Fulminant Myocarditis: A Review of the Current Literature

Myocarditis is an inflammatory disease of the myocardium with a wide spectrum of symptoms and severity. Fulminant myocarditis is a small cohort of this disease that tends to present with sudden onset acute heart failure, cardiogenic shock, or life-threatening arrhythmias. The most common type, and the one with the best likelihood for recovery, is lymphocytic myocarditis. More rare, and often more fatal, forms are eosinophilic myocarditis and giant cell myocarditis. Delayed recognition and lack of standardized therapy guidelines continue to challenge clinicians treating these critically ill patients. This article will review the most up-to-date literature regarding recognition and recommended treatment for fulminant myocarditis as it pertains to clinical practice.

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Noticing and analysis of pedagogical practices in mathematics

Memorias del I Congreso Internacional de Ciencias Exactas y Naturales ◽

10.15359/cicen.1.88 ◽

2019 ◽

Author(s):

Yuri Morales López ◽

Marianela Alpízar Vargas ◽

Ana Lucía Alfaro Arce ◽

Vicenç Font-Moll

Keyword(s):

Classroom Management ◽

Wide Spectrum ◽

Math Education ◽

Pedagogical Practices ◽

Math Teachers ◽

Education Activity ◽

The One ◽

Analysis Models ◽

Teacher's Knowledge ◽

Math Teacher

The purpose of this presentation is to show elements associated to the study and analysis of pedagogical practices used by mathematics teachers, taking into consideration different approaches and conceptions derived from theories related to the role of the math teacher. The project highlights the need to use different strategies to analyze the processes occurring in the activities and tasks organized and implemented by the teacher. One of the main tasks in teacher training is to promote the capacity to noticing on the pedagogical activity, where noticing is understood as an inherent process to improve the quality of classroom management. In addition, different analysis models should be compared using examples and experiential practices and the different theories and research projects developed in this field related to this type of analysis. Knowing what happens in the classroom is a task inherent to the math teacher. For sure, if the teacher does not understand or is even able to perceive what is happening in the class, improvement actions are very difficult to implement. Consequently, math teachers must develop the capability of analyzing their pedagogical activity and the related elements. It is not about isolating variables and looking for causal relationships, but rather about understanding the teacher’s activity as the center of the multiple situations occurring in the classroom, which may be known more in depth, if the attention is focused on the organization, ordering, and execution of the tasks planned by the teacher. It must also be understood that the competence of analyzing mentioned here is not an isolated activity without an effect. Such analysis must be approached from an active perspective where scenarios are generated to mitigate complex situations or to value an approach different than the one happening in the classroom. Being aware that there are many aspects to analyze (most likely almost everything that happens is analyzable), we must take a stand on which situations are highly related to what happens in our classroom and which could eventually happen. With such a wide spectrum, some questions that need to be addressed are: What is important in the math education activity and who defines what is important? What elements are of interest to math teachers? How does the analysis conducted relate to the different models of the teacher's knowledge? How does our previous experience influence the assessments we make? How do we distinguish elements of interest to analysis? What is the relationship between reflecting and analyzing? At what stages of the teacher’s activity is an analysis required? What is the ultimate purpose of analyzing teaching activities? What competencies or skills are related to the analysis? What types of analysis are appropriate (content, cognitive, media, among others)? How can we balance the actions derived from the analyses we conduct? From all these questions the most important one that can guide the study of this reflection would be: What should be assessed in pedagogical activities and what is the objective of analyzing such pedagogical activities in math education?

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Many faces of acute bowel ischemia: overview of radiologic staging

Insights into Imaging ◽

10.1186/s13244-021-00985-9 ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Amir H. Davarpanah ◽

Afshar Ghamari Khameneh ◽

Bardia Khosravi ◽

Ali Mir ◽

Hiva Saffar ◽

...

