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Dual antiplatelet therapy (DAPT) combining aspirin and a P2Y12 receptor inhibitor has been consistently shown to reduce recurrent major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD) compared with aspirin monotherapy but at the expense of an increased risk of significant bleeding. Among patients with stable CAD undergoing PCI with drug-eluting stents (DES), shorter duration of DAPT (3–6 months) were shown non-inferior to 12 or 24 months duration concerning MACE but reduced the rates of major bleeding? Contrariwise, prolonged DAPT durations (18–48 months) reduced the incidence of myocardial infarction and stent thrombosis, but at the cost of an increased risk of majör bleeding and all-cause mortality. Until more evidence becomes available, the choice of optimal DAPT regimen and duration for patients with CAD requires a tailored approach based on the patient clinical presentation, baseline risk profile and management strategy. Patients with acute coronary syndromes (ACS) and a history of atrial fibrillation (AF) have indications for both dual antiplatelet therapy (DAPT) and oral anticoagulation (OAC). Triple therapy (TT), the combination of DAPT and OAC, is recommended in guidelines. This article provides a contemporary state-of-the-art review of the current evidence on DAPT for secondary prevention of patients with CAD and its future perspectives.

Background: Various surgical methods have been utilized in the management of complete atrioventricular septal defects (CAVSD). Early intervention and achievement of a competent left atrioventricular valve are the key factors for successful treatment. Methods: A total of 66 patients with complete atrioventricular septal defect have been operated in a tertiary care center. Patient group consisted of 28 males and 38 females with an average age of 6.2 ± 3.3 months. Ventricular and atrial defects were repaired generally with single-patch technique using autogenous pericardium. Results: Preoperative catheterization and angiography was performed in 41 patients. Single patch and modified single patch techniques were preferred in 57 and 9 patients respectively. The average duration for respiratory support, intensive care unit stay and discharge from hospital were 36 ± 49.3 hours, 4.1 ± 1.9 days, and 10.1 ± 3.3 days respectively. In the left atrioventricular valve mild, moderate and severe regurgitation were detected in 44 (66.6%), 17 (25.7%) and 2 (3%) patients postoperatively. No regurgitation was determined in 3 patients (4.5%). Two cases ended up with mortality (3%). Conclusion: Single patch repair technique can provide satisfactory surgical outcomes in patients with complete atrioventricular septal defect.

Objective: The long-term outcome of percutaneous transluminal angioplasties is mainly determined by restenoses, either by progression of the underlying disease or by intimal hyperplasia. Pharmacological substances on the one hand and the implantation of stents on the other have been developed with the intention of preventing precisely this complication. While patients are treated after PTA of peripheral vessels with different low-molecular-weight heparins, the indication for stent implantation is determined individually rather by experience. The aim of this study was to determine gender-specific risk factors of long-term outcome after percutaneous transluminal angioplasty (PTA) of peripheral vessels with or without stentimplantation. Methods: In the present study, we examined the long-term results of percutaneous transluminal angioplasty (PTA) of peripheral vessels. Between 2007 and 2017, in total, 3,276 patients underwent PTA with or without stent implantation in our clinic. All patients were treated postinterventionally for 48 hours with 25,000 IU heparin (Unfractionated Heparin (UFH), heparinsodium-Braun, 25,000 I.E./5 ml, 2 ml/h) monitored by the partial thromboplastin time and subsequently underwent a control investigation every 6 months. The endpoint of the study was determination of symptomatic stenosis larger than 50% that required reintervention. Results: 239 (68.2% with mean age 68.02 years) male patients and 111 female patients (31.71% with mean age 62.92 years) were evaluated with complete follow-up. A total of 470 PTAs were performed on male patients and 213 on female patients in multiple interventions. The majority of patients at the time of treatment were in stage IIb according to the classification of Fontaine (81.6% of male patients and 68% of females). In our sample, peripheral arterial disease stage III and IV according to Fontaine classification occurred twice as frequently in female patients as in male patients (stage III in 12.6% in female versus 6.1% in male, and stage IV in 18% in female versus 8.9% in males). In both groups, the femoral superficialis artery was most frequently dilated (64 cases, 30% in female and 155 cases, 32.9% in male), followed by the iliacal communis artery (46 cases in female and 99 cases in male, both with 21.5%). A balloon angioplasty of the tibialis anterior and posterior arteries was performed twice as frequently in female patients as in male patients (28 cases with 13.1% of tibialis ant. artery in female versus 32 cases with 6.8% in male patients, and in 17 cases with 7.9% of tibialis post. artery in female versus 16 cases with 3.4% in male patients). In this study, without consideration of gender, patency rates of 79% after 2.5 years, 67% after 5 years, 49% after 7.5 years and 37% after 10 years were determined for PTA without stent implantation. Between the 7th and 10th year in follow-up, the cumulative patency rates for stent implantation was 49%, whereas it was 31% for PTA alone. The results of this study show that the stent assisted PTA`s of comm. artery and external iliacal artery are significantly independent of risk factors better than the femoral vessels, and these in female patients better than in male patients. Male patients do not benefit significantly from stent implantation in the long term. As the COXI and II regression analyses show, gender-linked results are most evident for renal insufficiency and diabetes mellitus, and less pronounced also for the number of open lower leg vessels. Conclusion: Under consideration of gender and risk factors, while male patients with diabetes mellitus, renal insufficiency and/or poor run-off did not benefit from stent implantation in the long-term, female patients with similar risk factors showed higher patency rates after stent therapy. In addition, the long-term results after PTA of femoral superficialis artery and poplitea artery are significantly worse than PTA of the pelvic vessels in both genders.

