Articles

Objectives: We describe the clinical course and management of two patients with post-capillary pulmonary hypertension due to diffuse pulmonary venous baffle calcification decades post-Mustard procedure.Background: From the late 1950s to the early 1990s, the definitive surgical repair for children with D-transposition of the great vessels (D-TGA) was an atrial switch procedure (either Senning or Mustard operation) which utilizes atrial-level baffles to shunt pulmonary venous blood to the morphologic right (systemic) ventricle and caval blood to the morphologic left (sub-pulmonary) ventricle. From a hemodynamic standpoint, baffle leaks and stenoses as well as precapillary pulmonary hypertension have all been described as both early and late complications [1]. Recently, delayed post-capillary pulmonary hypertension (in the absence of discrete baffle obstruction) decades post-atrial switch has also been described [2]. The underlying pathophysiology for this postcapillary pulmonary hypertension is unclear but is theorized to involve impaired diastology referable to the pulmonary venous baffle. Methods/Results: Using hemodynamic and imaging data, we describe two patients with extensive pulmonary venous baffle calcification and resultant pulmonary hypertension from the so-called “stiff left atrial (LA) syndrome.” This problem can be difficult to treat medically and is not amenable to catheter-based interventions. We hypothesize that this is an underlying mechanism for pulmonary hypertension in at least some post-Mustard and Senning patients. Conclusion: We describe the treatments and clinical course for each of these patients, and in particular describe how the surgical revision of the pulmonary venous baffle in one case led to the complete resolution of symptoms.

The fungal pathogen, Nothophaeocryptopus gaeumannii, occurs wherever Douglas-fir is found but disease damage is believed to be limited to the Coast Range and is of no concern outside the coastal fog zone (Shaw, et al., 2011). However, knowledge remains limited on the history and spatial distribution of Swiss Needle Cast (SNC) impacts in the Pacific Northwest (PNW). We reconstructed the history of SNC impacts on mature Douglas-fir trees based on tree ringwidth chronologies from the west slope of the Coast Range to the high Cascades of Oregon. Our findings show that SNC impacts on growth occur wherever Douglas-fir is found in western Oregon and is not limited to the coastal fog zone. The spatiotemporal patterns of growth impact from SNC disease were synchronous across the region, displayed periodicities of 25-30 years, strongly correlated with winter and summer temperatures and summer precipitation, and matched the patterns of enriched cellulosic stable carbon isotope indicative of physiological stress. While winter and summer temperature and summer precipitation influenced pathogen dynamics at all sites, the primary climatic factor of these three limiting factors varied spatially by location, topography, and elevation. In the 20th century, SNC impacts at low- to mid-elevations were least severe during the warm phase of the Pacific Decadal Oscillation (PDO, 1924-1945) and most severe in 1984-1986, following the cool phase of the PDO (1945-1977). At high elevations on the west slope of the Cascade Mountains, SNC impacts were the greatest in the 1990s and 2000s, a period of warmer winter temperatures associated with climate change. Warmer winters will likely continue to increase SNC severity at higher elevations, north along the coast from northern Oregon to British Columbia, and inland where low winter temperatures currently limit growth of the pathogen. Surprisingly, tree-ring records of ancient Douglas-fir logs dated ~53K radioactive years B.P. from Eddyville, OR displayed 7.5- and 20-year periodicities of low growth, similar to those found in modern day coastal Douglas-fir tree-ring records which we interpret as being due to cyclic fluctuations in SNC severity. Our findings indicate that SNC has persisted for as long as its host, and as a result of changing climate, may become a significant forest health problem in areas of the PNW beyond the coastal fog zone.

Tumoral calcinosis is a rare, benign entity characterized by the deposition of calcium in periarticular soft tissues. We report the original case of an idiopathic tumoral calcinosis of the elbow in a 6-year-old girl successfully treated by drainage with no signs of recurrence after a 3-year follow-up. We discuss the particularities of this joint location and our therapeutic management. 

Background: Although acute inferior myocardial infarction (MI) is usually regarded as being lower risk compared with acute anterior MI, right ventricular (RV) myocardial involvement (RVMI) may show an increased risk of cardiovascular (CV) morbidity and mortality in patients with inferior MI. CMR is ideal for assessing the RV because it allows comprehensive evaluation of cardiovascular morphology and physiology without most limitations that hinder alternative imaging modalities. Objectives: To evaluate the sensitivity of strain and strain rate of the RV using 2D speckle tracking echo and the neutrophil/ lymphocyte ratio (NLR) compared to cardiac MRI (CMR) as the gold standard among patients with inferior STEMI undergoing primary percutaneous coronary intervention (PCI). Methodology: 40 Patients with inferior MI who had primary PCI were included in the study; they were divided into two groups according to the RVEF using CMR. NLR was done in comparison to RVEF.Results: out of the 40 patients, 18 (45%) patients had RV dysfunction. 2D echocardiography was done for all patients, where fractional area change (FAC) in the RV dysfunction group appeared to be significantly reduced compared to the group without RV dysfunction (p value = 0.03). In addition, RV longitudinal strain (LS) by speckle tracking echo was reduced with an average of 19.5 ± 3.9% in the RV dysfunction group.Both CMR- derived RV SV, and EF were lower among the RV dysfunction group, (26.8 ± 15.8) ml and (35.4 ± 6.9)% respectively, with large RV systolic volume, with a highly statistically significant difference in comparison to the other group (p value = 0.000). Complications, heart block was significantly higher in patients with RV dysfunction (p value = 0.008) as it occurred in 5 (27.8%) patients.N/L ratio for predicting RV dysfunction by CMR had a cut-off value of > 7.7 with low sensitivity (38.8%) and high specificity (77.3 %). In contrast, LS for predicting RV dysfunction by CMR had high sensitivity (83.3%) and high specificity (63.6%) with p value = 0.005.Conclusion: Our results showed that RV dysfunction in inferior MI is better detected using cardiac magnetic resonance imaging. In inferior STEMI patients who underwent primary PCI, NLR has low sensitivity but high specificity for predicting RVD when measured by cardiac MRI.