Keyword(s):

Wide Spectrum ◽

Bowel Ischemia ◽

Management Approach ◽

Final Decision ◽

Imaging Findings ◽

Life Threatening ◽

Imaging Signs ◽

Late Stages ◽

Underlying Pathophysiology ◽

Made In

AbstractAcute bowel ischemia (ABI) can be life threatening with high mortality rate. In spite of the advances made in diagnosis and treatment of ABI, no significant change has occurred in the mortality over the past decade. ABI is potentially reversible with prompt diagnosis. The radiologist plays a central role in the initial diagnosis and preventing progression to irreversible intestinal ischemic injury or bowel necrosis. The most single imaging findings described in the literature are either non-specific or only present in the late stages of ABI, urging the use of a constellation of features to reach a more confident diagnosis. While ABI has been traditionally categorized based on the etiology with a wide spectrum of imaging findings overlapped with each other, the final decision for patient’s management is usually made on the stage of the ABI with respect to the underlying pathophysiology. In this review, we first discuss the pathologic stages of ischemia and then summarize the various imaging signs and causes of ABI. We also emphasize on the correlation of imaging findings and pathological staging of the disease. Finally, a management approach is proposed using combined clinical and radiological findings to determine whether the patient may benefit from surgery or not.

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Unilateral mydriasis in a child with a ventriculoperitoneal shunt for obstructive hydrocephalus: a diagnostic dilemma

BMJ Case Reports ◽

10.1136/bcr-2020-237257 ◽

2020 ◽

Vol 13 (12) ◽

pp. e237257

Author(s):

Monidipa Banerjee ◽

Eiman Haj Ahmed ◽

Kathryn Foster ◽

Arundoss Gangadharan

Keyword(s):

Ipratropium Bromide ◽

Obstructive Hydrocephalus ◽

Sudden Onset ◽

Unique Case ◽

Diagnostic Dilemma ◽

Vp Shunt ◽

Life Threatening ◽

Unilateral Mydriasis ◽

The Brain ◽

Rule Out

There are several causes for sudden onset unilateral mydriasis, however impending transtentorial uncal herniation needs to be ruled out. This unique case highlights an uncommon adverse response to a common mode of treatment that leads to a diagnostic dilemma. A 3-year-old boy with a ventriculoperitoneal (VP) shunt for an obstructive hydrocephalus presented with an acute respiratory distress. He developed unilateral mydriasis with absent light reflex during treatment with nebulisers. An urgent CT scan of the brain did not show any new intracranial abnormality. A case of pharmacological anisocoria was diagnosed that resolved completely within 24 hours of discontinuation of ipratropium bromide. Although ipratropium-induced anisocoria has been reported in children, but to our knowledge none in a child with VP shunt for hydrocephalus. This emphasises the urgency in evaluating unilateral mydriasis to rule out life-threatening conditions. Clinicians should remember that ipratropium administered through ill-fitting face masks could cause this completely reversible adverse effect.

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Polymeric Nanocarriers: A Transformation in Doxorubicin Therapies

Materials ◽

10.3390/ma14092135 ◽

2021 ◽

Vol 14 (9) ◽

pp. 2135

Author(s):

Kamila Butowska ◽

Anna Woziwodzka ◽

Agnieszka Borowik ◽

Jacek Piosik

Keyword(s):

Drug Delivery ◽

Wide Spectrum ◽

Stimuli Responsive ◽

First Line ◽

Medical Expenses ◽

Polymeric Nanocarriers ◽

Essential Properties ◽

Life Threatening ◽

History Of ◽

Cancerous Cells

Doxorubicin, a member of the anthracycline family, is a common anticancer agent often used as a first line treatment for the wide spectrum of cancers. Doxorubicin-based chemotherapy, although effective, is associated with serious side effects, such as irreversible cardiotoxicity or nephrotoxicity. Those often life-threatening adverse risks, responsible for the elongation of the patients’ recuperation period and increasing medical expenses, have prompted the need for creating novel and safer drug delivery systems. Among many proposed concepts, polymeric nanocarriers are shown to be a promising approach, allowing for controlled and selective drug delivery, simultaneously enhancing its activity towards cancerous cells and reducing toxic effects on healthy tissues. This article is a chronological examination of the history of the work progress on polymeric nanostructures, designed as efficient doxorubicin nanocarriers, with the emphasis on the main achievements of 2010–2020. Numerous publications have been reviewed to provide an essential summation of the nanopolymer types and their essential properties, mechanisms towards efficient drug delivery, as well as active targeting stimuli-responsive strategies that are currently utilized in the doxorubicin transportation field.

