Reconstruction of the right atrium using an extracellular matrix patch in a patient with severe mediastinal aspergillosis

INTRODUCTIONWe report a case of reconstruction of the right atrial wall using a novel bioresorbable patch derived from porcine small intestinal submucosa.PRESENTATION OF CASEOur patient presented with mediastinal aspergillosis as a result of chronic steroid therapy for an oligodendroglioma. Hemodynamic compromise and syncopal episodes secondary to the mass effect of the aspergilloma prolapsing through tricuspid valve necessitated palliative surgical excision.DISCUSSIONIntraoperatively, it was con?rmed that the lesion had eroded into the right atrium and partially occluded right ventricular in?ow. In order to achieve appropriate palliation a wide resection of the atrial wall was necessary. The atrial reconstruction was then performed using an extracellular matrix-derived biopatch. This case was further complicated by postoperative bleeding requiring re-operation.CONCLUSIONWe describe the methods used for repair using a novel patch in this rare case of invasive aspergillosis extending into the right atrium and resulting in compromise of diastolic right ventricular ?lling.     

Role of Antithrombotic Agents in Heart Failure

Despite a vast body of research on antithrombotic therapy for patients with cardiac disease, there are few clinical settings where robust evidence of their benefit exists. Patients with heart failure often have vascular disease and atrial fibrillation contributing to their poor prognosis. For patients with heart failure and atrial fibrillation, anticoagulants are appropriate. For patients with heart failure in sinus rhythm, the weight of evidence suggests that doctors should generally avoid using any antithrombotic agent even if the patient has coronary artery disease. If there is a compulsion to treat, then there is less evidence of harm with clopidogrel or warfarin than with aspirin, although most receive aspirin. More research is required for this "evidence-light" problem. For those with the opportunity, engaging with a randomized trial is clinically and scientifically appropriate. The dilemma for such studies is the comparator. Should it be against or in addition to "standard of care" or both?     

Insights into the role of vaginal microbiome in women's health

The vaginal microbiome is a complex and dynamic microecosystem that fluctuates continually throughout a woman's life. Lactobacillus, a bacterium that possesses antibacterial properties dominates a healthy vaginal microbiome. Bacterial vaginosis is the most common vaginal disorder that has been linked with the dysbiosis of normal vaginal microbiota. Despite the importance of vaginal microbiome, little is known about functions it performs especially, how it helps in protecting the female reproductive tract. This knowledge gap is a significant impediment to the development of effective and feasible clinical treatments that might be required to improve women's health. Thus, a deeper understanding of the functional aspects and not just the composition of vaginal microbiome may aid in improving the diagnostics and treatment strategies. Recent advancement in molecular methods and computational biology have allowed researchers to acquire more knowledge about the vaginal microbiome. The use of metagenomics (culture-independent high-throughput technology) and bioinformatics tools have improved our understanding of the vaginal microbiome. In this review, we have attempted to explore the factors that may alter normal vaginal microbiota homeostasis such as age, sexual behavior, ethnicity, and hygiene, and so forth. We also discuss the role of probiotics in restoring healthy vaginal microbiome.