Ventricular assist device is a portable machine which is also called an artificial heart for the patients who have terminal heart failure. The device maintains the heart’s vital functions until the suitable donor is found for the heart transplantation. It can be applied to either ventricles or both (biventricular). Although the device provides independence for the patient, it also has life-threatening complications. Such as infection, stroke secondary to thromboembolism, hemorrhage depending on anticoagulant use, right heart failure… and most of the time it is really hard to manage those complications. We will present a case, who had ischemic stroke as a complication of VAD even though he has been using aspirin, warfarin and had effective INR value.

In recent years there has been increasing concern about the growing burden of cardiovascular disease (CVD) in developing countries. Systemic hypertension remains the commonest form of CVD and is identified as a key modifiable risk factor for cardiovascular morbidity and mortality. Primary and secondary prevention of cardiovascular adverse events are public health priorities. This review highlights the potential barriers and challenges to hypertension care in Africa’s most populous country, Nigeria, and proffers relevant recommendations.

Important differences has been found in assessing the effects of obesity on cardiovascular disease (CVD) risk [1]. Interestingly, accurate estimation of the body composition (BC) is highly relevant from a public health perspective [2], and it has the importance of being essential in establishing the impact of adiposity on increased myocardial infarction (MI) risk. However, in non-randomized studies, baseline differences of BC between groups to be compared may introduce bias in results.

Sildenafil citrate is one of the frontline drugs used to manage erectile dysfunction (ED). Chemically, it is described as 1-[[3-(6,7-dihydro-1-methyl-7-oxo-3-propyl-1H –pyrazolo [4,3-d]pyrimidin-5-yl)-4 ethoxyphenyl] sulfonyl]-4-methylpiperazine citrate (C22H30N6O4 S). It is a highly selective inhibitor of cyclic guanine monophosphate-specific phosphodiesterase type-5. There had been heightened concerns following reports that sildenafil citrate may increase the risk of cardiovascular events, particularly fatal arrhythmias, in patients with cardiovascular disease. So the cardiac electrophysiological effects of sildenafil citrate have been investigated extensively in both animal and clinical studies. This article ties up the various outcomes of the investigations with a view to guiding physicians and patients that use sildenafil citrate to manage erectile dysfunction, especially as it concerns its effect on their cardiovascular function in health and in disease. Sildenafil citrate could impact negatively on ailing hearts, but on a healthy heart, there may not be any such impact, rather, it improves on heart performance as it lowers the blood pressure.

Peripartum cardiomyopathy (PPCM) is a relatively rare cardiac disease that manifests in the final stage of pregnancy and in the first months after delivery in women with no preexisting heart disease. Many etiological processes have been suggested: viral myocarditis, abnormal immune response to pregnancy, excessive prolactin excretion, prolonged tocolysis and a familiar predisposition to PPCM. Its diagnosis is often delayed because its symptoms, which include fatigue, dyspnea and palpitations are nonspecific. For this reason the diagnosis of PPCM is still made by exclusion of other etiologies. The long-term prognosis, once the acute phase is over, is a function of myocardial damage, this varies from complete functional recovery to chronic HF. The outcome of PPCM is highly variable with an alevated risk of fetomaternal morbidity and mortality. We report a serious case of a 40 years old female with biamniotic bicorionic twin pregnancy (PMA) who delivered by caesarean section and developed acute PPCM on post-operative. Symptoms occurred two hours after an intramuscular injection of two vials of methylergonovine the same day of cesarean delivery. These manifested in sudden tachypnoe, tachycardia and the appearance itchy maculopapular rash on her chest. On further evaluation, ECHO revealed cardiomegaly with reduced ejection fraction (< 15%). The case was successfully managed by a multidisciplinary team, using drugs like levosimendan and cabergoline, which rapresent emerging strategy in this clinical context.