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X/XY Chromosome Mosaicism: Turner Syndrome and Other Clinical Conditions

Proceedings of the Latvian Academy of Sciences Section B Natural Exact and Applied Sciences ◽

10.2478/v10046-009-0014-9 ◽

2009 ◽

Vol 63 (1-2) ◽

pp. 1-4

Author(s):

Irena Andriuškevičiūtė ◽

Loreta Šalomskienė ◽

Lina Jurkėnienė ◽

Algimantas Sinkus

Keyword(s):

Turner Syndrome ◽

Y Chromosome ◽

Wide Spectrum ◽

Normal Male ◽

Chromosome Mosaicism ◽

Lymphocyte Cultures ◽

Nosological Entity ◽

The One ◽

Clinical Conditions ◽

Pierre Robin

X/XY Chromosome Mosaicism: Turner Syndrome and Other Clinical Conditions The 45,X/46,XY mosaicism shows a wide spectrum of phenotypes ranging from females with Turner syndrome, male or female pseudohermaphroditism, to appearently normal male development. Chromosome anomalies accompanying Turner syndrome were found in lymphocyte cultures of 236 patients. Chromosomal analysis revealed the karyotype 45,X in 118 (50.0%) patients. X monosomy mosaics or structural rearrangements of the X chromosome was established in 112 (47.5%) patients. The Y chromosome was found in six (2.5%) patients with typical features of Turner syndrome. In five mosaics 45,X/46,XY the proportion of the XY clone ranged from 46% to 76%. In one Turner syndrome patient only 47,XYY cells were found (solely blood culture investigated). In most cases of 45,X/46,XY mosaicism, the cause is considered to be the loss of the Y chromosome because of nondisjunction after normal disomic fertilisation. Five other patients with X/XY chromosome mosaicism showed mixed gonadal dysgenesis (two patients), one male pseudohermafroditism, one male with Pierre Robin syndrome, and one normal male phenotype. In two non Turner syndrome patients nondisjunction of the primary clone 46,XY was obvious and resulted in mosaicism 45,X/46,XY/47,XYY, the one patient contained dicentric Y. The similarities between X/XY Turner syndrome and other nosological entity of females possessing Y chromosome — the Swyer syndrome — are discussed.

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ERBB4 and Multiple MicroRNAs That Target ERBB4 Participate in Pregnancy-Related Cardiomyopathy

Circulation Heart Failure ◽

10.1161/circheartfailure.120.006898 ◽

2021 ◽

Author(s):

Eline Feyen ◽

Melanie Ricke-Hoch ◽

Jens Van fraeyenhove ◽

Zarha Vermeulen ◽

Michaela Scherr ◽

...

Keyword(s):

