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Despite the noteworthy advancements and the introduction of new technologies in diagnostic tools for cardiovascular disorders, the electrocardiogram (ECG) remains a reliable, easily accessible, and affordable tool to use. In addition to its crucial role in cardiac emergencies, ECG can be considered a very useful ancillary tool for the diagnosis of many non-cardiac diseases as well. In this narrative review, we aimed to explore the potential contributions of ECG for the diagnosis of non-cardiac diseases such as stroke, migraine, pancreatitis, Kounis syndrome, hypothermia, esophageal disorders, pulmonary embolism, pulmonary diseases, electrolyte disturbances, anemia, coronavirus disease 2019, different intoxications and pregnancy. [ABSTRACT FROM AUTHOR]

Background and Aims Even though vegetation size in infective endocarditis (IE) has been associated with embolic events (EEs) and mortality risk, it is unclear whether vegetation size associated with these potential outcomes is different in left-sided IE (LSIE). This study aimed to seek assessing the vegetation cut-off size as predictor of EE or 30-day mortality for LSIE and to determine risk predictors of these outcomes. Methods The European Society of Cardiology EURObservational Research Programme European Infective Endocarditis is a prospective, multicentre registry including patients with definite or possible IE throughout 2016–18. Cox multivariable logistic regression analysis was performed to assess variables associated with EE or 30-day mortality. Results There were 2171 patients with LSIE (women 31.5%). Among these affected patients, 459 (21.1%) had a new EE or died in 30 days. The cut-off value of vegetation size for predicting EEs or 30-day mortality was >10 mm [hazard ratio (HR) 1.38, 95% confidence interval (CI) 1.13–1.69, P =.0015]. Other adjusted predictors of risk of EE or death were as follows: EE on admission (HR 1.89, 95% CI 1.54–2.33, P <.0001), history of heart failure (HR 1.53, 95% CI 1.21–1.93, P =.0004), creatinine >2 mg/dL (HR 1.59, 95% CI 1.25–2.03, P =.0002), Staphylococcus aureus (HR 1.36, 95% CI 1.08–1.70, P =.008), congestive heart failure (HR 1.40, 95% CI 1.12–1.75, P =.003), presence of haemorrhagic stroke (HR 4.57, 95% CI 3.08–6.79, P <.0001), alcohol abuse (HR 1.45, 95% CI 1.04–2.03, P =.03), presence of cardiogenic shock (HR 2.07, 95% CI 1.29–3.34, P =.003), and not performing left surgery (HR 1.30 95% CI 1.05–1.61, P =.016) (C -statistic =.68). Conclusions Prognosis after LSIE is determined by multiple factors, including vegetation size. [ABSTRACT FROM AUTHOR]

In an attempt to improve the thermoelectric (TE) properties of conducting polymers, polypyrrole/metal hydroxide composites were prepared. Oxidative polymerization technique was used to prepare polypyrrole (PPy), while sol gel method was used to produce the metal hydroxides of Ni(II), Co(II), Sr(II), Si(IV) and Zn (II). Typically, an in-situ approach was used to polymerize pyrrole monomer on the surface of the resultant hydroxides. The structural and surface properties of the prepared composites were analyzed by different techniques. The prepared composites were compacted into pellets to investigate their thermoelectric properties. The presence of metal hydroxides with polypyrrole were found to significantly enhance the power factors and the figure of merits values. At room temperature the first factor increased from 0.07 µW/m K2 for the neat PPy to approximately 0.32 µW/m K2 for the polypyrrole/metal hydroxide composites mainly of Co, while the second one increased from 0.05 × 10−3 to 0.36 × 10−3. The TE properties of polypyrrole/metal hydroxide composites of Ni and Si were also enhanced due to the significant reduction in their thermal conductivity. The findings from this study may potentially serve as a valuable resource for the advancement of future thermoelectric materials and devices. [ABSTRACT FROM AUTHOR]

