Tricuspid Regurgitation in Patients With Pacemakers and Implantable Cardiac Defibrillators: A Comprehensive Review

Implantable cardiac devices, including defibrillators and pacemakers, may be the cause of tricuspid regurgitation (TR) or may worsen existing TR. This review of the literature suggests that TR usually occurs over time after lead implantation. Diagnosis by clinical exam and 2‐dimensional echocardiography may be augmented by 3‐dimensional echocardiography and/or computed tomography. The mechanism may be mechanical perforation or laceration of leaflets, scarring and restriction of leaflets, or asynchronized activation of the right ventricle. Pacemaker‐related TR might cause severe right‐sided heart failure, but data regarding associated mortality are lacking. This comprehensive review summarizes the data regarding incidence, mechanism, and treatment of lead‐related TR.     

Synthesis and Pharmacological Screening of Novel meso‐Substituted Porphyrin Analogs

A novel series of mesotetrakis[aryl]‐21H,23H‐porphyrin derivatives 2a – j was synthesized from the condensation of aldehyde derivatives 1a – j with pyrrole in the presence of p‐toluenesulfonic acid. The synthesized porphyrins were considered as a model to study the free radical‐induced damage of biological membranes and the protective effects of these porphyrins. It was found that these compounds effectively inhibit the free radical‐induced oxidative hemolysis of red blood cells. Compounds 2c and 2d which bear a sulfur atom, a nitro group, and a chlorine atom exhibited markedly higher antihemolysis activity than the other analogous. Compounds 2a , 2c , 2d , and 2j showed the highest protection activity against DNA damage induced by the bleomycin–iron complex. Compounds 2d , 2f , 2i , and 2j were proved to exhibit antioxidative activity.     

Therapeutic benefits of zinc sulfate on neonatal hyperbilirubinemia

Neonatal hyperbilirubinemia is a common phenomenon shortly after birth and a frequent cause of prolonged hospi-talization[1].     

Plasma concentrations of growth arrest specific protein 6 and the soluble form of its tyrosine kinase receptor Axl in patients with Systemic lupus erythematosus and Behçets disease

Purpose

The aim of the present study was to investigate plasma concentrations of Gas6 and its soluble tyrosine kinase receptor sAxl in Systemic lupus erythematosus (SLE) and Behçets disease (BD) patients and to correlate those levels with clinical and laboratory manifestations of the diseases.

Methods

The study included 89 female SLE and 49 male BD patients. Twenty-seven age and sex matched healthy volunteers served as controls. All patients were subjected to full clinical examination, laboratory investigations and assessment of disease activity. Plasma concentrations of Gas6 and sAxl were quantified using ELISA technique.

Results

The level of Gas6 and Axl were significantly altered in the SLE patients (p?<?0.001) and in the BD patients (p 0.001 and 0.04 respectively) compared to those of the control. In SLE, the Gas6 was remarkably lower in those with class 1 lupus nephritis and in those with neuropsychiatric manifestations. In the BD patients, the level of Axl was significantly increased in those with neurological disease activity. The number of lymphocytes significantly negatively correlated with the gas6 and Axl levels significantly correlated with the number of neutrophils and negatively with the lymphocytic count in the BD patients.

Conclusion

The plasma concentrations of Gas6 and Axl were significantly altered in SLE and BD patients, suggesting that the Axl receptor shedding is an active process affected by and influences Gas6-mediated Axl-signaling in both diseases. Special attention is required in SLE patients with early lupus nephritis and neuropsychiatric manifestations and BD patients presenting with neurological disease activity. The relation with lymphocytes and neutrophils in BD throws light on the role of gas6 and Axl on their known resistance to cell death. Although the mechanisms responsible for the initiation of BD remain to be clarified, the role of the apoptotic process seems critical throughout the disease.     

Helminth infections: therapeutic potential in autoimmune disorders

Knowledge of immunity enables us to predict that the reactions set in response to infection with helminth would prevent concomitant disease driven by an opposing spectrum of immune events. In another way, the immune response generated to combat the helminth infection could counteract the immunopathological reactions that drive autoimmune diseases. Rodent model systems recapitulate many aspects of human autoimmune diseases and have been enormously useful in defining mechanisms of immunopathology after infection. From this theoretical perspective, many researchers have proved that infection with a variety of helminth can ameliorate disease in murine model systems. Thus, helminth‐evoked Th2 events were shown to improve disorders in which Th1 events predominated. This raised the question, ‘Can this information be translated into therapies for autoimmune diseases in humans via actual infection, cell delivery or drug intervention?’ In this review, we will present some experimental trails to treat autoimmune disorders through establishment of some parasitic infections.     

Intranodal angiolipoma

Angiolipomas are not uncommon tumors of the soft tissue, but are rarely found in other parts of the body. We report a case of intranodal angiolipoma in a 64-year-old man who presented with right inguinal swelling. Histopathological examination showed a tumor composed of mature adipose tissue and prominent vascular component, which is consistent with angiolipoma. We conclude that angiolipoma can be added to the list of conditions or diseases in the differential diagnosis of localized lymphadenopathy.     

Challenges in the acute management of profound hyponatremia presenting with severe symptoms

Currently available guidelines in the acute management of severely symptomatic hypotonic hyponatremia vary in their approach to the use of hypertonic saline. In the acute setting, deciding on when to implement available treatment algorithm using hypertonic saline may be difficult, given that the duration of hyponatremia and potential alternative diagnoses presenting with similar symptoms may be hard to establish promptly. We present the case of a young female with symptomatic profound hyponatremia who subsequently developed osmotic demyelination syndrome due to rapid overcorrection of serum sodium concentration. We discuss the interplay between the dynamic pathophysiological processes responsible for hypotonic hyponatremia in adrenal insufficiency and conduct a detailed analysis of currently available guidelines to highlight the challenges in acute and reactive treatment in clinical practice.     

Acute non traumatic abdominal pain of small bowel origin: Can multi-detector CT enterography provide a potential contribution to the diagnosis of underlying causes?

Purpose

To analyze the diagnostic value of multi-detector CT enterography (MDCTE) in identifying small bowel causes of acute non traumatic abdominal pain and in determining the extent of bowel lesion.