Background: This meta-analysis aims to evaluate the utility of speckle tracking echocardiography (STE) as a tool to evaluate for cardiac sarcoidosis (CS) early in its course. Electrocardiography and echocardiography have limited sensitivity in this role, while advanced imaging modalities such as cardiac magnetic resonance (CMR) and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) are limited by cost and availability. Methods: We compiled English language articles that reported left ventricular global longitudinal strain (LVGLS) or global circumferential strain (GCS) in patients with confirmed extra-cardiac sarcoidosis versus healthy controls. Studies that exclusively included patients with probable or definite CS were excluded. Continuous data were pooled as a standard mean difference (SMD), comparing sarcoidosis group with healthy controls. A random-effect model was adopted in all analyses. Heterogeneity was assessed using Q and I2 statistics. Results: Nine studies were included in our final analysis with an aggregate of 967 patients. LVGLS was significantly lower in the extra-cardiac sarcoidosis group as compared with controls, SMD −3.98, 95% confidence interval (CI): −5.32, −2.64, P < .001, also was significantly lower in patients who suffered major cardiac events (MCE), −3.89, 95% CI −6.14, −1.64, P < .001. GCS was significantly lower in the extra-cardiac sarcoidosis group as compared with controls, SMD: −3.33, 95% CI −4.71, −1.95, P < .001. Conclusion: LVGLS and GCS were significantly lower in extra-cardiac sarcoidosis patients despite not exhibiting any cardiac symptoms. LVGLS correlates with MCEs in CS. Further studies are required to investigate the role of STE in the early screening of CS.

A 24-year-old man complained of a right temporal headache for four weeks. The patient denied any trauma or previous anticoagulation use. He also reported tender right facial swelling. His physical exam was unrevealing except for right cranial nerve (CN) VI palsy, right parotid enlargement, and cervical adenopathy. Laboratory findings were significant for mild leukopenia at 3300 cells/uL. The computed tomography (CT) scan obtained showed a chronic left subdural effusion with a 4 mm midline shift and confirmed right parotid enlargement and cervical lymphadenopathy. Surgical burr hole evacuation was done and the fluid was sent for wound culture analysis. The infectious diseases service recommended initiating antibiotics, which were later stopped due to cerebrospinal fluid (CSF) cultures with no growth of any organisms. His CN VI palsy resolved during admission. The patient was discharged with follow-up for biopsy. The patient was lost to follow-up. The patient presented to the emergency department (ED) three months later, with a left-sided frontal headache. A repeat CT scan showed a new, right-sided fluid collection outside the brain parenchyma. Burr hole evacuation was done again and purulent fluid was drained. Antibiotics were held this time, but anti-tuberculous therapy was initiated empirically. The otolaryngology service was consulted and a lymph node biopsy was performed. The pathology showed histiocytic necrotizing lymphadenitis. A dural biopsy was done as well and was consistent with histiocytic necrotizing lymphadenitis involving the dura. Cultures from the subdural fluid did not grow any organism. The patient remained neurologically intact. He improved after surgery was done to drain the fluid and was managed by analgesics. The cultures from the extra-parenchymal fluid collection remained negative for pathogens and tuberculous mycobacteria. The patient was discharged with rheumatology clinic follow-up. He saw the rheumatologist six weeks after the discharge. During his clinic visit, the patient reported no recurrence of headaches, fevers, rash, or joint pain. Our patient had a rare presentation of Kikuchi-Fujimoto disease, in which he had a subdural fluid collection resulting in neurological complications that required surgical intervention.

Background This meta-analysis aims to evaluate the utility of speckle tracking echocardiography (STE) as a tool to evaluate for cardiac sarcoidosis (CS) early in its course. Electrocardiography and echocardiography have limited sensitivity in this role, while advanced imaging modalities such as cardiac magnetic resonance (CMR) and 18F-Fluorodeoxyglucose-Positron Emission Tomography (FDG-PET) are limited by cost and availability. Methods We compiled English language articles that reported left ventricular global longitudinal strain (LVGLS) or global circumferential strain (GCS) in patients with confirmed extra-cardiac sarcoidosis versus healthy controls. Studies that exclusively included patients with probable or definite CS were excluded. Continuous data were pooled as a standard mean difference (SMD) between the sarcoidosis group and controls. A random effect model was adopted in all analyses. Heterogeneity was assessed using Q and I2 statistics. Results Nine studies with 967 patients were included in our analysis. LVGLS was significantly lower in the extra-cardiac sarcoidosis group as compared to controls, SMD -3.98, 95% confidence interval (CI): -5.32, -2.64, p< 0.001, also was significantly lower in patients who suffered Major Cardiac Events(MCE), -3.89, 95% CI -6.14, -1.64, p< 0.001 . GCS was significantly lower in the extra-cardiac sarcoidosis group as compared to controls, SMD: -3.33, 95% CI -4.71, -1.95, p< 0.001 Conclusion LVGLS and GCS were significantly lower in extra-cardiac sarcoidosis patients despite not exhibiting any cardiac symptoms. LVGLS correlates with MCEs in CS. Further studies are required to investigate the role of STE in the early screening of CS.