Snijders Blok‐Campeau syndrome is an autosomal dominant genetic disorder first described in 2018, mostly associated with de novo variants in the CHD3 gene that affects chromatin remodeling. This syndrome is characterized by developmental delay, speech delay, and intellectual disability, but only about 60 affected individuals have been reported to date. We report a de novo likely pathogenic CHD3 variant (c.5609G > A; p. (Arg1870Gln)) in a young female presenting with features of Snijders Blok‐Campeau syndrome including speech delay, autism spectrum disorder, learning difficulties, characteristic facial dysmorphisms, and a feature not previously described in this syndrome, idiopathic central precocious puberty. Her puberty was controlled with monthly injections of a GnRH analogue. Targeted exome sequencing was negative for genes known to be responsible for central precocious puberty. Our case raises the possibility that variants in CHD3 gene may also result in central precocious puberty. Strengthening this association could expand the phenotypic spectrum of the Snijders Blok‐Campeau syndrome and should be included in multigene panels for precocious puberty. [ABSTRACT FROM AUTHOR]

Despite the improved safety and efficacy profile of non-Vitamin K Antagonist Oral Anticoagulants (NOACAs), the current guidelines still limit their use to stroke prevention in non-valvular atrial fibrillation (AF) patients and venous thromboembolism prophylaxis and treatment. In this report, the authors discussed the published data related to NOACs use in prosthetic valves highlighting the proposed mechanisms of NOACs failure and other controversial data regarding their efficacy and safety in prosthetic valves. Although NOACs have proven to be even safer and more effective alternatives to vitamin K antagonists (VKAs) in several indications for anticoagulation, the data regarding their safety and efficacy in prosthetic heart valves is still debatable. The controversial data regarding NOACs use in prosthetic valves renders it difficult to define specific guideline-recommendation for safe and efficient use in this population. The available evidence suggesting that NOACs are as safe and as efficient as VKA regarding thromboembolic prophylaxis and risk of bleeding was primarily based on patients who had undergone bioprosthetic valve and concomitant atrial fibrillation. Further research is warranted to establish if NOACs can be a safer and more efficient alternative to VKAs in patients with prosthetic valves either metallic or bioprosthetic. [ABSTRACT FROM AUTHOR]

Key Clinical Message: The role of 3D echocardiography has been increasing in the management of patients with congenital heart disease (CHD), particularly in pre‐surgical planning, catheter‐guided interventions, and functional assessment of the heart. [ABSTRACT FROM AUTHOR]

Left ventricular thrombi form due to the presence of Virchow's triad in patients with left ventricular systolic dysfunction. This complication increases the incidence of systemic embolization, hence anticoagulation is recommended to decrease this risk. Up to the present time, vitamin K antagonists are recommended by all societal guidelines for patients with left ventricular thrombi. Recently, several studies have investigated the role of different anticoagulants and yielded promising outcomes. This opinion article focuses on the evidence supporting vitamin K antagonists and direct oral anticoagulants in patients with left ventricular thrombi. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) pandemic has threatened global health and prompted the need for mass vaccination. We aimed to assess the efficacy and effectiveness of COVID-19 vaccines to prevent mortality and reduce the risk of developing severe disease after the 1st and 2nd doses. From conception to 28 June 2021, we searched PubMed, Cochrane, EBSCO, Scopus, ProQuest, Web of Science, WHO-ICTRP, and Google Scholar. We included both observational and randomized controlled trials. The pooled vaccine efficacy and effectiveness following vaccination, as well as their 95 percent confidence intervals (CI), were estimated using the random-effects model. In total, 22 of the 21,567 screened articles were eligible for quantitative analysis. Mortality 7 and 14 days after full vaccination decreased significantly among the vaccinated group compared to the unvaccinated group (OR = 0.10, ([95% CI, 0.04–0.27], I2 = 54%) and (OR = 0.46, [95% CI, 0.35–0.61], I2 = 0%), respectively. The probability of having severe disease one or two weeks after 2nd dose decreased significantly (OR = 0.29 [95% CI, 0.19–0.46], I2 = 25%) and (OR = 0.08 [95% CI, 0.03–0.25], I2 = 74%), respectively. The incidence of infection any time after the 1st and 2nd doses diminished significantly (OR = 0.14 [95% CI, 0.07–0.4], I2 = 100%) and (OR = 0.179 [95% CI, 0.15–0.19], I2 = 98%), respectively. Also, incidence of infection one week after 2nd dose decreased significantly, (OR = 0.04, [95% CI (0.01–0.2], I2 = 100%). After meta-regression, the type of vaccine and country were the main predictors of outcome [non-mRNA type, ß = 2.99, p = 0.0001; country UK, ß = −0.75, p = 0.038; country USA, ß = 0.8, p = 0.02]. This study showed that most vaccines have comparable effectiveness, and it is purported that mass vaccination may help to end this pandemic. [ABSTRACT FROM AUTHOR]

