Delayed Treatment of Acute Myocardial Infarction With Ventricular Septal Rupture Due to Patient Fear During the COVID-19 Pandemic

During the coronavirus disease 2019 (COVID-19) pandmic, more patients are presenting with complications late after acute myocardial infarction. We report the case of a 71-year-old man who delayed seeking medical care for 2 weeks, despite progressive shortness of breath, cough, and tactile fever, for fear of contracting COVID-19 in the hospital. Clinical and echocardiographic evaluation revealed a ventricular septal rupture secondary to acute myocardial infarction. The patient underwent urgent cardiac catheterization, followed by successful saphenous vein grafting to the left anterior descending coronary artery and open surgical repair of the ventricular septal rupture with a bovine pericardial patch. This case highlights a potential long-lasting negative effect that the COVID-19 pandemic will have on the care-seeking behavior and health of patients with acute cardiovascular disease.     

Head movements of children in MEG: quantification, effects on source estimation, and compensation

Head movements during magnetoencephalography (MEG) recordings may lead to inaccurate localization of brain activity. This can be particularly problematic for studies with children. We quantified head movements in 8- to 12-year-old children performing a cognitive task and examined how the movements affected source estimation. Each child was presented auditory word stimuli in five 4-min runs. The mean change in the MEG sensor locations during the experiment ranged from 3 to 26mm across subjects. The variation in the head position was largest in the up-down direction. The mean localization error in equivalent current dipole (ECD) simulations was 12mm for runs with the most head movement, with the frontal cortex appearing to be most prone to errors due to head movements. In addition, we examined the effect of head movements on two types of source estimates, ECDs and minimum-norm estimates (MNE), for an auditory evoked response. Application of a recently introduced signal space separation (SSS) method to compensate for the head movements was found to increase the goodness-of-fit of the ECDs, reduce the spatial confidence intervals of the ECDs, and enhance the peak amplitude in the MNE. These results are indicative of the SSS method being able to compensate for the spatial smoothing of the signals caused by head movements. Overall, the results suggest that MEG source estimates are relatively robust against head movements in children, and that confounds due to head movements can be successfully dealt with in MEG studies of developmental cognition.     

Jordanian nursing students' knowledge of osteoporosis

The aim of this study was to explore baccalaureate nursing students' knowledge of osteoporosis for beginning practice in the community. A cross-sectional study design was used. Students were selected by convenience sampling ( n  = 85) from one University in Jordan in the final of 4 years. Students were asked to complete a 23-item-knowledge questionnaire based on two earlier published studies of osteoporosis. Results indicated poor level of knowledge of osteoporosis on all dimensions: prevention (11 items) 62.6%; SD 14.2; general (5 items) 59.5%; SD 20.6; and the pathophysiology (7 items) 39.6%; SD 15.6, and an overall mean grade of 54.9%; SD 10.3. This result provides information that graduating nursing students have limited knowledge to undertake the role of health promotion and disease prevention in the community.     

Range of movements of lower limb joints in cross-legged sitting posture

Cross-legged sitting posture is integral to activities of daily living in Eastern and Asian cultures. This posture has not been studied or defined in any significant detail from an orthopedic view point. The movements of right lower limb joints were measured in cross-legged sitting posture in 44 volunteers from the Indian population with no prior history of problems related to the knee or hip joint. Flexion at the hip joint ranged from 82 degrees to 100 degrees , with a mean of 91 degrees . Abduction at the hip joint ranged from 19 degrees to 57 degrees , with a mean of 39 degrees . The external rotation ranged from 42 degrees to 58 degrees , with a mean of 49 degrees . Flexion at the knee ranged from 126 degrees to 142 degrees , with a mean of 135 degrees .Equinus at the ankle ranged from 17 degrees to 34 degrees , with a mean of 29 degrees . The resultant data would be useful in understanding kinematics of the knee and hip in the healthy and post-total joint arthroplasty population. The data could be used for design features of prosthetic joints, surgical technique, and rehabilitation protocols. Such data have not been available hitherto in any relevant published literature.     

