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BackgroundPre-treatment biomarkers for outcome of repetitive Transcranial Magnetic Stimulation (rTMS) treatment of Major Depressive Disorder (MDD) have proven elusive. One promising family of biomarkers involves the autonomic nervous system (ANS), which is dysregulated in individuals with MDD.MethodsWe examined the relationship between the pre-treatment pupillary light reflex (PLR) and rTMS outcome in 51 MDD patients. Outcome was measured as the percent change in the 30-item Inventory of Depressive Symptomatology Self Rated (IDS-SR) score from baseline to treatment 30.ResultsPatients showed significant improvement with rTMS treatment. There was a significant correlation between baseline pupillary Constriction Amplitude (CA) and clinical improvement over the treatment course (R = 0.41, p = 0.003).LimitationsWe examined a limited number of subjects who received heterogeneous treatment protocols. Almost all patients in the study received psychotropic medications concomitant with rTMS treatment.ConclusionPLR measured before treatment may be a predictive biomarker for clinical improvement from rTMS in subjects with MDD.

Background and Objective: This study aimed to explore the association between coronary artery calcification and air pollutant exposure from all potential sources using microenvironment modeling. Methods: The present study recruited consecutive consenting patients, who visiting the radiology division of the tertiary cardiac specialty hospital for coronary artery calcification (CAC) evaluation, after obtaining institutional human ethics approval. Fifty participants each with CAC scores <100, 100–399, and ≥400, categorized as low, intermediate, and high risk, respectively, were recruited. Details on basic demographics and exposure to the potential sources of air pollutants from individual microenvironments, namely indoors, workplace, and outdoors, were collected by interview, using prevalidated, semi-structured questionnaire by trained staff. The cumulative exposure was reported as exposure risk hours, from the individual microenvironments and total exposure was estimated using mathematical modeling. In addition, cumulative (particulate matter) PM2.5 exposure for participants residing adjacent to air monitoring stations was estimated. The association between exposure to air pollutants and risk for coronary artery disease was evaluated with standard statistics. Results: Basic demographics revealed a significant association between CAC groups and age (i.e., "low," "intermediate," and "high" risk were, respectively, 54.7 ± 10.12, 58.52 ± 8.89, and 64.38 ± 8.74 years, respectively) and gender; wherein higher age and male sex were associated with higher CAC scores. Cumulative PM2.5 exposure was significantly different among the risk categories (i.e., "low," "intermediate," and "high" risk were, respectively, 976.14 ± 371.7, 975.78 ± 433.2, and 1215.58 ± 265.5 units). Further, exposure to the potential pollutants at outdoors and at workplace was independently associated with high CAC risk with statistical significance (P < 0.05). While exposure to the potential pollutants recorded at indoors during the transit/commute to residence and workplace was not statistically associated with the CAC risk categories (P > 0.05). Conclusion: Exposure to air pollutants from the workplace and outdoors was significantly associated with higher coronary artery calcification, thereby increasing the risk for coronary artery diseases. [ABSTRACT FROM AUTHOR]

Background: The perforating artery aneurysm arising from stem of perforating artery away from parent artery should be considered separate entity from those arising from parent artery in the adjacent to their origin or incorporating their origin. Case report: A 34 years old, right-handed gentleman, presented to with multiple episodes of right sided facial and extremity tingling numbness and minimal weakness of extremities, episodes lasted for few minutes to maximum of 30 minutes. On examination there was no neuro deficit with all other vital parameters within normal limits. CT scan & MRI examination showed perimesencephalic cisren and suprasellar cistern SAH. Digital Substraction Angiography showed Aneurysm on the basilar top perforator. Very tiny perforator artery arising from basilar top is harbouring the aneurysm distally. It was decided to conserve this patient. Patient fully recovered over a period of 2 weeks. Repeat angiogram after 6 weeks showed complete resolution of the aneurysm. Conclusion: A conservative approach may be considered for selected cases where potential atherosclerosis is not present and where consecutive imaging shows a decrease in size and flow of the aneurysm. The surgical approach can be considered the next best mode of management Conservative observation for certain cases with periodic angiography follow-up was considered in order to prevent the patients from potential iatrogenic effects. [ABSTRACT FROM AUTHOR]