Objective: The objective was to evaluate the efficacy and safety of single‐dose ketamine infusion in adults with sickle cell disease (SCD) who presented with acute sickle vasoocclusive crisis (VOC). Methods: This study was a parallel‐group, prospective, randomized, double‐blind, pragmatic trial. Participants were randomized to receive a single dose of either ketamine or morphine, infused over 30 min. Primary outcome was mean difference in the numerical pain rating scale (NPRS) score over 2 h. NPRS was recorded every 30 min for a maximum of 180 min and secondary outcomes were cumulative dose of opioids, emergency department (ED) length of stay, hospital admission, change in vital signs, and drug‐related side effects. Authors performed the analysis using intention‐to‐treat principle. Result: A total of 278 adults with SCD and who presented with acute sickle VOC participated in this trial. A total of 138 were allocated to the ketamine group. Mean (±standard deviation [SD]) NPRS scores over 2 h were 5.7 (±2.13) and 5.6 (±1.90) in the ketamine and morphine groups. The ketamine group received significantly lower cumulative doses of morphine during their ED stay (mean ± SD = 4.5 ± 4.6 mg) than of the morphine group (mean ± SD = 8.5 ± 7.55 mg). Both groups had similar rates of hospital admission: 6.3% in the ketamine group had drug‐related side effects compared to 2.2% in the morphine group. Conclusion: Early use of ketamine in adults with VOC resulted in a meaningful reduction in pain scores over a 2‐h period and reduced the cumulative morphine dose in the ED with no significant drug‐related side effects in the ketamine‐treated group. [ABSTRACT FROM AUTHOR]

Background COVID-19 has challenged the health system organization requiring a fast reorganization of diagnostic/therapeutic pathways for patients affected by time-dependent diseases such as acute coronary syndromes (ACS). Aim To describe ACS hospitalizations, management, and complication rate before and after the COVID-19 pandemic was declared. Design Ecological retrospective study. Methods: We analyzed aggregated epidemiological data of all patients > 18 years old admitted for ACS in twenty-nine hub cardiac centers from 17 Countries across 4 continents, from December 1st, 2019 to April 15th, 2020. Data from December 2018 to April 2019 were used as historical period. Results A significant overall trend for reduction in the weekly number of ACS hospitalizations was observed (20.2%; 95% confidence interval CI [1.6, 35.4] P = 0.04). The incidence rate reached a 54% reduction during the second week of April (incidence rate ratio: 0.46, 95% CI [0.36, 0.58]) and was also significant when compared to the same months in 2019 (March and April, respectively IRR: 0.56, 95%CI [0.48, 0.67]; IRR: 0.43, 95%CI [0.32, 0.58] p < 0.001). A significant increase in door-to-balloon, door-to-needle, and total ischemic time (p <0.04 for all) in STEMI patents were reported during pandemic period. Finally, the proportion of patients with mechanical complications was higher (1.98% vs. 0.98%; P = 0.006) whereas GRACE risk score was not different. Conclusions Our results confirm that COVID-19 pandemic was associated with a significant decrease in ACS hospitalizations rate, an increase in total ischemic time and a higher rate of mechanical complications on a international scale. [ABSTRACT FROM AUTHOR]

