Ranolazine as a First-Choice Anti-anginal Medication for Patients With Coronary Artery Ectasia: A Case Series

Coronary artery ectasia (CAE) is characterized by the abnormal dilation of coronary arteries, resulting in disturbed or slow blood flow, which causes angina pectoris-the most prevalent symptom of CAE. To date, there is no consensus on the therapeutic management of CAE due to its rarity and the scarcity of research. We present a case series of five patients with different ethnicities, including both men and women, whose CAE was successfully managed by the administration of ranolazine. All five patients were found to have CAE by coronary angiography, which was also associated with slow blood flow. Clinically, the patients had accelerating angina. They were prescribed an initial dose of 500 mg of ranolazine twice daily, which led to the resolution of their anginal symptoms. They have been clinically and hemodynamically stable for the last several years. In light of these results, we propose that ranolazine be considered as a first-choice anti-anginal medication for patients with CAE.

Surprising Resolution of Life-Long Severe Generalized Hyperhidrosis Post-angioplasty and Stenting

Hyperhidrosis (HH) is a condition characterized by excessive sweating beyond thermoregulation needs. HH can be primary with no known etiology or secondary, as a symptom of underlying medical disease or a side effect of certain medications. Furthermore, HH can be focal, affecting one or a few body parts, or generalized, affecting the entire body. We present the case of a 49-year-old male with a history of primary generalized HH as well as coronary artery disease whose HH symptoms surprisingly resolved following coronary angioplasty and stenting. This unprecedented outcome of the procedure points to a potential association between HH and coronary artery disease, proposing potential management of HH through cardiovascular workup. In light of this result, we suggest that patients exhibiting generalized primary HH undergo a thorough comprehensive cardiovascular workup.

Severe Bilateral Vertebral Arterial Disease Masquerading as Vertigo

Vertebral artery stenosis (VAS), manifesting as vertebrobasilar insufficiency (VBI), results from the narrowing of the vertebral artery's lumen because of diverse vascular pathological processes, leading to various clinical presentations. We present the case of a 71-year-old male who experienced vertigo for almost two years and was ultimately diagnosed with severe bilateral VAS. Despite initial management for vertigo, the patient's symptoms persisted, prompting a referral to a cardiologist. Several assessments were performed, including an MRI of the brain, which ruled out acute intracerebral hemorrhage or infarction. After some visits to the cardiologist's office, the patient was referred to a neurologist who conducted a magnetic resonance angiography (MRA) of the neck, which showed an occlusion of the left vertebral artery at the origin and a patent right vertebral artery. Because of worsening symptoms of vertigo and the results of the MRA, the patient underwent invasive angiography that confirmed the occlusion of the left vertebral artery and also revealed severe stenosis of the right vertebral artery. This case report discusses an unusual presentation of VAS with vertigo as the primary symptom, emphasizing the importance of recognizing seemingly minor symptoms as manifestations of the underlying vascular pathology that requires careful evaluation. Furthermore, this case emphasizes the limitation of relying solely on noninvasive imaging for diagnosis as, in this instance, noninvasive imaging failed to detect the severe stenosis of the right vertebral artery, which was revealed by invasive angiography. Finally, this case report underscores the significance of collaboration across several disciplines, such as cardiology, neurology, and radiology, as well as endovascular medicine in diagnosing and managing atypical manifestations of complex conditions.