Pregnancy is a happy stage in life of every woman, but at the same time it is a rather difficult period, since pregnancy represents a serious strain on the body. In the body of a woman during this period there are significant physiological changes that ensure the correct development of the fetus, prepare the body for the upcoming delivery. In this difficult period, the burden on all organs and systems of the woman’s body is significantly increased. Especially often suffer joints; there is a risk of permanent pain, the development of diseases or exacerbation of existing diseases. One of the most common problems is Temporomandibular Dysfunction or Disorder (TMD) which many women face, but still hasn’t been explained.

Female genital mutilation / cutting remains a widespread practice throughout Africa. There has been a worldwide effort to do away with FMG/C, but tensions exist between those who aim to abolish FGM/C and those who desire to perpetuate the tradition. While many Western and African experts and organizations agree on the health risks and human rights concerns with FGM/C, others fear that Westerners are imposing their ideas and lack of cultural understanding, trying to eliminate a practice central to the identity of many Africans. The issue must be approached respectfully and collaboratively, with great effort on the part of Westerners to understand the cultural context and rationale of this tradition. Ultimately, if FGM/C is to be eradicated in the foreseeable future, whole African communities and international support agencies must be engaged and empowered to collectively evaluate the implications of the practice and accelerate its demise.

This report provides an insight into a very unusual problem in the first trimester of pregnancy, and describes the unfolding of a series of potential blunders. We all know that most problems in gynecologic oncology become terribly magnified when the patient is pregnant. HB had a routine ultrasound in the first trimester of pregnancy, and a large, extremely vascular mass occupying most of the lower anterior abdominal wall, was found (Figure 1). Because she had received methotrexate two years earlier for a persistent elevation of the hCG titer following surgery for an ectopic pregnancy, she was referred to the gynecologic-oncology service with the working diagnosis of metastatic gestational trophoblastic disease (GTD). An MRI showed a vascular mass in the subcutaneous tissue invading the rectus sheath and muscle, but not attached to the uterus (Figure 2). The report stated, in no uncertain terms, that the mass was strongly indicative of a metastasis from GTD. However, the hCG level was consistent with the estimated gestational age, and a mass such as this would represent an extremely unusual way for this disease to present. She had been told that she would need the have the pregnancy terminated, followed by chemotherapy to reduce the size of the mass prior to its removal.

Tilmicosin (TMC) is a semi synthetic macrolide antibiotic of tylosin derivatives commonly used by veterinaries, has been shown to reveal beneficial pharmacological activities. In the current study, the potential wound healing activity, Anti-oxidant effect (ulcer and hepatoprotective) were investigated. Anti-inflammatory, antipyretic, analgesic (central and peripheral), hypnotic and antispasmodic activity were also screened. This study included adult both sexes of rats (200-250 gm), mice (20-25 gm) and adult rabbits. Experimental wound was induced on the anterior-dorsal side of each rat whereas, ulcer induced by ethanol causing mucosal damage in rats. The oral anti-inflammatory induced through formalin producing edema, antipyretic (Brewer’s yeast induced hyperthermia) and analgesic (writhing test, hot plate method, tail immersion method) while hypnotic effects induced through thiopental sodium. Anti-spasmodic effect on isolated organs (intestinal and uterine muscles) using new method of Modular Single Chamber Organ Bath were carried out on experimental animals. Tilmicosin antibiotic at different two doses of 20 and 40 mg/kg b.wt., has an important role in treatment of ulcer (cytoprotective effect) and improvement the wound healing processes besides anti-inflammatory, analgesics, and anti-pyretic effects. Tilmicosin revealed also hypnotic and intestinal anti-spasmodic effects but showed Pharmacovigilence hepatotoxic effect through the histopathological studies which revealed sever hepatic damage especially at larger dose.