Background: Direct oral anticoagulants (DOACs) have a well-established role in the treatment of deep vein thrombosis and pulmonary embolism and in the reduction of thromboembolism in nonvalvular atrial fibrillation. However, limited evidence supports their role in patients with left ventricular thrombi. Methods: The PubMed, EMBASE, and Cochrane databases were searched for relevant articles published from inception to 1 August 2020. We included studies evaluating the effect of DOACs versus vitamin K antagonists (VKAs) in patients with left ventricular thrombi. The primary outcome was thrombus resolution, and the secondary outcomes were major bleeding and stroke or systemic embolization (SSE). Results: Five retrospective observational studies were included, with a total of 857 patients. VKAs and DOACs had a similar rate of thrombus resolution (odds ratio [OR] 0.97; 95% confidence interval [CI] 0.57–1.65; p = 0.90). Our analysis also demonstrated a similar rate of major bleeding (OR 0.62; 95% CI 0.27–1.44; p = 0.27) and SSE (OR 1.86; 95% CI 0.99–3.50; p = 0.05) between the two treatment groups. Conclusion: In patients with left ventricular thrombi, DOACs and VKAs are associated with similar rates of thrombus resolution, major bleeding, and SSE. [ABSTRACT FROM AUTHOR]

The probability of right heart thrombus co‐existence should be considered in patients with antiphospholipid syndrome (APS) who have pulmonary and cardiac symptoms. The prevention and management of intracardiac thrombotic events include early use of anticoagulation therapy. [ABSTRACT FROM AUTHOR]

A 60‐year‐old woman was referred to our clinic for evaluation of her rapidly progressive dyspnea, and she had no previous history of heart disease. A murmur was noted on her examination, and transthoracic echocardiography was so difficult to be performed due to poor acoustic windows so she was referred to do a transesophageal echocardiography that showed an ostium primum atrial septal defect (ASD) with left‐to‐right shunt and a quadrileaflet mitral valve with severe regurgitation. Later on, she underwent surgery with ostium primum ASD closure by a patch and double cleft repair by suture after right heart catheterization. [ABSTRACT FROM AUTHOR]

Introduction: Short stature is a common concern that necessitates pediatric endocrinology evaluation. Growth hormone deficiency (GHD) is a commonly considered etiology. Brain and pituitary magnetic resonance imaging (MRI) with gadolinium-based contrast agents (GBCAs) is the most widely used imaging in assessing patients with GHD. Given the significant strides made in MRI technology, the need for contrast material should be reassessed. Method: We performed a retrospective review of healthy patients with short stature and/or GHD who underwent brain and pituitary MRI with and without contrast to assess the added value of contrast administration. Results: 227/318 identified patients underwent growth hormone (GH) stimulation testing; 28 (12.3%) with normal GH response and 62 (27.3%) with severe GHD. We found a low incidence of sellar and suprasellar pathologies. When comparing noncontrast and contrast MRI, we found perfect agreement in detecting abnormal posterior pituitary bright spots (kappa:1.0) and substantial agreement in detecting pars intermedia cysts and posterior superior sellar cysts (kappa: 0.74 and 0.71, respectively). Initially, only moderate agreement was found in detecting infundibular abnormalities (kappa: 0.51), although a revised noncontrast MRI protocol with high-resolution 3D images enabled visualization of the infundibulum. Conclusion: The MRI evaluation of healthy patients with short stature and/or isolated GHD may be completed without the use of GBCAs. The slight overestimation of pituitary stalk interruption by noncontrast images can be overcome by adding newer high-resolution sequences. [ABSTRACT FROM AUTHOR]