Objective: Fragmented QRS (fQRS), as defined by additional spikes in the QRS complex of a 12-lead electrocardiogram (ECG), is a marker of scarred myocardium. In patients with coronary artery disease (CAD), fQRS is a predictor of heart failure (HF) and other major adverse cardiac events (MACE). The study was aimed to evaluate the role of fQRS in prediction of HF in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods: In a prospective, non-randomized, small observational study, we enrolled 188 consecutive patients with STEMI undergoing primary PCI. Patients were grouped according to the presence or absence of fQRS and their inhospital, 1 and 6-month MACE outcomes were assessed. Results: Of the 188 patients, fQRS were noted in 92 (48.94%) patients. Patients with fQRS were more likely to have Killip class II/III/IV. Patients with fQRS had a significantly higher corrected QT interval, lower left ventricular ejection fraction (LVEF), and higher N-terminal pro brain natriuretic peptide (NT-pro BNP) at 24 hours and 48 hours compared to patients without fQRS. The in-hospital (P=0.001), 30-day (P=0.03) and 6-month (p=0.01) MACE were higher in patients with fQRS. On logistic multiple analysis, fQRS in anterior leads (OR=3.70, CI=1.68-10.02, p=0.001), fQRS in more than 2 leads (OR=5.20, CI=1.51-12.83, p=0.01), NT-proBNP (OR=1.05, CI=1.03-1.08, p=0.02) and Killip class II/III/IV were found to be significant predictors for HF hospitalization. Conclusion: Our findings suggest that fQRS can be a predictor for HF in patients with STEMI and provide a simple and readily available technique for predicting prognosis. Larger studies are required to validate these findings. [ABSTRACT FROM AUTHOR]

Background: Despite improvement in the surgical procedure and strictly following the guidelines for mitral valve replacement (MVR), left ventricular dysfunction still occurs. Novel echocardiographic indices can predict development of LV (left ventricle) dysfunction post MVR. LV-GLS (global longitudinal strain) derived from speckle tracking echocardiography, has been proposed as a novel measure to better depict latent LV dysfunction. Methods: A total of 100 patients with severe MR (mitral regurgitation) planned for MVR were included. Speckle tracking echocardiography was performed at baseline and at follow up post MVR. ROC (Receiver operating characteristics) curve was plotted to derive the cutoff value of LV-GLS for prediction of LV dysfunction post MVR. Univariate and multi variate regression was analyzed to predict the independent predictors of LV dysfunction after MVR. Results: LV-GLS was decreased from baseline data (¡19.9 vs. ¡17.7) in patients with LVEF <50% after MVR compared to patients with LVEF= 50%. Baseline value of LVESD (35.36 mm vs. 28.23 mm) and LVEDD (49.33 mm vs. 45.10 mm) were significantly higher in patients with LVEF<50% compared to LVEF =50% at 3 months follow up. A cutoff value of GLS -19% with sensitivity of 80.3% and specificity of 75.7% was associated in patients with LV dysfunction after MVR. In multivariate regression model GLS < -19% (OR = 21.8, CI:6.61e82.4, P=<0.001) was an independent predictor of LV dysfunction post MVR. Conclusion: A GLS value of less than ¡19% was demonstrated as an independent predictor of short term LV dysfunction after mitral valve surgery, LVESD =40 mm was also verified additional parameter to predict the LV dysfunction post MVR. [ABSTRACT FROM AUTHOR]

Chemical investigation of the chloroform extract of heartwood of Tectona grandis L. f. led to the isolation of three new naphthoquinone derivatives, tectonaquinones A (1), B (2) and C (3), along with six known compounds: barleriaquinone-I (4), tectoquinone (5), tecomaquinone I (6), lapachol (7), obtusifolin (8) and 2-hydroxy-3-methyl anthraquinone (9). The structures of the new compounds were elucidated by spectroscopic methods including 2 D NMR experiments. Tectonaquinone B is the first natural compound that has a hexa-cyclic dinaphthofuran-dione scaffold. Tectonaquinone C has a bicyclic acetal motif that is unusual in nature. [ABSTRACT FROM AUTHOR]