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Severe aortic stenosis (AS) may rarely present like acute coronary syndrome with increased cardiac biomarker despite having normal coronaries. Here we describe a case of very severe AS, who presented with exertional and rest angina and a high level of TnI. Angiography revealed normal coronaries. Echocardiography showed very severe AS with peak velocity of 5.08 m/s and maximum and mean gradient of 103 and 54 mm Hg, respectively. The patient subsequently underwent aortic valve replacement (AVR) successfully. Subendocardial ischaemia may occur in patients with severe AS during haemodynamic stress, even in the setting of normal unobstructed coronaries due to supply-demand mismatch. Subsequent degeneration and death of the cardiac myocytes cause cTnI elevation, which anticipates the start of the clinical downhill course in severe AS. Our case highlights the importance of thorough physical examination and early use of echocardiography in patients with angina to detect the presence of severe AS.

The media industry plays a central role in the emergence of a politically, socially, and economically conscious citizenry. This role has elevated the industry as a major stakeholder in the political, socio-cultural, and economic development of the people. This essential role, however, has come under serious threat following the emergence of the Digital Age, changing social trends, and a global economy that is in distress. This is the main reason this paper investigates the survival strategies adopted by the US print media industry to deal with the decline and see how the Nigerian print media industry that is facing similar decline can benefit from the strategies. The method of study is qualitative. We gathered data through in-depth interviews and on-site observation of the operations of the selected media organizations. We also reviewed literature provided by the media firms and the ones that are already in the public domain. Our findings confirm recent projections that the American and Nigerian media industries are truly facing economics of decline and that the Nigerian industry is worst hit. The study identified some of the strategies adopted by the American print media industry to deal with the economic recession to include introduction of online editions, use of pay wall, free online views, Search Engine Optimization, Micro-funding, etc. After thorough interrogation of the literature and results, we conclude that the Nigerian print media industry could apply similar strategies used in the US to address its own negative economic situation. We also recommend an upgrade in the media training curricula to address some of these concerns effectively leading to the emergence of "Media Entrepreneurship" as a course in Communication/Media Departments in Nigerian universities.

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In this era of 21 st century, the most valuable resource is data. Digital technology can generate terabytes of data which has a tremendous potential in the modern-day world. Pharmaceuticals play an essential role in improving and maintaining the health of patients. However, their cost in health-care budget is a major issue. Due to high prevalence and unfavorable consequences, managing chronic and lifestyle disorders has now become areas of major clinical concern globally. Harnessing this digital technology in our overburdened health-care industry can improve the treatment outcome and even replace the existing treatment. Health authorities such as U.S. Food and Drug Administration (USFDA) are also acknowledging their potential. FDA's Center for Devices and Radiological Health has established the “Digital Health Program” which seeks to promote public health and provide continued regulatory clarity by enhancing outreach to digital health customers and developing and implementing regulatory strategies and policies for digital health technologies. The main focus of this article is to give an overview of digital therapeutics (DT), its clinical applications, role of regulators, and challenges ahead along with potential areas for developers and to present an update on major developments and initiatives taken in this field. The most important advantages of DT are that it has direct access to patients, decreases cost of treatment, encourages healthy lifestyle modifications, and can substitute or complement conventional treatments. Many of these models are still in infancy stage, and further research and development is needed to demonstrate their enormous potential in near future. If used judiciously, they can modernize our health-care industry.

Background Anemia affects one-third of heart failure patients and is associated with increased morbidity and mortality. Despite being one of the commonest comorbidities associated with heart failure, there is a significant knowledge gap about management of anemia in the setting of heart failure due to conflicting evidence from recent trials. Main body The etiology of anemia in heart failure is multifactorial, with absolute and functional iron deficiency, decreased erythropoietin levels and erythropoietin resistance, inflammatory state and heart failure medications being the important causative factors. Anemia adversely affects the already compromised hemodynamics in heart failure, besides being commonly associated with more comorbidities and more severe disease. Though low hemoglobin levels are associated with poor outcomes, the correction of anemia has not been consistently associated with improved outcomes. Parenteral iron improves the functional capacity in iron deficient heart failure patients, the effects are independent of hemoglobin levels, and also the evidence on hard clinical outcomes is yet to be ascertained. Conclusion Despite all the research, anemia in heart failure remains an enigma. Perhaps, anemia is a marker of severe disease, rather than the cause of poor outcome in these patients. In this review, we discuss the current understanding of anemia in heart failure, its management and the newer therapies being studied.