A malignant tumor has the capacity to grow rapidly and to metastasize to the other parts of the body. Ovary has been a common organ for secondaries caused by hematological spread of the tumor and exhibits the same histopathology as that of the primary tumor. Very rarely, it has been found that the patients suffer from two or more histologically distinct, simultaneously detected malignancies, which are called as synchronous tumors or multiple primaries [1]. These multiple primaries can have an impact on cancer treatment (e.g., surgery) and affect the overall prognosis of the patient. Although there is no consensus on the definition of synchronous cancer, commonly two or more primary tumors that occur in a patient closely with respect to the time interval are termed as synchronous tumors [2]. Simultaneous diagnosis of gall bladder carcinoma with ovarian carcinoma with distinct histopathology is rare. A very few cases have been reported so far in literature. We discuss here a rare case that presented with synchronous tumor of gall bladder and the ovary.

Dry eye or keratoconjunctivitis sicca, is commonly seen in the dog. Veterinary ophthalmologists diagnose this aqueous tear deficiency using the Schirmer tear test (STT), but this measures tear production and does not indicate ocular surface pathology. The vital dye Rose Bengal is commonly used in the diagnosis of dry eye in human patients but until now has not been reported in veterinary patients. Here we corelate the degree of Rose Bengal staining with the STT value and find a reasonable association between dye staining of the ocular surface and tear production, although clearly other factors are also important in the genesis of ocular surface damage in dry eye.

Investigation the influences of vitamin (vit) E over a period of 5 days on the pharmacokinetics of florfenicol after single and multiple oral administrations in broiler chickens. Total of 12 broiler chickens had been taken single and multiple oral administrations of florfenicol (30 mg/kg) alone or pre-treated with vit E (2 mg/kg). The serum concentrations of florfenicol were determined using microbiological assay with Bacillus subtilis (ATCC 25922) as a tested microorganism. The mean serum concentrations of florfenicol alone were markedly lower when compared with florfenicol pre-treated with vit E after single and multiple dosing. The peak serum concentrations (Cmax) were 5.9±0.46, 7.48±0.3 ug/ml, absorption half-life (t0.5ab) of 0.51±0.06, 0.71±0.1 h and elimination half-life (t0.5el) of 2.72±0.34, 3.34±0.5 after single florfenicol alone and florfenicol pre-treated with vit E respectively. While, after multiple dosing, (Cmax) were 7.4±0.3, 8.04±0.3 ug/ml, (t0.5ab) 0.82±0.04, 0.81±0.04 h and (t0.5 el) 3.77±0.2, 4.52±0.7 h after multiple dosing of florfenicol alone and florfenicol pre-treated with vit E respectively. In conclusion Vit E alter the disposition kinetics of florfenicol after single and multiple oral administrations as, vit E allows prolongation of the duration of action for more 24 and 48 h of the drug concentration in the serum indicated by prolonged elimination half-lives and MRT reflecting the importance of this combination for the drug duration in serum but the increase in the serum concentration of florfenicol increasing its efficacy not toxicity as florfenicol of wide safety margin so, it’s advisable for poultry farms owners to use this combinations.

Coactivation of agonist and antagonist muscles participates in the regulation of joint stiffness and postural instability. Alterations on muscle activity have been revealed as an important falling risk factor. It is unclear the effects, and age-related differences, of a prolonged demanding task on the muscular coactivation levels. We compared muscle activation amplitude and coactivation of the vastus medialis, biceps femoris, tibialis anterior, and gastrocnemius medialis from surface EMG in 16 young adults (age 21-33) and 8 elderly adults (age 66-72) while fast-walking at 70% of their maximum heart rate. Overall, the elderly demonstrated higher coactivation indexes than the young individuals. Ankle coactivation decreased in the first half of the swing phase, while coactivation at the knee increased in the latter half of the swing phase in our elders. Alterations of muscle activation and coactivation on the knee and ankle were more prominent close to landing and in the swing phase. Our results suggest that these alterations may suggest potential concerns with respect to the risk of falls.

Climate change brings extreme events like drought, landslide, flood and anticipated more constraint to profitable livestock production causing huge economical loss in the livestock sector of the country. Deaths of livestock and damage to farms and farm infrastructure is causing a huge loss, small livestock holders are highly venerable to such climatic hazards. So to cope with these uncertain climatic hazards livestock insurance is the one of the best strategies. This study reveals that different climatic hazards is been experienced by the livestock holders of Kaski, Dolakha and Jhapa district of Nepal, 62% of the respondent has observed the change in climate. Of the total respondents perceived around 47% farmer have insured their livestock in Kaski district, 33% in Jhapa and 20 % in Dolakha district. Beside the proper vaccination, deworming, management and feeding of animals people are insuring their livestock assets due to uncertain in the climatic pattern and its consequences, this shows that livestock insurance is the one of the tool to mitigate with changing climate and climate relate hazard in livestock sector of Nepal.

