Isolated rheumatic severe tricuspid regurgitation

Severe isolated tricuspid regurgitation (TR) is very rare, with most cases of TR being functional and secondary to pulmonary hypertension from left heart pathologies. We report an unusual case of a young Nigerian male, who presented to us with dyspnea, repeated hospital admissions for heart failure, and a childhood history of rheumatic fever. Echocardiogram showed massively dilated right atrium and ventricle, noncoaptation of thickened tricuspid valve with torrential free tricuspid regurgitation. Other valves were normal. Cardiac MRI showed normal right ventricular function and viability. Patient underwent tricuspid valve replacement with 35‐mm St. Jude valve.     

PEG Brushes on Porous,PDMS‐Coated Surfaces and Their Interaction with Carbon Dioxide

A porous polymeric substrate covered with a thin polydimethylsiloxane (PDMS) coating is used for the surface‐initiated polymerization of polyethylene glycol (PEG)‐based polymer brushes. Successful synthesis of the brushes is evidenced by several methods and their impact on the characteristics of the polymeric multilayer substrate is studied. Investigation into the behavior of PEG‐based brushes using atomic force microscopy and multiple transmission‐reflection infrared (MTR‐FTIR) spectroscopy reveals conformational changes of the brush chains upon exposure to carbon dioxide. The results presented here highlight an elegant way to covalently modify porous, PDMS‐coated substrates with polymer brushes to alter their characteristics.

     

Immunological basis for treatment of graft versus host disease after liver transplant

Graft versus host disease (GVHD) after liver transplant, although a rare disease, has a very high mortality rate. GVHD occurs due to immunoreactions caused by donor T lymphocytes and host cell surface antigens resulting in proliferation and clonal expansion of T lymphocyte. Migration of effector cells, including macrophages, NK cells and cytotoxic T lymphocyte, to the target organs such as skin, intestine and bone marrow results in skin rashes, diarrhea and bone marrow depression. GVHD is diagnosed by clinical symptoms, histopathological findings and by the presence of chimerism. The delayed diagnosis, opportunistic infections and lack of definitive treatment of post orthotopic liver transplant (OLT)-GVHD results in sepsis and multi-organ failure leading to very low survival rates. In this review, we have focused on early diagnosis and critically discuss novel treatment modalities to decrease the incidence of GVHD.     

Sinonasal Globular Amyloidosis Simulating Malignancy: A Rare Presentation

Primary localized amyloidosis in the head and neck region is a rare entity. The most commonly involved organ is larynx. Primary amyloidosis localized to the sinonasal tract is extremely rare. We report one such case along with a brief review of the associated literature. The aim of reporting this case is to emphasize the fact that sometimes nasal amyloidosis can also present with signs and symptoms of nasal and nasopharyngeal malignancy. The definitive diagnosis in such cases depends upon histopathology and further confirmed by immunohistochemistry. A 55-year old male presented with recurrent episodes of nasal bleed, bilateral nasal obstruction, and bilateral hearing loss from last 7 years. On clinical examination a mass was found in the nasal cavity on both sides reaching up to the nasopharynx. Contrast enhanced CT scan revealed that the mass was extending up to the skull base and destroying bony landmarks of the nasal cavity and paranasal sinuses. Mass was proved to be amyloidosis after histopathological examination. It showed multiple blotches of globular submucosal deposit of amyloid, on staining with Congo red. Immunohistochemistry confirmed AL amyloidosis with expression of mixed kappa and lambda light chain immunoglobulin (κ > λ). No evidence of systemic amyloidosis was found after proper work up. It was managed by conservative surgery.     

Role of postoperative vasopressor use in occurrence of atrial fibrillation after coronary artery bypass grafting

Vasopressor use is common after coronary artery bypass grafting surgery. This study evaluated the role of postoperative vasopressor use as a predictor of occurrence of atrial fibrillation after coronary artery bypass grafting and demonstrates that vasopressor use is an independent predictor of such an occurrence.     

Role of vitamins and minerals as immunity boosters in COVID-19

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) known as coronavirus disease (COVID-19), emerged in Wuhan, China, in December 2019. On March 11, 2020, it was declared a global pandemic. As the world grapples with COVID-19 and the paucity of clinically meaningful therapies, attention has been shifted to modalities that may aid in immune system strengthening. Taking into consideration that the COVID-19 infection strongly affects the immune system via multiple inflammatory responses, pharmaceutical companies are working to develop targeted drugs and vaccines against SARS-CoV-2 COVID-19. A balanced nutritional diet may play an essential role in maintaining general wellbeing by controlling chronic infectious diseases. A balanced diet including vitamin A, B, C, D, E, and K, and some micronutrients such as zinc, sodium, potassium, calcium, chloride, and phosphorus may be beneficial in various infectious diseases. This study aimed to discuss and present recent data regarding the role of vitamins and minerals in the treatment of COVID-19. A deficiency of these vitamins and minerals in the plasma concentration may lead to a reduction in the good performance of the immune system, which is one of the constituents that lead to a poor immune state. This is a narrative review concerning the features of the COVID-19 and data related to the usage of vitamins and minerals as preventive measures to decrease the morbidity and mortality rate in patients with COVID-19.

     

LVAD as a bridge to decision complicated with pump thrombosis and infection

Left ventricular assist devices (LVADs) emerged as an effective therapy for the treatment of symptomatic advanced heart failure in spite of maximum tolerated optimal medical treatment. LVADs were initially conceived as a bridge to transplantation, although with the continuing donor shortage, they also serve as a definitive therapy for some patients. Careful evaluation by a multidisciplinary team and proper patient selection are key factors for good outcomes. These patients are very high-risk surgical candidates, and their survival at 1 year after implantation is estimated to be around 81%. We report a unique case of a patient who underwent LVAD implantation as a bridge to candidacy and suffered several complications related to the device. We also present our experience dealing with these complications in a field of limited evidence. This gentleman developed pump thrombosis second- ary to heparin-induced thrombocytopenia, requiring an LVAD exchange during index admission. A year after being discharged from the first episode, he developed mediastinitis, needing removal of the pump, intravenous antibiotics, and veno-arterial extra corporeal membrane oxygenation (VA-ECMO) for hemodynamic support. A new LVAD insertion was required, and the gentleman could be eventually discharged after a prolonged admission.