Background Myocardial infarction in nonobstructive coronary artery disease (MINOCA) is a recently described infarct subtype. There are few studies that examine coronary artery disease (CAD) extent, MI size and type, and treatment differences at hospital discharge compared to myocardial infarction in obstructive coronary artery disease (MICAD), or that explore sex-specific MINOCA attributes of coronary anatomy and infarct size. Methods Our study population consisted of a single tertiary-center of consecutive patients that had coronary angiography for acute MI between 2005 and 2015. The MI type at presentation, MI size and ejection fraction (post-MI), and gender differences between MINOCA patients were examined. Result Among 1698 cases with acute MI, 95 had MINOCA (5.6%). MINOCA patients were younger, more often had NSTEMI, lower peak cardiac troponin (cTn) values, and greater ejection fraction than MICAD patients (all P-values <0.005). At hospital discharge, 30-day re-admission rates were similar. MINOCA patients less frequently received optimal medical therapy. When women were analyzed, the 45 women with MINOCA had smaller MIs (P < 0.001) and greater ejection fraction (P = 0.002) than the 358 women with MICAD. Sex comparisons of the 95 MINOCA patients revealed women were older than men (P < 0.001), had lower mean peak cTn values (P < 0.001), greater ejection fraction (P = 0.02), and more single-vessel disease involvement than men (P < 0.0001). Conclusion The average MI size is smaller in MINOCA than MICAD patients, and there are sex-related differences in clinical presentation, coronary artery disease extent, and MI size. Re-admission rates are similar and MINOCA patients are less likely to receive guideline recommended medical therapy at discharge.

In this paper, a compact multiple-input multiple-output (MIMO) antenna for an off/on-body wireless body area network (WBAN) is presented. The proposed antenna comprises eight elements arranged in a side-by-side, orthogonal, and across configuration on a planar laminate. This MIMO system achieves wideband impedance matching, i.e., fractional bandwidth (FBW) = 111% (7600 MHz) when placed off-body and FBW = 110% (7500 MHz) when placed on-body. The achieved bandwidth covers the ultrawideband (UWB) ranges 3.1–10.6 GHz for UWB-WBANs. To isolate the antenna elements, a Jerusalem cross (JC)-shaped frequency-selective surface (FSS) and meandered structure (MS) was designed and optimized. This proposed isolation mechanism offers at least 20 dB of isolation while maintaining an overall compact profile. Moreover, MIMO performance parameters for off/on-body and the specific absorption rate (SAR) were also evaluated. Stable MIMO performance, acceptable limits of SAR, and optimum radiation characteristics verify its suitability for wideband biotelemetry applications.

Background: Asthma is rapidly increasing globally. Inhalation therapy is the backbone for asthma management due to localized delivery and rapid onset of action. Currently, metered dose inhalers (MDIs) are the most widely prescribed and dispensed inhaler devices worldwide due to the advantage of portability, multiple dose delivery and better efficacy. Objectives: The current study aimed to access the effect of educational intervention on asthma patients' competency regarding pressurized metered dose inhaler (pMDI) technique. Methods: Asthma patients were recruited from Pakistan Institute of Medical Sciences (PIMS) Islamabad, Pakistan. Inhaler technique steps based upon "National Asthma Education and Preventive Program" (NAEPP) criteria was set as evaluating tool to evaluate competency of asthma patients regarding MDI appropriate technique. Intervention involved educating study subjects (asthma patients) practically through placebo inhaler and theoretically through inhaler technique directed literature brochures. Pre intervention and post intervention inhaler technique competency was accessed and evaluated statistically. Results: Among 207 asthma patients, majority were never instructed by healthcare professional regarding inhaler technique (78.8%).However, most of the patients were observed to have inadequate inhaler technique (76.3%) at baseline. As the result of educational intervention, the competency of patients regarding inhaler technique was significantly enhanced from 11.6% pre-intervention to 34.8% post-intervention (p<0.001), statistically analyzed by McNemar testing. Conclusion: Originally, inhaler technique competency of majority of asthma patients was observed to be inappropriate. However, educational intervention proved to be effective in substantially enhancing the competency of study subjects regarding MDI technique.

1. The detection of added inspiratory airflow resistances was studied in normal individuals under two circumstances: first, while breathing unhindered, and secondly, while breathing against continuously applied ('basal') inspiratory elastic loads. The addition of basal elastic loads resulted in impaired detection of flow-resistive loads whether expressed as added flow resistance or as a proportion of the basal flow resistance. 2. When loads were plotted on a logarithmic scale, load-detection relationships were linear, permitting both threshold and slope of the detection response ('sensitivity') to be assessed. Impaired detection associated with basal elastic loads was shown to be due to a raised threshold without change in 'sensitivity'. 3. When the flow resistances submitted for detection were expressed as a proportion of the sum of the basal flow resistance and added elastance, the probability of detection was independent of the magnitude of the added elastance. 4. The interaction between basal elastic and added flow-resistive loads suggests that at the time of detection the basal elastance acts in a manner similar to that of an added flow resistance. 5. Added basal flow resistances had no significant effect on the detection of threshold elastic loads.

Anti-neutrophil cytoplasmic antibodies (ANCA) associated vasculitis is a disease process with a wide range of presentations, from asymptomatic or minimally symptomatic disease with positive laboratory testing, to florid acute end-organ damage. Consensus has not been established as to the frequency and/or protocol by which ANCA testing should be repeated. We present the case of a 53-year-old woman who initially came to medical attention with persistent dyspnea and pulmonary infiltrates presumed to be due to acute exacerbation of chronic diastolic congestive heart failure. Extensive infectious disease testing was negative, but ANCA testing was positive. However, because antinuclear antibody (ANA) interference in the original sample rendered the test result difficult to interpret, the test was not repeated. The patient presented eight months after the initial hospitalization with acute hypoxemic respiratory failure requiring intubation, with an ANCA titer of 1:1280 with a negative ANA titer, and renal biopsy-proven severe crescentic glomerulonephritis. In the discussion of our case, we review the importance of interpreting ANCA testing in the correct clinical context. The ANCA laboratory testing requires cautious interpretation, and diagnosed ANCA-associated vasculitis (AAV) requires vigilance for prompt and proactive treatment.