Background: Primary focal segmental glomerular sclerosis (FSGS) frequently causes recurrence after kidney transplantation, leading to graft loss in half of the patients. Conservative treatment of FSGS is the main acceptable method due to the lack of randomized clinical trials. A few strategies are known to treat FSGS recurrence, such as plasmapheresis and intravenous immunoglobulin (IVIG), but failure to achieve remission may occur. In addition, some of these treatment strategies are more established in pediatric patients and lack evidence in adult patients. Case Report: We describe the case of a 24-year-old woman who had a kidney transplant due to FSGS and was admitted to the hospital for an evaluation of lower-limb and facial swelling. Her kidney biopsy showed segmental glomerulosclerosis compatible with recurrence of FSGS. Her FSGS relapses were further confirmed by increase in serum creatinine and proteinuria. The patient had several FSGS relapses that were treated by different combinations of plasmapheresis, pulse steroid, mycophenolic acid, tacrolimus, prednisolone, IVIG, and IV rituximab. She did not respond to conventional therapy and was eventually treated successfully using cyclophosphamide and remained in remission afterward. Conclusions: FSGS has a high recurrence rate after kidney transplantation. A few options to achieve remission have been investigated. In this report, we present the case of a young woman with FSGS recurrence after a kidney transplant, achieving remission successfully with cyclophosphamide. Cyclophosphamide can be used a treatment of FSGS recurrence in a transplanted kidney when all other options have been exhausted. Additional research is needed to assess the efficacy and safety profile of cyclophosphamide in such cases. [ABSTRACT FROM AUTHOR]

Background Timely use of Sacubitril/Valsartan has the potential to significantly improve cardiac function and dramatically reduce secondary mitral regurgitation (MR) severity even in patients presenting with acute decompensated heart failure (HF), not only in compensated chronic HF patients. The outstanding impact of echocardiography is obvious in monitoring improvement of cardiac function and MR severity in patients with HF with reduced ejection fraction (HFrEF). Case summary We report a relevant case of an elderly patient who presented with acute decompensated HF and severe MR. He was symptomatic despite being on maximally tolerated doses of ACEI, beta-blockers, and diuretics. Left ventricular ejection fraction (LVEF) improved from 15% to 35% 2 weeks following initiation of Sacubitril/Valsartan during second HF hospitalization. There was a dramatic improvement of patient's symptoms from New York Heart Association (NYHA) Class IV to NYHA I. N-terminal pro B-type natriuretic peptide reduced from 9000 pg/mL to 800 pg/mL. Coronary angiography depicted three-vessel coronary artery disease. The patient was advised to undergo coronary artery bypass graft surgery with mitral valve repair, then followed by implantation of a cardiac resynchronization therapy-defibrillator device (CRT-D) if no LV function improvement is observed after revascularization. The electrocardiogram showed Q waves in inferior leads with QRSd ≥ 125 ms, hence a good candidate for CRT. Following an elective percutaneous coronary intervention, LVEF further improved to 50%. The patient became asymptomatic with preserved LVEF on follow-up for 18 months later. Discussion This case report documents the swift echocardiographic and symptom improvement in a decompensated end-stage HF patient when Sacubitril/Valsartan initiated during acute setting. [ABSTRACT FROM AUTHOR]

Peripartum cardiomyopathy (PPCM) is an uncommon complication that occurs towards the end of pregnancy or in the months following delivery. Given the multiple confounding factors, a sub-study of the registry investigated the characteristics and outcomes of women with PPCM according to individual-level sociodemographic factors utilizing personal income and educational attainment. This registry highlighted the different demographics and outcomes in women with PPCM in different regions. [Extracted from the article]

