Towards understanding the clinical significance of QT peak prolongation: a novel marker of myocardial ischemia independently demonstrated in two prospective studies

Background: QT peak prolongation identified patients at risk of death or non-fatal MI. We tested the hypothesis that QT peak prolongation might be associated with significant myocardial ischaemia in two separate cohorts to see how widely applicable the concept was. Methods and Results: In the first study, 134 stroke survivors were prospectively recruited and had 12-lead ECGs and Nuclear myocardial perfusion scanning. QT peak was measured in lead I of a 12-lead ECG and heart rate corrected by Bazett’s formula (QTpc). QTpc prolongation to 360ms or more was 92% specific at diagnosing severe myocardial ischaemia. This hypothesis-generating study led us to perform a second prospective study in a different cohort of patients who were referred for dobutamine stress echocardiography. 13 of 102 patients had significant myocardial ischaemia. Significant myocardial ischaemia was associated with QT peak prolongation at rest (mean 354ms, 95% CI 341-367ms, compared with mean 332ms, 95% CI 327-337ms in those without significant ischaemia; p=0.002). QT peak prolongation to 360ms or more was 88% specific at diagnosing significant myocardial ischaemia in the stress echocardiography study. QT peak prolongation to 360ms or more was associated with over 4-fold increase odds ratio of significant myocardial ischaemia. The Mantel- Haenszel Common Odds Ratio Estimate=4.4, 95% CI=1.2-16.0, p=0.023. Conclusion: QT peak (QTpc) prolongation to 360ms or more should make us suspect the presence of significant myocardial ischaemia. Such patients merit further investigations for potentially treatable ischaemic heart disease to reduce their risk of subsequent death or non-fatal MI

Growth and Marketing of Banana in Tamil Nadu

Banana is an important fruit crop cultivated in India and Tamil Nadu ranks third in production in the country and the area under the banana is also increasing over the years in the state. However, high post-harvest losses were reported in banana due to improper development of marketing channels. Hence, this paper aimed to study marketing of banana and perform stakeholder analysis. Three districts namely Tiruchirappalli, Erode and Coimbatore were selected for the study based on the areaunder banana. The results of the study revealed that the growth rate of area was the highest in Vellore - Tiruvannamalai production centre with 7.75 per cent per annum and production and productivity growth were the highest in Cuddalore-Villupuram production centre with 8.39 and 7.23 per cent per annum respectively. Three banana marketing channels were identified in the study area. Pre- harvest contractor was the popular mode of sale by banana producers. The post-harvest loss of 8.5 to 14.5 kg/tonne was reported in selected banana cultivars. No packing method of banana was followed in the entire marketing channel and one third of market intermediaries did not have storage facility for banana. Hence, the marketing channels of the banana have to be improved on handling, storage and packing to reduce the losses

Transesterification of Waste Cooking Oil Catalysed by Crystalline Copper Doped Zinc Oxide Nanocatalyst

Biodiesel has its unique position in the field of renewable energy as alternate fuel to diesel due to fuel price, energy requirement and petroleum crisis. In this study, biodiesel was produced from Waste Cooking Oil (WCO) using Copper doped Zinc Oxide (CZO) nanocatalysts. The synthesized Copper doped Zinc Oxide nanocatalysts were characterized by X-Ray Diffraction (XRD) and High Resolution Transmission Electron Microscope (HRTEM). Design of experiment was framed using Taguchi method to limit the experiments and to find the optimum reaction conditions. The effect of process parameters such as oil-to-methanol ratio (O/M), catalyst type, catalyst concentration, temperature and time on the transesterification reactions using characterized Copper doped Zinc Oxide nanocatalyst were investigated. The 4% (weight /weight) nanocatalyst concentration, 1:5 Oil to methanol molar ratio at 60°C temperature and 40 minutes of reaction time were found to be optimum, in which the maximum biodiesel yield of 98 % (w/w) was obtained. Hence it was determined that nanocatalysts exhibited good catalytic activities on biodiesel production from Waste Cooking Oil (WCO)

Return of chloroquine-sensitive Plasmodium falciparum parasites and emergence of chloroquine-resistant Plasmodium vivax in Ethiopia

