Background and Purpose— Many ischemic strokes or transient ischemic attacks are labeled cryptogenic but may have undetected atrial fibrillation (AF). We sought to identify those most likely to have subclinical AF. Methods— We prospectively studied patients with cryptogenic stroke or transient ischemic attack aged ≥55 years in sinus rhythm, without known AF, enrolled in the intervention arm of the 30 Day Event Monitoring Belt for Recording Atrial Fibrillation After a Cerebral Ischemic Event (EMBRACE) trial. Participants underwent baseline 24-hour Holter ECG poststroke; if AF was not detected, they were randomly assigned to 30-day ECG monitoring with an AF auto-detect external loop recorder. Multivariable logistic regression assessed the association between baseline variables (Holter-detected atrial premature beats [APBs], runs of atrial tachycardia, age, and left atrial enlargement) and subsequent AF detection. Results— Among 237 participants, the median baseline Holter APB count/24 h was 629 (interquartile range, 142–1973) among those who subsequently had AF detected versus 45 (interquartile range, 14–250) in those without AF ( P <0.001). APB count was the only significant predictor of AF detection by 30-day ECG ( P <0.0001), and at 90 days ( P =0.0017) and 2 years ( P =0.0027). Compared with the 16% overall 90-day AF detection rate, the probability of AF increased from <9% among patients with <100 APBs/24 h to 9% to 24% in those with 100 to 499 APBs/24 h, 25% to 37% with 500 to 999 APBs/24 h, 37% to 40% with 1000 to 1499 APBs/24 h, and 40% beyond 1500 APBs/24 h. Conclusions— Among older cryptogenic stroke or transient ischemic attack patients, the number of APBs on a routine 24-hour Holter ECG was a strong dose-dependent independent predictor of prevalent subclinical AF. Those with frequent APBs have a high probability of AF and represent ideal candidates for prolonged ECG monitoring for AF detection. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00846924.

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Among the 65,000 live births in the Ukraine, 3 result in maternal demise. Some of these passings happen taking after difficulties related with placenta previa, which is show in roughly 1 in 200 pregnancies. Placenta previa happen when the placenta is situated in the lower some portion of the uterus, near or including the cervical opening. Commonly connected with or suspected in the nearness of placenta previa is the turmoil of placenta accreta, which is a type of unusual placentation and happens when the placenta imbeds defectively into the mass of the myometrium. The event rate of placenta accreta is around 1 in each 2,500 pregnancies. Placenta previa and placenta accreta are related with expanded maternal discharge and coming about expanded maternal mortality and morbidity. When the rate of cesarean conveyance expands, a relating increment in the event rate of placenta previa and placenta accreta has been watched. The rate of cesarean conveyance in the joined States is 31.1% and is at a record-breaking high. The expanded rate of cesarean conveyance is multifactorial. The number of essential cesarean conveyances being performed has expanded. In the interim, the quantity of vaginal births after cesarean conveyance has diminished. This diminished number has added to an expanded rate of rehashed cesarean conveyance. The reason for this case report is to survey the administration of a patient conceded for elective cesarean conveyance with known placenta previa and suspected placenta accreta. The case report will be trailed by a general talk identified with the administration of obstetric patients with placenta previa and placenta.

EditorialA 55 year female patient with history of hypertension, dyslipidemia, diabetes mellitus and past myocardial dead tissue (MI) displayed to the crisis office with intense coronary disorder. His past coronary occasion was a substandard MI which was treated with thrombolysis six years back inside 7 hours of onset. Catheterization around then uncovered abnormal right coronary vein beginning from the left valsalva sinus with direct proximal deterrent and the patient gotten restorative treatment. He had as of late played out a clinical assessment with an ordinary treadmill test and typical echocardiogram in another hospital. He introduced to the crisis bureau of a non every minute of every day essential PCI medicinal focus with intense onset (2 hours) of serious chest torment and diaphoresis. On confirmation he was on edge, his circulatory strain was 80/50 mmHg and he had typical heart and lung auscultation. His first electrocardiogram demonstrated an ectopic atrial musicality, second rate inert zone and ST rise in precordial leads V1-V3 (there were no past electrocardiogram tracings accessible for correlation). He was treated with IV hydration, acetylsalicylic corrosive 275 mg, clopidogrel 450 mg and thrombolysed with Tenecteplase 25 mg with change of fringe perfusion furthermore, pulse.Coronary angiography showed a left prevailing framework with obstructive injuries in the second harsh peripheral, ramus intermedius and the proximal left front diving (LAD) supply routes, and in addition the nondominant right coronary. Finish impediment of the infra-renal aorta with patent two-sided renal courses and prevalent mesenteric corridor was noted. Fruitful stenting of LAD, harsh peripheral and ramus intermedius supply routes was performed after 72 hours, the patient griped of intense chest torment a rehash coronary angiogram demonstrated intense stent thrombosis in ramus intermedius requiring rehash angioplasty and stent arrangement. The healing facility course was additionally entangled by intermittent fevers and the patient was found to have declining rhabdomyolysis of the lower furthest points with rising creatinine kinase levels. Persistent proceeded to have fevers notwithstanding anti-infection agents and created compounding left lower limit swelling and vanishing of Doppler signs of the left foot.In more established cases it is accounted for that a comparative instance of patient with CAD with Leriche disorder, who was moderately stable permitting tending to the aortic impediment as an initial step taken after by complex PCI of the RCA injury. Not at all like our patient, the aortic injury in that patient could be crossed with ordinary approach utilizing bifemoral also, left brachial approach and two self-extending stents were conveyed at the aorto-iliac bifurcation. An investigation by Kim et al examined 49 patients with a CTO of the aorta treated through endovascular approach. They announced procedural accomplishment in 40 cases with 7 patients requiring remediation and an general 80% patency rate at 3 years. ...

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