Many recent studies have investigated the role of either Chloroquine (CQ) or Hydroxychloroquine (HCQ) alone or in combination with azithromycin (AZM) in the management of the emerging coronavirus. This systematic review and meta-analysis of either published or preprint observational studies or randomized control trials (RCT) aimed to assess mortality rate, duration of hospital stay, need for mechanical ventilation (MV), virologic cure rate (VQR), time to a negative viral polymerase chain reaction (PCR), radiological progression, experiencing drug side effects, and clinical worsening. A search of the online database through June 2020 was performed and examined the reference lists of pertinent articles for in-vivo studies only. Pooled relative risks (RRs), standard mean differences of 95% confidence intervals (CIs) were calculated with the random-effects model. Mortality was not different between the standard care (SC) and HCQ groups (RR = 0.99, 95% CI 0.61–1.59, I2 = 82%), meta-regression analysis proved that mortality was significantly different across the studies from different countries. However, mortality among the HCQ + AZM was significantly higher than among the SC (RR = 1.8, 95% CI 1.19–2.27, I2 = 70%). The duration of hospital stay in days was shorter in the SC in comparison with the HCQ group (standard mean difference = 0.57, 95% CI 0.20–0.94, I2 = 92%), or the HCQ + AZM (standard mean difference = 0.77, 95% CI 0.46–1.08, I2 = 81). Overall VQR, and that at days 4, 10, and 14 among patients exposed to HCQ did not differ significantly from the SC [(RR = 0.92, 95% CI 0.69–1.23, I2 = 67%), (RR = 1.11, 95% CI 0.26–4.69, I2 = 85%), (RR = 1.21, 95% CI 0.70–2.01, I2 = 95%), and (RR = 0.98, 95% CI 0.76–1.27, I2 = 85%)] respectively. Exposure to HCQ + AZM did not improve the VQR as well (RR = 3.23, 95% CI 0.70–14.97, I2 = 58%). The need for MV was not significantly different between the SC and HCQ (RR = 1.5, 95% CI 0.78–2.89, I2 = 81%), or HCQ + AZM (RR = 1.27, 95% CI 0.7–2.13, I2 = 88%). Side effects were more reported in the HCQ group than in the SC (RR = 3.14, 95% CI 1.58–6.24, I2 = 0). Radiological improvement and clinical worsening were not statistically different between HCQ and SC [(RR = 1.11, 95% CI 0.74–1.65, I2 = 45%) and (RR = 1.28, 95% CI 0.33–4.99), I2 = 54%] respectively. Despite the scarcity of published data of good quality, the effectiveness and safety of either HCQ alone or in combination with AZM in treating COVID-19 cannot be assured. Future high-quality RCTs need to be carried out. PROSPERO registration: CRD42020192084. [ABSTRACT FROM AUTHOR]

Undergraduate, patients, dental, management, acceptance, peer-dentist, reciprocal. [Extracted from the article]

Strategies used for the treatment of children with Hodgkin lymphoma (HL) over the last four decades have resulted in excellent long-term survivals. However, the short- and long-term treatment-associated morbidities were high. In an attempt to reduce complications, the current treatment strategies apply initial risk stratification principles based on certain host and tumor risk factors to help assign patients to the appropriate risk group and tailor therapy based on response to chemotherapy (CTR). Radiotherapy (RT) was only given to certain groups of patients who show suboptimal response to CTR. Enrollment of patients in clinical trials allowed testing newer treatment strategies, which has improved the outcome significantly. High-dose CTR with stem cell support remains the mainstay of treatment for relapsed and refractory HL. Newer targeted medications are being increasingly used for the treatment of patients with relapsed and refractory HL, but results are variable. In this review report, we give extensive account about the pathophysiology, clinical presentation, histopathological diagnosis, modern investigation techniques, the most recent risk adapted treatment strategies, and the use and effect of novel medications. In addition, we discuss in details the short- and long-term therapy-related complications and future prospects in the management of HL. [ABSTRACT FROM AUTHOR]

Introduction: Emergency departments use triage systems to prioritize patients according to the severity of their condition. The Electronic Canadian Triage and Acuity Scale (E-CTAS) is a popular system that categorizes patients into five levels to manage patient flow and prioritize patient access to health-care services. Methods: We assessed the factors that influence E-CTAS usage in emergency departments in Eastern Saudi Arabia. Seventy-one nurses were included from two emergency departments that adopted E-CTAS. We used the technology acceptance model (TAM) to assess the influencing factors. The TAM was reliable in the study setting (Cronbach's α = 0.87). Results: All of the TAM domains were significantly related to the usage of E-CTAS: perceived ease of use, perceived usefulness, importance of training, social influence, behavior intention, and attitude. We also showed that E-CTAS use significantly increased with years of experience and training. Discussion: Many factors influenced the use of this electronic triage system. Focusing on these factors in future electronic triage system implementations might increase the hospital staff's compliance, thus improving accuracy and better organizing the patient flow in emergency departments. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Membranous interventricular septal (MIVS) aneurysm is a rare often asymptomatic, accidentally discovered congenital anomaly, which might be complicated with right ventricular obstruction, rupture, thromboembolism, and conduction abnormalities. [ABSTRACT FROM AUTHOR]

