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Left atrial appendage and atrial septal occlusion in elderly patients with atrial septal defect and atrial fibrillation

Leong MC, Kandavello G, Husin A, Perumal D, Kaur Khelae S

Pacing Clin Electrophysiol, 2020 11;43(11):1252-1257.
PMID: 32845014 DOI: 10.1111/pace.14049

BACKGROUND: Elderly patients with atrial septal defect (ASD) often present with chronic atrial fibrillation and large left to right shunt. This study reports the experience of left atrial appendage (LAA) and ASD closure in patients with significant ASD and chronic atrial fibrillation.
METHODS: We report six consecutive elderly patients with chronic atrial fibrillation and significant ASD who underwent LAA and fenestrated ASD closure from January 1, 2014 until December 31, 2019. All periprocedural and long-term (>1 year) outcomes were reported.
RESULTS: Six patients (male: 33.3%; mean age: 66.8 ± 3.3 years) were included. Mean CHADS2 , CHA2 DS2 -VASc , and HAS-BLED scores were 2.33 ± 0.82, 3.83 ± 0.75, and 1.83 ± 0.75. Four patients underwent simultaneous procedure, while two patients underwent a staged procedure. Procedural success was achieved in all patients. Total occlusion was achieved during LAA occlusion without device embolization prior to ASD closure. Patients who underwent simultaneous procedure had a shorter total hospital stay and lower total hospital stay. During a follow-up period of 32.8 ± 19.4 months, both the devices were well seated. No device-related thrombosis or erosion reported. All patients remained in atrial fibrillation. No patients experienced any thromboembolic stroke or transient ischemic attack.
CONCLUSIONS: LAA and ASD closure is feasible and can be safely performed in the same seating in elderly patients with a significant ASD.
Fulltext The Incidence of Gastrocnemius Tightness Among Clinic Staff in a District Hospital's Clinic in the State of Kedah, Malaysia

Ramalingam K, Perumal D, Balan H, Leong JF, Thiruselvam T

Cureus, 2023 Jun;15(6):e40714.
PMID: 37485103 DOI: 10.7759/cureus.40714

Aim Musculus Gastrocnemius Tightness (MGT) has been linked with common foot and ankle pathologies. These symptoms sometimes are not severe enough for the patient to seek treatment. This study aims to determine the incidence rate of MGT among our clinical personnel and if there is any association between foot and ankle symptoms with MGT. Materials and methods This observational cross-sectional study involves clinical personnel from our Specialist Clinics at Hospital Kulim, Malaysia. We interviewed and assessed 85 volunteers of which, we measured the passive ankle dorsiflexion of the volunteers (the Silfverskiöld) test, to diagnose MGT. We then used the Manchester Oxford Foot Questionnaire (MOxFQ) is used to determine the functional outcome of our volunteers. Results Out of a total of 85 volunteers assessed, 12 (14%) volunteers were found to have gastrocnemius tightness. Among this cohort, 11 were symptomatic. Out of the 73 who did not have MGT, there were three symptomatic volunteers. There was a significant association between volunteers with foot and ankle symptoms with gastrocnemius tightness, compared to those without. There was a significant difference in the relationship between the MOxFQ scores in all components (walking, pain, and social) when comparing those with and those without MGT. Conclusion We conclude that there is a significant association between foot and ankle symptoms and MGT in our clinic sample population. However, these symptoms were not severe enough for these symptomatic volunteers to seek treatment. We should consider screening symptomatic staff and implementing stretching protocols.
Potential use of bio functionalized nanoparticles to attenuate triple negative breast cancer (MDA-MB-231 cells)

Santhoshkumar M, Perumal D, Narenkumar J, Ramachandran V, Muthusamy K, Alfarhan A, et al.

Bioprocess Biosyst Eng, 2023 Mar 28.
PMID: 36977929 DOI: 10.1007/s00449-023-02858-5

This study showed that bio-functional silver nanoparticles (AgNPs) and zinc oxide nanoparticles (ZnONPs) were synthesized in aqueous extracts of Gymnema sylvestre leaves and tested for toxicity assessment against triple-negative breast cancer cells (TNBC). Biofunctional nanoparticle (NPs) samples were characterized using UV-Vis spectroscopy, FT-IR, XRD, SEM, and TEM. The results showed that the phytofabrication of AgNPs resulted in a dark brown, UV-vis maximum absorbance peak at 413 nm. The AgNPs were crystalline and spherical, with sizes ranging from 20 to 60 nm, as confirmed by the XRD pattern and TEM images. Another phytofabrication of ZnONPs exhibited a white precipitate corresponding to a UV-Vis maximum absorption peak at 377 nm and a fine micro flower morphology with a particle-sized tribution between 100 and 200 nm. In addition, FT-IR spectra showed that bioorganic compounds are associated with NPs that respond to reduced Ag+ ions and AgNPs tabilizers. Invitro cytotoxicity studies revealed the potent anti-cancer effects of phytofabricated AgNPs and ZnONPs on TNBC cells. Furthermore, the AO/EB double staining assay results proved that apoptotic cells are distinguished by greenish-yellow fluorescence of the cell nuclei with IC50 concentrations of 44 ± 0.8 µg/mL for AgNPs and 26.2 ± 0.5 µg/mL for ZnONPs, respectively. Based on our results, we expect that the anticancer function of the biofunctional NPs is due to the apoptotic activation of TNBC cells by increased ROS. Therefore, the presented study demonstrated that biofunctional AgNPs and ZnONPs have excellent prospects for the anti-cancer activity that can be used in pharmaceutical and medical fields.

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