Although the veterinary art has been practiced since antiquity, the modern era began in the 18th century with the establishment of the discipline of “Veterinary Science” at universities. In the 19th century, veterinary education began in Australia with Kendall’s private veterinary school in 1888 [1]. In 1909, a Veterinary Faculty was established at the University of Melbourne and Kendall’s school was incorporated into it. In 1910, a second faculty was established at the University of Sydney and in 1936, a third was established at the University of Queensland [2-4]. A fourth school was established at Murdoch University in Western Australia (WA) in 1974 [5].

Introduction: Radioiodine therapy is a standard procedure in thyroid autonomy treatment. Discrepancies in the visual comparisons of the scintigraphies prepared for this purpose using Tc-99m-O4- and I-131 have been known for years. In this study a new method is used to calculate and perform a quantitative comparison of both uptakes using subtraction analysis and 3D imaging. The results and their causes are discussed together with practice-relevant conclusions for better clinical results. Material and Methods: The new method was used in 38 patients with thyroid autonomies for the subtraction analysis of standardized pretherapeutic and intratherapeutic scintigraphies. The parametric distribution of activity was calculated absolutely and as a percentage and displayed three-dimensionally. These results were compared with the visual assessment of the different scintigraphies by the experts. Inclusion criteria were pretherapeutic and intratherapeutic hyperthyroidism without medication affecting the thyroid. The time difference between acquiring the scintigraphies was 28 days maximum. Results: Activity distribution was visually discrepant in 39.5% of cases. 60.5% displayed comparable uptake. The calculated values showed reversed results after applying the new method. The results using our method show a higher rate of calculated discrepancies compared with visual analysis. Conclusion: Accurate functional imaging of the thyroid is next to further aspects very important in establishing the diagnosis and deciding about the therapy activity for thyroid treatment. In combination with clinical symptoms and laboratory values, Tc-99m-O4 - scintigram can be used for an orientated, preliminary assessment of functional disorders of the thyroid. But because of the higher rate of found discrepancies, the solely use of Tc-99m-O4 - scintigram is not always capable for exact and reliable diagnosis. The known reason for this is most probably due to the different biokinetics of both radiopharmaceuticals, which can be imaged more sensitively with this method. Consequently, a scintigram should be performed in the pretherapeutic radioiodine uptake test. Despite higher costs and radiation exposure, alternatively, pretherapeutic use of other diagnostic iodine isotopes like I-123 or -124 should be discussed, because they could overcome the limitation of the different biokinetics. Following this approach the preliminary assessment using Tc-99m-O4 - scintigraphy can be precised and double checked to improve diagnostic confi dence and treatment results for a better outcome of the patients.  

Worldwide, Canine Distemper Virus (CDV) infection is a highly prevalent disease with high morbidity and mortality. CDV causes a multisystemic disease in a wide range of hosts including 9 families of mammals among them some primates, cetaceans and numerous carnivores. It presents a high tropism for lymphoid, neurological and epithelial tissue, leading to an infection of almost all systems, so the clinical signs observed are very varied. The diagnosis is made based on the clinical presentation of the disease, which considers a variety of signs and must be confirmed by a laboratory diagnostic method. The molecular technique called Reverse Transcription Polymerase Chain Reaction (RT-PCR) has been used to characterize viral strains based on the basis of genetic differences on the hemagglutinin (H) gene of CDV has allowed the identification of 14 circulating lineages in the world. Two lineages, namely the America-1 and the Europe-1/South America-1 have been described in Chile. The goal of this work was to implement a multiplex RT-PCR protocol, which was built on the in silico design of primers based on the H gene nucleotide sequences stored in the Genbank® database. This method was capable of detecting the previously described two circulating genetic lineages of CDV in a differential way providing a supporting diagnostic tool for epidemiological studies in the country. These results suggest that the primers described here are extremely selective for the above-mentioned lineages. In addition, our initial screening indicated that most analyzed clinical samples corresponded to the America-1 lineage, stressing the need for a continuous surveillance in order to properly address the prevalence of both lineages in Chile.