for effective solutions to issues related to monitoring, assessment, and treatment of polluted watercourses. The aim of our study was to assess water safety, the current ecological status of the Southern Bug River within the Khmelnytsky region in three areas (Maryanivske Reservoir, Kopystyn, Shchedrivske Reservoir) and use in domestic needs, with analysis of potential risks to human health, development of new biotechnological and improvement of existing measures to improve water supply. The experimental part of the work was performed on the basis of the Khmelnytsky Regional Department of Water Resources in the laboratory at the address Khmelnytsky, st. Soborna, 29. We conducted a chemical assessment of the Southern Bug River on three indicators: salt composition (I1), tropho-saprobiological (I2), and specific toxic substances (I3). Research of river waters was carried out in order to control the MPC (maximum permissible concentrations) of substances for use in household and food needs of the population and to propose biotechnological methods of river water purification within the Khmelnytsky region. According to our research on hydrochemical characteristics, the water contained elevated levels of NH4, NO2, NO3, PO4, the average values of HSC (chemical oxygen demand) exceeded the MPC in all areas by 2 to 5 times. This may be due to exposure to organic compounds of natural origin. The content of nitrites, nitrates is within normal limits, but the content of ammonium salt exceeds the MPC up to 20 times in the village Kopystyn and from 2 to 7 times in the village of Letychiv. According to many indicators of the salt block, the maximum concentration limit was not exceeded, except for the village Kopystyn, the concentration of Magnesium (Mg) was 84.33 mg/dm3 at a rate of 40.00 mg/dm3. According to specific toxic substances, the water belonged to the III class 4 quality category, Chromium (Cr) was not detected, Manganese (Mn) and Copper (Cu) were within normal limits, although the Copper content was high. The concentration of Iron (Fe) varies in different areas and during the year, there is a case of excess Iron in the village. Kopistin up to 0.86 mg/dm3 at a rate of 0.30 mg/dm3. Iron affects the intensity of phytoplankton development and the qualitative composition of the microflora, so its concentration is subject to seasonal fluctuations. To improve the quality of water in the Southern Bug River, we have proposed the use of biotechnological methods, including those that provide many opportunities to effectively address issues related to monitoring, assessment, and treatment of polluted watercourses.

Mayer-Rokitansky-Kuster-Hauser Syndrome (MRKH) Patients Treated with Laparoscopic Neovaginal with The Davydov Procedure with Epidural Anesthesia: A Case Report

Introduction. MRKH syndrome is characterized by incomplete or absent of vaginal and uterine agenesis. Currently there are no official guidelines on the management of MRKH syndrome. This case report is about the operative management in MRKH patients by neovaginal with laparoscopic Davydov procedure. Case presentation. A 26-year-old woman admitted that she had never had a period, the patient admitted that her breasts began to grow at the age of 13, and the patient was planning to get married, and refused to take further planning. The patient then came back to the RSMH urogynecology clinic after marriage, from the examination it was found that the pubic hole was ± 0.5 cm deep, speculum examination could not be done, the uterus could not be palpable from the rectal toucher. From the ultrasound examination, it was found that both ovaries were within normal limits and suspected uterine hypoplasia. Hormone tests were within normal limits, with the following values: LH 27.01 mIU / mL, FSH 57.08 mIU / mL, Estradiol 10 pg / mL, Prolactin 5.94 ng / mL. Patients with a history of atrial septal defect (ASD) and ventricular septal defect (VSD) Conclusion. Treatment of MRKH syndrome patients is usually complex and requires multidisciplinary counseling, therapy, and management, so it is hoped that it can help patients to make a functional vagina. Further research and collaboration from various multidisciplinary make pregnancy in patients with MRKH syndrome, not impossible, along with current technological and scientific developments, the selection of surrogate mothers, and uterine transplantation is an option.