Background: Dipylidium caninum, a zoonotic cyclophyllidean tapeworm, mainly infects dogs, cats, and occasionally humans as well. Here, we present D. caninum infection in a domestic cat. A cat of about one year of age with a history of intermittent diarrhea and shedding stool containing whitish cooked rice like soft particles. Methods: The case was identified by thorough clinical, coprological, and parasitological examinations, and treated accordingly.Results: During the physical examination, the cat was found to be infested with flea, and coprological investigation revealed the presence of gravid segments of cestodes. By preparing a permanent slide, we conducted a microscopic examination, and the cestode was confirmed as D. caninum. The cat was treated with albendazole and levamisole, which were ineffective; additionally, levamisole showed toxicity. Then, we administered niclosamide which completely cured the animal. On re-examination after a week, feces were found negative for eggs/gravid segments of any cestode. Conclusion: Niclosamide was found effective against dipylidiasis and can be treated similar infections in pets.

Progeria syndromes are very rare genetic diseases characterized by premature aging changes. There are several phenotypes and variables noted in literature in some cases difficult to specifically classify a specific syndrome. It occurs due to mutation in DNA repair genes. The most common ocular findings are loss of eyebrow and eyelashes, brow ptosis, lid margin changes, entropion, Meibomian gland dysfunction, severe dry eye, corneal opacity, cataract, poor mydriasis, and rod-cone dystrophy. We report this case with all the above ocular manifestations in 19year old teenager with additional finding being retinal detachment.

Video objective: To demonstrate that surgical technique of vaginal cervicoisthmic cerclage must be performed in women with history of cervical incompetence with more than two late miscarriages before 24 weeks or premature deliveries before 28 weeks and after prior failure of preventive Mc Donald cerclage. In this video, the authors describe the complete procedure in 8 steps to standardize and facilitate the procedure in a simple and safe way during pregnancy. Design: Step-by-step video demonstration of the surgical technique.Setting: Tertiary Center for University Hospital.

Chronic Lymphocytic Leukemia (CLL) is a common clonal neoplasm of small, mature B-lymphocytes. CLL is a heterogeneous disease with different clinical presentation, response to treatment and survival. This heterogeneity could be explained by the different genetic aberrations in CLL [1]. The most important chromosomal defects correlated to a poor prognosis are 17p13.1 deletion (loss of TP53) or 11q22.3 deletion (loss of ATM) [1,2]. In the era of new drugs in CLL it is mandatory to perform the interphase fluorescence in situ hybridization (FISH) test in order to assess these aberrations, before starting any lines of therapy [3]. Moreover, recent evidence suggests that complex karyotype (CK) with structural chromosomal aberrations identified by using chromosome-banding analysis may be relevant to better define CLL prognosis. It is known that 80% of CLL patients harbor at cytogenetic aberrations [3].

Objective: To verify whether preterm premature rupture of membranes has effect on neurodevelopmental outcome of Infant among preterm infants born at Hawassa Comprehensive Specialized Hospital of Sidama region, Ethiopia, 2022.Methods and materials: A prospective cohort study design will be conducted for 2 years and 6 months from March 1/2022 to August 30/2024. A total of 12 Midwives. 6 supervisors and 1 pediatric neurologist or psychiatrist will be involved in the data collection process. All preterm infants will be recruited consecutively from preterm infants admitted to neonatal intensive care unit from March 1/2022 to August 30/2022. The preterm infants will be categorized into Exposed group (preterm infants born after preterm PROM) and non-exposed group (preterm infants born after spontaneous preterm labour) and followed until 2 years of age to assess neurodevelopmental outcome of infants The data will be entered into Epidata software and exported to SPSS software for windows version 23. For analysis. Descriptive statistics will be computed. One-way Anova and post hoc comparisons with Scheffe’s procedure will be used X2 test or Fisher’s exact test will be used to compare categorical variables.

Background: Perinatal asphyxia (PA) which may result in hypoxic ischaemic encephalopathy (HIE) affects four million neonates worldwide and accounts for the death of one million of affected babies. The science of metabolomics has become an area of growing interest in neonatal research, with a potential role in identifying useful biomarkers that can accurately predict injury severity in perinatal asphyxia and HIE.The aim of this review is to look at the evidence of the usefulness of urine metabolomics in predicting outcome in PA/HIE. Methods: The key words used in the advanced search ‘urine metabolomics’ AND ‘perinatal asphyxia’ OR ‘hypoxic ischaemic encephalopathy’, yielded 13 articles. Results: Of the selected thirteen studies, 38% (n = 5) were human studies, 31% (n = 4) were animal studies and 31% (n = 4) were review articles. The studies confirmed the involvement of known pathways in the development of PA/HIE, primarily the Krebs cycle evidenced by accumulation of TCA cycle intermediates (citrate, α-ketoglutarate, succinate) and anaerobic pathways indicated by increased lactate. Other pathways involved include amino acid and carbohydrate pathways. Conclusion: Metabolomic studies so far are promising in highlighting potential biomarker profiles in PA/HIE. Further research is necessary to further clarify the role of identified metabolites in predicting outcome and prognosis in neonates affected by PA/HIE.