Introduction: A critical mechanism of how hypoxia/ischemia causes irreversible myocardial injury is through the exhaustion of adenosine triphosphate (ATP). Cyclocreatine (CCr) and its water-soluble salt Cyclocreatine-Phosphate (CCrP) are potent bioenergetic agents that preserve high levels of ATP during ischemia. Areas covered: CCr and CCrP treatment prior to the onset of ischemia, preserved high levels of ATP in ischemic myocardium, reduced myocardial cell injury, exerted anti-inflammatory and anti-apoptotic activities, and restored contractile function during reperfusion in animal models of acute myocardial infarction (AMI), global cardiac arrest, cardiopulmonary bypass, and heart transplantation. Medline and Embase (1970 - Feb 2019), the WIPO databank (up to Feb 2019); no language restriction. Expert opinion: This review provides the basis for a number of clinical applications of CCrP and CCr to minimize ischemic injury and necrosis. One strategy is to administer CCrP to AMI patients in the pre-hospital phase, as well as during, or after Percutaneous Coronary Intervention (PCI) procedure to potentially achieve protection of the myocardium, reduce infarcted-size, and, thus, limit the progression to heart failure. Another clinical applications are in predictable myocardial ischemia where pretreatment with CCrP would likely improve outcome and quality of life of patients who will undergo cardiopulmonary bypass for coronary revascularization and end-stage heart failure patients scheduled for heart transplantation. [ABSTRACT FROM AUTHOR]

Cogan's syndrome is a rare disorder characterized by the coexistence of ocular and audio‐vestibular manifestations. Systemic manifestations are quite unusual with pan‐vasculitis and cardiac involvement reported in the form of aortitis with aortic aneurysm, dissection, or extremely rare aortic valve perforation. Hereby, we report a case of a 56‐year‐old woman presented with ocular, audio‐vestibular, and systemic manifestations with medium‐sized vasculitis in the form of multiple splenic artery aneurysms, superior mesenteric artery thrombosis, and cardiovascular involvement in the form of aortic regurgitation due to noncoronary cusp perforation. To the best of our knowledge, this is the second case to report aortic perforation in the setting of Cogan's syndrome. [ABSTRACT FROM AUTHOR]

The article reports on the effectiveness of rivaroxaban, a direct oral anticoagulant (DOAC), in dissolving left ventricular (LV) thrombi in patients with acute coronary syndrome (ACS) who are taking dual antiplatelet therapy (DPAT) without valvular heart disease. Also cited are the distal systemic embolization as main risk factor of LV thrombi, and the possible risk of stroke due to thromboembolism.

Background: Tumor-induced hypoglycemia is a rare and serious complication that is usually a consequence of either excessive insulin secretion (insulinoma) or because of non-islet cell tumor hypoglycemia (NICTH). NICTH is a rare phenomenon seen most often in adult patients. It is associated with different tumor types. Here, we report the first case to the best of our knowledge in the literature of a pediatric patient with NICTH associated with desmoplastic small round cell tumor (DSRT). Case presentation: This is a 15-year-old girl who presented with symptomatic hypoglycemia and abdominal mass. She required an intravenous glucose infusion rate as high as 9 mg/kg/min in addition to glucose containing oral supplements in order to maintain her blood glucose above 60 mg/dL. Computed tomography (CT) scan of the chest, abdomen and pelvis showed multiple hepatic lesions with an intraperitoneal soft tissue mass which subsequently was diagnosed as DSRT. When the blood glucose was 45 mg/dL, the insulin, growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels were suppressed with an appropriate elevation of cortisol. Subsequently, an insulin-like growth factor-2 (IGF-2) level was sent and the IGF-2:IGF-1 ratio was found to be elevated >10 consistent with NICTH. After the first dose of chemotherapy, hypoglycemia improved, and she was weaned off glucose containing fluids. Conclusions: NICTH should be considered in all cancer patients regardless of their age with refractory hypoglycemia. [ABSTRACT FROM AUTHOR]