Fold Increase ◽

Sudden Onset ◽

Left Ventricular ◽

Tyrosine Kinase Receptor ◽

Internal Diameter ◽

Unique Identifier ◽

Myocardial Apoptosis ◽

Life Threatening ◽

Apoptosis And Inflammation ◽

Endothelial Growth Factor

Background: Peripartum cardiomyopathy (PPCM) is a life-threatening disease in women without previously known cardiovascular disease. It is characterized by a sudden onset of heart failure before or after delivery. Previous studies revealed that the generation of a 16-kDa PRL (prolactin) metabolite, the subsequent upregulation of miR-146a, and the downregulation of the target gene Erbb4 is a common driving factor of PPCM. Methods: miRNA profiling was performed in plasma of PPCM patients (n=33) and postpartum-matched healthy CTRLs (controls; n=36). Elevated miRNAs in PPCM plasma, potentially targeting ERBB4 (erythroblastic leukemia viral oncogene homolog 4), were overexpressed in cardiomyocytes using lentiviral vectors. Next, cardiac function, cardiac morphology, and PPCM phenotype were investigated after recurrent pregnancies of HZ (heterozygous) cardiomyocyte-specific Erbb4 mice ( Erbb4 F/+ αMHC-Cre + , n=9) with their age-matched nonpregnant CTRLs (n=9–10). Results: Here, we identify 9 additional highly conserved miRNAs (miR-199a-5p and miR-199a-3p, miR-145a-5p, miR-130a-3p, miR-135a-5p, miR-221-3p, miR-222-3p, miR-23a-3p, and miR19b-3p) that target tyrosine kinase receptor ERBB4 and are over 4-fold upregulated in plasma of PPCM patients at the time of diagnosis. We confirmed that miR-146a, miR-199a-5p, miR-221-3p, miR-222-3p, miR-23a-3p, miR-130a-5p, and miR-135-3p overexpression decreases ERBB4 expression in cardiomyocytes (−29% to −50%; P <0.05). In addition, we demonstrate that genetic cardiomyocyte-specific downregulation of Erbb4 during pregnancy suffices to induce a variant of PPCM in mice, characterized by left ventricular dilatation (postpartum second delivery: left ventricular internal diameter in diastole, +19±7% versus HZ-CTRL; P <0.05), increased atrial natriuretic peptide (ANP) levels (4-fold increase versus HZ-CTRL mice, P <0.001), decreased VEGF (vascular endothelial growth factor) and VE-cadherin levels (−33±17%, P =0.07; −27±20%, P <0.05 versus HZ-CTRL), and histologically enlarged cardiomyocytes (+20±21%, versus HZ-CTRL, P <0.05) but without signs of myocardial apoptosis and inflammation. Conclusions: ERBB4 is essential to protect the maternal heart from peripartum stress. Downregulation of ERBB4 in cardiomyocytes induced by multiple miRNAs in the peripartum period may be crucial in PPCM pathophysiology. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00998556.

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A dangerous pleural effusion

Annals of The Royal College of Surgeons of England ◽

10.1308/147870810x12699662980637 ◽

2010 ◽

Vol 92 (5) ◽

pp. e53-e54 ◽

Cited By ~ 3

Author(s):

Somprakas Basu ◽

Shilpi Bhadani ◽

Vijay K Shukla

Keyword(s):

Rare Complication ◽

Sudden Onset ◽

Biliary Surgery ◽

Biliary Leak ◽

X Ray ◽

Delay In Diagnosis ◽

Aged Woman ◽

Middle Aged Woman ◽

Life Threatening ◽

Chest X Ray

Bilothorax is a rare complication of biliary peritonitis and, if not treated promptly, can be life-threatening. We report a case of a middle-aged woman who had undergone a bilio-enteric bypass and subsequently a biliary leak developed, which finally led to intra-abdominal biliary collection and spontaneous bilothorax. The clinical course was rapid and mimicked venous thromboembolism, myocardial infarction and pulmonary oedema, which led to a delay in diagnosis and management and finally death. We high-light the fact that bilothorax, although a rare complication of biliary surgery, should always be considered as a probable cause of massive effusion and sudden-onset respiratory and cardiovascular collapse in the postoperative period. A chest X-ray and a diagnostic pleural tap can confirm the diagnosis. Once detected, an aggressive management should be instituted to prevent organ failure and death.

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Chronic granulomatous ‘Aspergillus lung mass’

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2020.1371 ◽

2020 ◽

Vol 90 (3) ◽

Author(s):

Kavitha Venkatnarayan ◽

Uma Devaraj ◽

Uma Maheswari Krishnaswamy ◽

Priya Ramachandran ◽

Sreekar Balasundaram ◽

...

Keyword(s):

Immune Response ◽

Lung Disease ◽

Respiratory Symptoms ◽

Clinical Presentation ◽

Wide Spectrum ◽

Lung Mass ◽

Pulmonary Aspergillosis ◽

Histological Picture ◽

Life Threatening ◽

Disseminated Disease

The diverse clinicopathological spectrum of pulmonary aspergillosis is a consequence of varying levels of invasiveness of this ubiquitous fungus, which largely depends on the host immune response and pre-existing lung disease. The clinical presentation of pulmonary aspergillosis spans a wide spectrum from hypersensitivity to life threatening angio-invasive and disseminated disease. We report the case of a young immunocompetent male with no underlying lung disease, who presented with an incidentally detected ‘infective mass’ lesion in the lung associated with minimal respiratory symptoms. The diagnostic challenges posed by the unusual clinical, radiological and histological picture as well as the therapeutic dilemmas faced are discussed in this report.

