An Unusual Complication of Paracentesis

Paracentesis is an important and commonly performed procedure in patients with ascites. It is a safe procedure when carried out in the midline below the umbilicus, with a complication rate of less than 1%. We report an instance in which a large midline varix was entered during paracentesis. The utility of different imaging techniques in detecting such anomalies in the portal hypertensive patient with portal hypertension and ascites is discussed. The approach and management of this complication are outlined.     

Myocardial Hematoma Documented by Transthoracic Echocardiography After Sequential Coronary Artery Stenting

We report the case of a patient who deteriorated suddenly while undergoing endoluminal coronary artery reconstruction with multiple stents to the left anterior descending coronary artery. With the aid of transthoracic echocardiography, a pericardial effusion was noted; however, dissection of the ventricular wall due to a large myocardial hematoma was also identified. Emergency exploration with evacuation of the pericardial blood with coronary artery bypass graft surgery was successfully accomplished. We discuss the possible factors that could have been associated with this unforeseen complication and the potential benefit of transthoracic echocardiography in early recognition.     

Static and dynamic electro-optical properties of liquid crystals mediated by ferroelectric polymer films

This paper reports the electro-optical properties of high resistivity nematic liquid crystals sandwiched between ferroelectric polymer films. Interactions between liquid crystals and the film result in a series of interesting optical and electro-optical features. For example, the visualization of ferroelectric domains by means of liquid crystals has been known for decades. However, here we demonstrate that liquid crystals can also reveal the fractal dimension of multi—domain poly(vinylidene fluoride)-based films. Unidirectionally rubbed films made of poly(vinylidene fluoride)-based (PVDF) materials align liquid crystals (LC) homogeneously, with the pretilt angle on the order of 1–2 degrees. This property was implemented in the design of hybrid cells composed of liquid crystals sandwiched between PVDF-based films. The designed PVDF|LC|PVDF cells exhibit tunable electro-optical performance originating from the presence of the PVDF-based films. More specifically, (i) the threshold voltage characterizing the transition of liquid crystals from a planar to a homeotropic state can be tuned by varying the film thickness, and (ii) total fall time (turn-off time) can be controlled by varying the frequency and amplitude of the driving voltage. This frequency dependence of the fall time is strongly pronounced at a relatively high voltage applied across the cell. In the low frequency regime, an increase in the turn-off time can be approximated as a linear function of the applied electric field. An electric-field induced polarization of the PVDF-based films is considered a major reason leading to the afore-mentioned amplitude and frequency dependence of the switching time.

Liquid crystals (LC) can reveal the fractal dimension of multi-domain ferroelectric films (FF) while these films can control the switching time of FF–LC hybrids.     

The interplay between metabolic alterations,diastolic strain rate and exercise capacity in mild heart failure with preserved ejection fraction: a cardiovascular magnetic resonance study

Background

Heart failure (HF) is characterized by altered myocardial substrate metabolism which can lead to myocardial triglyceride accumulation (steatosis) and lipotoxicity. However its role in mild HF with preserved ejection fraction (HFpEF) is uncertain. We measured myocardial triglyceride content (MTG) in HFpEF and assessed its relationships with diastolic function and exercise capacity.

Methods

Twenty seven HFpEF (clinical features of HF, left ventricular EF >50%, evidence of mild diastolic dysfunction and evidence of exercise limitation as assessed by cardiopulmonary exercise test) and 14 controls underwent ¹H-cardiovascular magnetic resonance spectroscopy (¹H-CMRS) to measure MTG (lipid/water, %), ³¹P-CMRS to measure myocardial energetics (phosphocreatine-to-adenosine triphosphate - PCr/ATP) and feature-tracking cardiovascular magnetic resonance (CMR) imaging for diastolic strain rate.

Results

When compared to controls, HFpEF had 2.3 fold higher in MTG (1.45?±?0.25% vs. 0.64?±?0.16%, p?=?0.009) and reduced PCr/ATP (1.60?±?0.09 vs. 2.00?±?0.10, p?=?0.005). HFpEF had significantly reduced diastolic strain rate and maximal oxygen consumption (VO₂ max), which both correlated significantly with elevated MTG and reduced PCr/ATP. On multivariate analyses, MTG was independently associated with diastolic strain rate while diastolic strain rate was independently associated with VO₂ max.

Conclusions

Myocardial steatosis is pronounced in mild HFpEF, and is independently associated with impaired diastolic strain rate which is itself related to exercise capacity. Steatosis may adversely affect exercise capacity by indirect effect occurring via impairment in diastolic function. As such, myocardial triglyceride may become a potential therapeutic target to treat the increasing number of patients with HFpEF.

     

A unifying modeling framework for highly multivariate disease mapping

Multivariate disease mapping refers to the joint mapping of multiple diseases from regionally aggregated data and continues to be the subject of considerable attention for biostatisticians and spatial epidemiologists. The key issue is to map multiple diseases accounting for any correlations among themselves. Recently, Martinez‐Beneito (2013) provided a unifying framework for multivariate disease mapping. While attractive in that it colligates a variety of existing statistical models for mapping multiple diseases, this and other existing approaches are computationally burdensome and preclude the multivariate analysis of moderate to large numbers of diseases. Here, we propose an alternative reformulation that accrues substantial computational benefits enabling the joint mapping of tens of diseases. Furthermore, the approach subsumes almost all existing classes of multivariate disease mapping models and offers substantial insight into the properties of statistical disease mapping models. Copyright © 2015 John Wiley & Sons, Ltd.     

Associations Between Abortion Services and Acceptance of Postabortion Contraception in Six Indian States

Women receiving induced abortions or postabortion care are at high risk of subsequent unintended pregnancy, and intervals of less than six months between abortion and subsequent pregnancy may be associated with adverse outcomes. This study highlights the prevalence and attributes of postabortion contraceptive acceptance from 2,456 health facilities in six major Indian states, among 292,508 women who received abortion care services from July 2011 through June 2014. Eighty‐one percent of the women accepted postabortion contraceptive methods: 53 percent short‐term, 11 percent intrauterine devices, and 16 percent sterilization. Postabortion contraceptive acceptance was highest among women who were aged 25 years and older, received first‐trimester services, received induced abortion, attended primary‐level health facilities, and had medical abortions. Doctors receiving post‐training support were more likely to offer contraceptives, but no association was observed between such support and acceptance of IUDs or sterilization. Comprehensive service‐delivery interventions, including ensuring availability of skilled providers and contraceptive commodities, offering clinical mentoring for providers, identifying and addressing provider bias, and improving provider counseling skills, can increase postabortion contraceptive acceptance and reduce unintended pregnancy.     

Aluminium Induced Glutathione is Essential for Developing Resistance Against Fusarium Infection in Wheat

Proceedings of the National Academy of Sciences, India Section B: Biological Sciences - Pre-treatment of wheat seedlings with 50 μM concentration of aluminium sulphate (Al) induces...     

Frontal osteomyelitis presenting as upper eyelid ectropion: A cautionary tale

Frontal osteomyelitis is a rare clinical entity that can occur as sequelae to frontal sinusitis, head trauma, as a postoperative complication following sinus surgery or due to haematogenous spread. It usually presents with a soft, fluctuant forehead swelling with pain and fever. Cicatricial ectropion is an extremely rare feature of frontal osteomyelitis. We present a young male patient presenting with cicatricial ectropion that occurred as the sole manifestation of an underlying frontal osteomyelitis. Extensive Medline search did not find any such reported case. We feel that frontal osteomyelitis should be kept in mind as a possible etiology when considering the differential diagnosis of cicatricial ectropion.