Primary Cough Headache: A Case Report

Primary cough headache (PCH) is an uncommon condition characterized by episodes of sudden onset, bilateral headaches typically lasting from a second to two hours. Headaches are notably associated with Valsalva maneuvers such as coughing or straining but not a prolonged physical exercise in the absence of intracranial abnormalities. We report an unusual presentation of PCH in a 53-year-old female suffering from episodes of severe sudden-onset headaches that lasted several hours. The headaches were initially precipitated by coughing as is typical with PCH but were unusual in the way the triggers for the episodes evolved. Headaches began occurring without any association of Valsalva maneuvers and ultimately occurred with no discernible trigger. The patient initially came to the cardiologist's office who then referred her to a neurologist for further evaluation. The neurologist initially prescribed methylprednisolone tablets, primarily to suppress the cough. Magnetic resonance imaging, magnetic resonance angiography (MRA) of the brain, and a head CT scan were then performed to rule out possible secondary causes such as a mass, intracranial bleed, aneurysms, or other vascular anomalies. The neurologist prescribed indomethacin and topiramate four and nine days after diagnosis of PCH, respectively. After five days, the beta blocker metoprolol tartrate was prescribed as the patient's blood pressure was rising significantly in correlation to the headaches. The above treatment was effective in limiting the intensity and duration of the headaches and the symptoms resolved after four weeks. This case contributes towards the understanding of the potential evolution of PCH presenting with triggers unassociated with Valsalva maneuvers and ultimately occurring with no known trigger as well as providing an example of PCH with an unusually long duration.

Skills-Building Programs to Reduce Child Marriage in Bangladesh: A Randomized Controlled Trial

PURPOSE

Child marriage is the norm in Bangladesh, leading to lifelong negative consequences. Evidence on sustainable child marriage programs is scant. Our study aimed to evaluate the impact of three community-based skills-building programs to delay child marriage among adolescent girls in rural Bangladesh.

METHODS

The study used a cluster randomized controlled trial design with four arms-ARM1 offered educational support, ARM2 promoted gender rights awareness, ARM3 offered livelihoods training, and ARM4 was a control area. All adolescent girls were offered 144 hours of skills training in village centers over 18 months. Among 11,609 baseline survey respondents, 91% were successfully included in the endline analysis. Program impact was assessed using discrete time hazard models.

RESULTS

The program reduced child marriages (<18) significantly in all arms relative to control-(adjusted hazard ratio [AHR]: .75; 95% confidence interval [CI]: .60-.92) for the education arm, (AHR: .72; 95% CI: .59-.88) for the gender arm, and (AHR: .70; 95% CI: .56-.87) for the livelihoods arm. Program participants were younger and more likely to be in school and faced lower risk of marriage relative to nonparticipants. In the gender and livelihoods arm, nonparticipants had lower risk of child marriage relative to the control group significant at the 10% level.

CONCLUSIONS

The study demonstrates it is possible to reduce the prevalence of child marriage in a relatively short period of time by working with communities to implement holistic programs to build skills among girls. The program had similarly large impact and did not depend on the type of skills offered.

Flooding transition in the topography of toppling surfaces of stochastic and rotational sandpile models

A continuous phase transition occurs in the topography of toppling surfaces of stochastic and rotational sandpile models when they are flooded with liquid, say water. The toppling surfaces are extracted from the sandpile avalanches that appear due to sudden burst of toppling activity in the steady state of these sandpile models. Though a wide distribution of critical flooding heights exists, a critical point is defined by merging the flooding thresholds of all the toppling surfaces. The criticality of the transition is characterized by power-law distribution of island area in the critical regime. A finite size scaling theory is developed and verified by calculating several new critical exponents. The flooding transition is found to be an interesting phase transition and does not belong to the percolation universality class. The universality class of this transition is found to depend on the degree of self-affinity of the toppling surfaces characterized by the Hurst exponent H and the fractal dimension D(f) of critical spanning islands. The toppling surfaces of different stochastic sandpile models are found to have a single Hurst exponent, whereas those of different rotational sandpile models have another Hurst exponent. As a consequence, the universality class of different sandpile models remains preserved within the same symmetry of the models.

Parasitological aspects of Capillaria philippinensis recovered from Egyptian patients

Seven new cases of intestinal capillariasis were detected in Kasr El-Aini University Hospitals, Cairo, during the period from July 1997 to June 1998. A parasitological study concerning the morphological features of Capillaria philippinensis recovered from the stool of Egyptian cases was carried out. Eggs were separated, cultured and used to infect Oreochromis nilotica niloticus, a famous popularly consumed type of fresh water fish in Egypt in a trial for identification of the fish intermediate host for this parasite, but infection had not developed in the intestine of this species of fish.