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Highly Variable Clinical Pictures in Dogs Naturally Infected with Angiostrongylus vasorum

Pathogens ◽

10.3390/pathogens10111372 ◽

2021 ◽

Vol 10 (11) ◽

pp. 1372

Author(s):

Mariasole Colombo ◽

Donato Traversa ◽

Eleonora Grillotti ◽

Carlo Pezzuto ◽

Cesare De Tommaso ◽

...

Keyword(s):

Southern Italy ◽

Clinical Signs ◽

Sudden Onset ◽

High Variability ◽

Angiostrongylus Vasorum ◽

Coagulation Disorders ◽

Life Threatening ◽

Healthy Dogs ◽

Clinical Pictures ◽

Apparently Healthy

Canine angiostrongylosis by Angiostrongylus vasorum is increasingly reported in both enzootic and previously free areas. The complex pathogenesis of the disease makes the clinical workup challenging. Infected dogs show highly variable clinical pictures, characterized by subclinical to life-threatening general, cardio-respiratory, neurological and/or gastrointestinal signs. The present study reports the high variability of clinical pictures from 36 dogs across central and southern Italy that were naturally infected by A. vasorum. Of them, 23 (63.9%) presented at least one clinical sign, while 13 (36.1%) were subclinically infected and apparently healthy. Overall, 19 dogs (52.8%) showed cardiorespiratory signs, 14 (38.9%) had non-specific abnormalities, 2 (5.6%) presented coagulation disorders and 1 (2.8%) had a severe neurological condition. Importantly, four dogs presenting with clinical signs had neither cough nor dyspnea. These results underline that angiostrongylosis should be included in the differential diagnosis, even when dogs display only non-specific clinical signs. The proportion of apparently healthy dogs highlights the relevance of routine copromicroscopic and/or antigenic tests in enzootic areas to avoid the sudden onset of potentially life-threatening signs.

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Two-faced Janus: the dual role of macrophages in atherosclerotic calcification

Cardiovascular Research ◽

10.1093/cvr/cvab301 ◽

2021 ◽

Author(s):

Olivia J Waring ◽

Nikolaos T Skenteris ◽

Erik A L Biessen ◽

Marjo M P C Donners

Keyword(s):

Current Knowledge ◽

Wide Spectrum ◽

Inflammatory Cells ◽

Cell Types ◽

Macrophage Phenotype ◽

Phenotypic Changes ◽

Direct Exposure ◽

Stable Plaque ◽

Mechanisms Of Development ◽

The One

Abstract Calcification is an independent predictor of atherosclerosis-related cardiovascular events. Microcalcification is linked to inflamed, unstable lesions, in comparison to the fibrotic stable plaque phenotype generally associated with advanced calcification. This paradox relates to recognition that calcification presents in a wide spectrum of manifestations that differentially impact plaque’s fate. Macrophages, the main inflammatory cells in atherosclerotic plaque, have a multifaceted role in disease progression. They crucially control the mineralization process, from microcalcification to the osteoid metaplasia of bone-like tissue. It is a bilateral interaction that weighs heavily on the overall plaque fate but remains rather unexplored. This review highlights current knowledge about macrophage phenotypic changes in relation to and interaction with the calcifying environment. On the one hand, macrophage-led inflammation kickstarts microcalcification through a multitude of interlinked mechanisms, which in turn stimulates phenotypic changes in vascular cell types to drive microcalcification. Macrophages may also modulate the expression/activity of calcification inhibitors and inducers, or eliminate hydroxyapatite nucleation points. Contrarily, direct exposure of macrophages to an early calcifying milieu impacts macrophage phenotype, with repercussions for plaque progression and/or stability. Macrophages surrounding macrocalcification deposits show a more reparative phenotype, modulating extracellular matrix, and expressing osteoclast genes. This phenotypic shift favours gradual displacement of the pro-inflammatory hubs; the lipid necrotic core, by macrocalcification. Parallels to bone metabolism may explain many of these changes to macrophage phenotype, with advanced calcification able to show homeostatic osteoid metaplasia. As the targeted treatment of vascular calcification developing in atherosclerosis is thus far severely lacking, it is crucial to better understand its mechanisms of development.

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