Massive haemorrhagic pericardial effusion as the cardiac manifestation of Salmonella enteritidis infection in a severely immunocompromised patient

A 41-years-old gentleman was admitted for reduced effort tolerance with non-specific symptoms of weight loss and generalised body weakness. Chest X-ray (CXR) showed cardiomegaly. Echocardiography showed a large pericardial effusion with septation. Emergency pericardiocentesis was performed and pericardial fluid culture grew Salmonella enteritidis (S. enteritidis). He tested positive for the retroviral disease, with a CD4 count of 10 cells/µL. Intravenous (IV) ceftriaxone was administered. A pericardial drain was inserted due to the rapid re-accumulation of pericardial fluid after the initial pericardiocentesis. He also had drainage of his left pleural effusion. He had a guidewire exchange of pericardial drain around 2 weeks after admission, with flushing performed whenever the flow was poor. A repeat echocardiogram showed early signs of constrictive pericarditis with residual pericardial effusion in which intrapericardial fibrinolysis was considered. He was started on antiretroviral therapy (ART) and his condition remained stable. The pericardial drain was kept throughout his admission. Unfortunately, he developed severe sepsis and succumbed to it about a month post-admission

A common variant near TGFBR3 is associated with primary open angle glaucoma

Primary open angle glaucoma (POAG), a major cause of blindness worldwide, is a complex disease with a significant genetic contribution. We performed Exome Array (Illumina) analysis on 3504 POAG cases and 9746 controls with replication of the most significant findings in 9173 POAG cases and 26 780 controls across 18 collections of Asian, African and European descent. Apart from confirming strong evidence of association at CDKN2B-AS1 (rs2157719 [G], odds ratio [OR] = 0.71, P = 2.81 × 10−33), we observed one SNP showing significant association to POAG (CDC7–TGFBR3 rs1192415, ORG-allele = 1.13, Pmeta = 1.60 × 10−8). This particular SNP has previously been shown to be strongly associated with optic disc area and vertical cup-to-disc ratio, which are regarded as glaucoma-related quantitative traits. Our study now extends this by directly implicating it in POAG disease pathogenesis

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Abstract Primary open angle glaucoma (POAG), a major cause of blindness worldwide, is a complex disease with a significant genetic contribution. We performed Exome Array ), we observed one SNP showing significant association to POAG (CDC7-TGFBR3 rs1192415, OR G-allele = 1.13, P meta = 1.60 × 10 −8 ). This particular SNP has previously been shown to be strongly associated with optic disc area and vertical cup-to-disc ratio, which are regarded as glaucoma-related quantitative traits. Our study now extends this by directly implicating it in POAG disease pathogenesis

A stormy chase of coronary artery spasm : Thyroid storm in acute myocardial infarction

SUMMARY Cardiovascular disease represents the largest cause of death globally, with multifactorial causes. This is a case study of a thyroid storm with hyperactive coronary arteries resulting in acute myocardial infarction (AMI). A 56-year-old gentleman presented with left-sided chest pain radiating to the neck. Initial ECG showed ST elevation over anterior leads, which dynamically changed to Lambda-wave (“shark fin” pattern) over inferior leads 60 minutes later, along with raised cardiac enzymes. Urgent invasive coronary angiogram was performed, in which we repeatedly did ballooning of the left anterior descending coronary artery due to recurrent spasms in the artery, with the patient’s haemodynamics being labile with systolic blood pressure of as low as 60 mmHg. He was intubated for acute pulmonary oedema and admitted to cardiac intensive care unit postprocedure and had persistent tachycardia with multiple episodes of tachyarrhythmia. Laboratory test revealed hyperthyroidism, and he was treated for thyroid storm with Burch-Wartofsky Point Scale of 50 points. However, his clinical condition deteriorated rapidly with the development of acute kidney injury and severe metabolic acidosis. He eventually succumbed after 4 days of intensive care despite maximum multidisciplinary resuscitation effort. This study calls for routine screening of thyroid function test in patients with persistent tachycardia during AMI

Ventricular tachycardia storm as predominant cardiac manifestation of lupus myocarditis

SUMMARY Systemic lupus erythematosus (SLE) is a multi-system autoimmune disease that can affect any part of the heart, causing arrhythmias on top of other cardiac manifestations. Malignant ventricular tachyarrhythmias are rare manifestations of SLE. Our case is the first one reported in the literature of an SLE patient with multi-organ involvement who subsequently presented with ventricular tachycardia (VT) storm as a cardiac manifestation. This case also demonstrates the use of Stellate ganglion block to treat intractable VT storm when chemical and electrical cardioversions failed, while waiting for immunosuppressive drugs to take effect. Timely treatment resulted in a good outcome for our patient

Chemical Composition of Gas and Particle Phase Products of Toluene Photooxidation Reaction under High OH Exposure Condition

In the current study, the photooxidation reaction of toluene (C7H8) was investigated in a Potential Aerosol Mass Oxidation Flow Reactor (PAM OFR). The hydroxyl radical (OH) exposure of toluene in the PAM OFR ranged from 0.4 to 1.4 x 10(12) molec cm(-3) s, which is equivalent to 3 to 12 days of atmospheric oxidation. A proton transfer reaction-mass spectrometer (PTR-MS) and a scanning mobility particle sizer (SMPS) were used to study the gas-phase products formed and particle number changes of the oxidation reaction in PAM OFR. The secondary organic aerosol (SOA) formed in the PAM OFR was also collected for off-line chemical analysis. Key gas-phase reaction products of toluene, including glyoxal, methyl glyoxal, unsaturated carbonyl compounds, and benzaldehyde, were identified by the PTR-MS. Second generation products, including acetic acid, formaldehyde, formic acid, and acetaldehyde, were also detected. By comparing the mass spectrums obtained under different OH exposures and relative humidity (RH), changes in the two parameters have minimal effects on the composition of gas-phase products formed, expect for the spectrum obtained at OH exposure of 0.4 x 10(12) cm(-3) s and RH = 17%, which is slightly different from other spectrums. SMPS results showed that particle mass concentration increases with increasing OH exposure, while particle number concentration first increases and then decreases with increasing OH exposure. This result probably suggests the formation of oligomers at high OH exposure conditions. Off-line chemical analysis of the SOA sample was dominated by C4 diacids, including malic acid, citramalic acid, and tartaric acid. The well-known toluene SOA marker 2,3-Dihydroxy-4-oxopentanoic acid, as well as 2,3-dihydroxyglutaric acid, which has not been identified in previous toluene photooxidation experiments, were also detected in the SOA sample. Our results showed good agreements with the results of previous smog chamber studies of toluene photooxidation reaction, and they suggested that using PAM OFR for studies of oxidation reaction of different VOCs can be atmospherically relevant

Genome-wide association analyses identify three new susceptibility loci for primary angle closure glaucoma.

Primary angle closure glaucoma (PACG) is a major cause of blindness worldwide. We conducted a genome-wide association study including 1,854 PACG cases and 9,608 controls across 5 sample collections in Asia. Replication experiments were conducted in 1,917 PACG cases and 8,943 controls collected from a further 6 sample collections. We report significant associations at three new loci: rs11024102 in PLEKHA7 (per-allele odds ratio (OR)=1.22; P=5.33×10(-12)), rs3753841 in COL11A1 (per-allele OR=1.20; P=9.22×10(-10)) and rs1015213 located between PCMTD1 and ST18 on chromosome 8q (per-allele OR=1.50; P=3.29×10(-9)). Our findings, accumulated across these independent worldwide collections, suggest possible mechanisms explaining the pathogenesis of PACG