Carney complex is a rare autosomal dominant disorder characterized by multiple tumors, including cardiac and extracardiac myxomas, skin lesions, and various endocrine disorders. We are reporting a 21-year-old female patient with past surgical history significant for excision of a cutaneous myxoma who presented with multicentric cardiac myxomas involving the four cardiac chambers. She also presented with endocrinal disorders in the form of an enlarged right lobe of the thyroid, hyperthyroid state, and an incidentally noted adrenal cyst; hence, she was diagnosed with carney complex syndrome. [ABSTRACT FROM AUTHOR]

We report a case of colonic adenosquamous carcinoma with MSI-H (microsatellite instability-high) in a 43-year-old male who presented with bowel obstruction due to a circumferential mass involving the descending colon and splenic flexure. Microscopically, it showed poorly differentiated adenocarcinoma with squamous differentiation, tumor infiltrating lymphocytes >3/high-power field, and mild peritumoral lymphocytic response. Immunohistochemistry was equivocal for MLH-1, PMS-2, and MSH-2, with retention of MSH-6 expression. Polymerase chain reaction testing demonstrated MSI-H pattern with instability of BAT-25, BAT-26, and NR-21. Review of the literature revealed only one recently published case of MSI-H adenosquamous carcinoma. The role of MSI in adenosquamous carcinoma pathogenesis is still unknown. In conclusion, MSI testing in colonic adenosquamous carcinoma combined with other MSI-related clinical and histological features is indicated. [ABSTRACT FROM AUTHOR]

A 40-year-old woman presented with postoperative fever. Echocardiography revealed a large pedunculated cauliflower right atrial mass of heterogeneous echogenicity attached to the eustachian valve measuring about 2×3 cm. She underwent surgical excision, gross and microscopical examination were consistent with eustachian valve infective endocarditis. [ABSTRACT FROM AUTHOR]

Unguarded tricuspid orifice is the most extreme of tricuspid valve dysplasia with a very variable natural history. They can tolerate tricuspid regurgitation well, and they become symptomatic only if significant right ventricular dysfunction or atrial fibrillation occurs. Patients with a mild degree of right ventricular dysfunction can survive to adulthood and even reach old age. Surgical treatment is a difficult option due to variable natural history, and surgical results are not too encouraging. [ABSTRACT FROM AUTHOR]

Pericardial sarcomas are extremely rare aggressive neoplasms. Non-specific symptoms and incidental discovery are usually the rule. Multimodality imaging is extremely important for diagnosis and tissue characterisation of all cardiac masses. Despite treatment, pericardial sarcomas are considered extremely fatal. We encountered a 27-year-old female patient who presented to our facility with progressive dyspnoea. On examination, clinical signs of cardiac tamponade were appreciated, transthoracic echocardiography revealed a tamponading pericardial effusion and a large heterogeneous pericardial mass. Pericardiocentesis revealed haemorrhagic fluid. Subsequently, CT revealed a pericardial mass compressing the right atrium. Excision biopsy showed a well-circumscribed mass, and cut sections showed friable grey-white tissue with areas of haemorrhage and necrosis. Pathological examination confirmed the diagnosis of high-grade undifferentiated sarcoma of the pericardium. The patient was started on adjuvant chemotherapy and radiotherapy. Follow-up after 1 year showed no relapse. [ABSTRACT FROM AUTHOR]

Ortner's syndrome (cardiovocal syndrome) is a rare cause of unilateral vocal cord paralysis that results from compression of the left recurrent laryngeal nerve by enlarged vascular structures. Most commonly, it is caused by an enlarged left atrium, but other rare causes include ascending aortic aneurysm or pulmonary artery aneurysm. Although very rarely encountered nowadays, bilharziasis is still one of the main causes of pulmonary artery aneurysm in endemic areas. Hereby, we report a case of Ortner's syndrome due to a large pulmonary artery aneurysm in a woman with history of bilharziasis. [ABSTRACT FROM AUTHOR]