BACKGROUND: Increased resistance by Plasmodium falciparum parasites led to the withdrawal of the antimalarial drugs chloroquine and sulphadoxine-pyrimethamine in Ethiopia. Since 2004 artemether-lumefantrine has served to treat uncomplicated P. falciparum malaria. However, increasing reports on delayed parasite clearance to artemisinin opens up a new challenge in anti-malarial therapy. With the complete withdrawal of CQ for the treatment of Plasmodium falciparum malaria, this study assessed the evolution of CQ resistance by investigating the prevalence of mutant alleles in the pfmdr1 and pfcrt genes in P. falciparum and pvmdr1 gene in Plasmodium vivax in Southern and Eastern Ethiopia. METHODS: Of the 1,416 febrile patients attending primary health facilities in Southern Ethiopia, 329 febrile patients positive for P. falciparum or P. vivax were recruited. Similarly of the 1,304 febrile patients from Eastern Ethiopia, 81 febrile patients positive for P. falciparum or P. vivax were included in the study. Of the 410 finger prick blood samples collected from malaria patients, we used direct sequencing to investigate the prevalence of mutations in pfcrt and pfmdr1. This included determining the gene copy number in pfmdr1 in 195 P. falciparum clinical isolates, and mutations in the pvmdr1 locus in 215 P. vivax clinical isolates. RESULTS: The pfcrt K76 CQ-sensitive allele was observed in 84.1% of the investigated P.falciparum clinical isolates. The pfcrt double mutations (K76T and C72S) were observed less than 3%. The pfcrt SVMNT haplotype was also found to be present in clinical isolates from Ethiopia. The pfcrt CVMNK-sensitive haplotypes were frequently observed (95.9%). The pfmdr1 mutation N86Y was observed only in 14.9% compared to 85.1% of the clinical isolates that carried sensitive alleles. Also, the sensitive pfmdr1 Y184 allele was more common, in 94.9% of clinical isolates. None of the investigated P. falciparum clinical isolates carried S1034C, N1042D and D1246Y pfmdr1 polymorphisms. All investigated P. falciparum clinical isolates from Southern and Eastern Ethiopia carried only a single copy of the mutant pfmdr1 gene. CONCLUSION: The study reports for the first time the return of chloroquine sensitive P. falciparum in Ethiopia. These findings support the rationale for the use of CQ-based combination drugs as a possible future alternative

A clinical challenging situation of Intra oral fibroma mimicking pyogenic granuloma

A 45 year old female presented to the Department of Dentistry and Faciomaxillary Surgery complaining of difficulty in swallowing and tongue movements. General health examination revealed that the patient was conscious, oriented, a febrile and vitals were stable. Occlusion stable. Mouth opening was of three finger breadth. Lateral temporomandibular joint movements were satisfactory. On intra oral clinical examination, a pedunculated mass was observed palatally in relation to left maxillary molar teeth region, where a root stump was evident. Patient stated that the swelling has started as a pinpoint lesion before 1 year and progressed to the size of 5cm x 3cm as seen during clinical examination. The colour of the mass was of coral pink, smooth, nodular in some areas and symptomatic during contact between maxillary and mandibular teeth. Radiological investigations such as orthopantomograph and maxillary occlusal views revealed absence of bony involvement. To differentiate the clinical mimicking situation of intra oral fibroma and pyogenic granuloma, surgical excision was done followed by histopathological examination reporting as intra oral fibroma. Fibroma is of smooth surfaced painless solid mass, occasionally nodular, with collagen and connective tissue histopathologically. Whereas, pyogenic granuloma present as painless and smooth mass which bleeds on palpation clinically with histopathological picture of chronic inflammatory infiltrate, endothelial cell proliferation and hyperplastic granulation tissue. Postoperative review was after 1 month with good prognosis thereby facilitating efficient swallowing and tongue movements.Pan African Medical Journal 2015; 2

Regulatory T Cells and Parasites

Human host encounters a wide array of parasites; however, the crucial aspect is the failure of the host immune system to clear these parasites despite antigen recognition. In the recent past, a new immunological concept has emerged, which provides a framework to better understand several aspects of host susceptibility to parasitic infection. It is widely believed that parasites are able to modulate the magnitude of effector responses by inducing regulatory T cell (Tregs) population and several studies have investigated whether this cell population plays a role in balancing protective immunity and pathogenesis during parasite infection. This review discusses the several mechanism of Treg-mediated immunosuppression in the human host and focuses on the functional role of Tregs and regulatory gene polymorphisms in infectious diseases