Preanalytical requirements for flow cytometric evaluation of platelet activation: choice of anticoagulant

Accurate assessment of in vivo or in vitro platelet activation requires optimal preanalytical conditions to prevent artefactual in vitro activation of the platelets. The choice of anticoagulant is one of the critical preanalytical conditions as anticoagulants exert different effects on the activation of platelets ex vivo. We tested the effectiveness of Diatube-H (also known as CTAD; sodium citrate, theophylline, adenosine and dipyridamole) and citrate vacutainer tubes in preventing artefactual activation of platelets and preserving functional reserve. Platelet surface expression of the CD62P (reflecting alpha granule release), CD63 (reflecting lysosomal release) and modulation of normal platelet membrane glycoproteins CD41a and CD42b, were measured in whole blood and in isolated platelets immediately after collection and at 6, 24 and 48 h after venipuncture. Samples taken into Diatube-H showed less spontaneous platelet activation than did those taken into citrate. To measure in vitro platelet functional reserve, thrombin was added as agonist to blood stored for varying periods up to 48 h. Although Diatube-H suppressed in vitro platelet activation for up to 4 h, in samples kept for 6-24 h before thrombin addition, the inhibitory effect was lost and platelets responded fully to agonist activation. Hence, Diatube-H preserved platelets and allowed for measurement of in vivo platelet activation as well as thrombin-induced in vitro platelet activation after 6-24 h, in both whole blood and isolated platelets.     

Eikenella corrodens endocarditis in an intravenous drug user: case report and literature review.

A rare case of Eikenella corrodens endocarditis in an intravenous drug user is reported. Repeated blood cultures from the patient established the diagnosis of this infection. However, evaluation of the cardiac function using two-dimensional echocardiography with Doppler flow demonstrated a large pedunculated tricuspid vegetation. Also evident on this study was a dilated right ventricle with diminished contractility and regurgitation. Complete sterilization of the blood was achieved after a 2-week course of intravenous penicillin and gentamicin followed by an additional 4-week course of intravenous penicillin alone. Clinicians treating suspected IV drug users should be aware of the potential pathogenicity of this rare, facultative, anaerobic gram-negative bacillus (E corrodens). A combination of intravenous penicillin and aminoglycoside should be considered as the initial treatment followed by an additional course of intravenous penicillin for such patients with valvular vegetation.     

Lasting potentiation of inhibition is associated with an increased number of gamma-aminobutyric acid type A receptors activated during miniature inhibitory postsynaptic currents.

Whole-cell patch-clamp recordings unveiled a substantial increase in the amplitude, but no change in the frequency, of miniature inhibitory postsynaptic currents (mIPSCs) in dentate gyrus granule cells following chronic epilepsy induced by kindling. This novel and persistent enhancement of gamma-aminobutyric acid type A (GABAA) receptor-mediated inhibition lasted for at least 48 hr following its induction. Nearly a doubling of the number of activated functional postsynaptic GABAA receptor channels during mIPSCs without any change in single-channel conductance or kinetics could be demonstrated using nonstationary fluctuation analysis. As postsynaptic GABAA receptors are likely to be pharmacologically saturated by the transmitter concentration in the cleft, incrementing the number of functional receptor channels may be the most effective means to augment inhibition in the mammalian brain.     

Immune Profiling of T Cells Infiltrating Vitreous Humor in Tubercular Uveitis

Purpose: To assess cellular composition and local cytokine response in vitreous humor of tubercular uveitis.

Methods: Cells were collected from vitreous cassettes and peripheral blood of 8 tubercular uveitis and 5 control subjects, undergoing vitrectomy and analyzed by flow cytometry for cellular composition, activation status, proinflammatory cytokine expression, and uptake of TLR9 ligand, CpG ODN 2216.

Results: CD3 + T cells with equal proportion of CD4+ and CD8 + T cells formed major fraction of infiltrating cells. The vitreous humor showed higher expression of recent activation marker, CD69, and proinflammatory cytokines, IFN-γ and IL-17A, in CD4 + T cells as compared to peripheral blood. Lastly, intraocular CD4 + T cells showed reduced uptake of ODN 2216 than peripheral blood.

Conclusions: Our results indicate that local antigenic stimuli trigger T cell infiltration and activation of CD4 + T cells that are hyporesponsive to TLR9 stimulation. These infiltrating T cells might be responsible in further aggravating ocular inflammation.