The Effectiveness of Anatomy Laboratory Videos on Osteopathic Medical Students’ Performance

Introduction: The usage of audio-visual aids in medical education has always been rewarding. This study aimed at evaluating the efficacy of supplementing traditional dissection based laboratories with the video demonstration of specimens. Methods: The study was conducted among first-year osteopathic medical students of two consecutive years. The laboratory demonstration videos were recorded and provided to the experimental group and the previous class served as the historical controls. Two Likert scale based questionnaires were completed by the experimental group before and after their final examination. The students\u27 performance in the Anatomy practical examinations were compared between the two groups. Results: The students’ response showed that the videos added value to their knowledge. The videos helped them in understanding the structures in the dissection lab with ease they felt more confident about the examinations. The experimental group scored significantly higher grades in the practical examinations than the control group. The results confirm that the video demonstration has a positive impact on the traditional dissection method. Conclusion: The effect on the student’s perception is impressive and the positive outcome in the examination grades adds on to the significance of this teaching methodology. Integration of multimedia with dissection is suggested as a helpful model to improve Anatomy learning process

Integration of Virtual Microscopy Podcasts in Histology Discipline in Osteopathic Medical School: Learning Outcomes

The study evaluates the outcome of integrating narrative podcasts of virtual Histology Slides into teaching Histology discipline to the medical students at Marian University College of Osteopathic Medicine. Short recordings of digital microscopic slides were created as supplementary resources of Histology. A voluntary and anonymous survey was obtained from the classes 2020, 2021 and 2022 using a Likert-scale based questionnaire regarding the students’ perception of the virtual microscopy podcasts. A summary of students’ feedback and academic performance will help us understand the significance of integrating multimedia with Histology teaching. The study will also facilitate planning a curricular modification when needed

A direct comparison of decision rules for early discharge of suspected acute coronary syndromes in the era of high sensitivity troponin

Background: We tested the hypothesis that a single high sensitivity troponin at limits of detection (LOD HSTnT) (&lt;5 ng/l) combined with a presentation non-ischaemic electrocardiogram is superior to low-risk Global Registry of Acute Coronary Events (GRACE) (&lt;75), Thrombolysis in Myocardial Infarction (TIMI) (≤1) and History, ECG, Age, Risk factors and Troponin (HEART) score (≤3) as an aid to early, safe discharge for suspected acute coronary syndrome. Methods: In a prospective cohort study, risk scores were computed in consecutive patients with suspected acute coronary syndrome presenting to the Emergency Room of a large English hospital. Adjudication of myocardial infarction, as per third universal definition, involved a two-physician, blinded, independent review of all biomarker positive chest pain re-presentations to any national hospital. The primary and secondary outcome was a composite of type 1 myocardial infarction, unplanned coronary revascularisation and all cause death (MACE) at six weeks and one year. Results: Of 3054 consecutive presentations with chest pain 1642 had suspected acute coronary syndrome (52% male, median age 59 years, 14% diabetic, 20% previous myocardial infarction). Median time from chest pain to presentation was 9.7 h. Re-presentations occurred in eight hospitals with 100% follow-up achieved. Two hundred and eleven (12.9%) and 279 (17%) were adjudicated to suffer MACE at six weeks and one year respectively. Only HEART ≤3 (negative predictive value MACE 99.4%, sensitivity 97.6%, %discharge 53.4) and LOD HSTnT strategy (negative predictive value MACE 99.8%, sensitivity 99.5%, %discharge 36.9) achieved pre-specified negative predictive value of &gt;99% for MACE at six weeks. For type 1 myocardial infarction alone the negative predictive values at six weeks and one year were identical, for both HEART ≤3 and LOD HSTnT at 99.8% and 99.5% respectively. Conclusion: HEART ≤3 or LOD HSTnT strategy rules out short and medium term myocardial infarction with ≥99.5% certainty, and short-term MACE with &gt;99% certainty, allowing for early discharge of 53.4% and 36.9% respectively of suspected acute coronary syndrome. Adoption of either strategy has the potential to greatly reduce Emergency Room pressures and minimise follow-up investigations. Very early presenters (&lt;3 h), due to limited numbers, are excluded from these conclusions. </jats:sec