Strongyloides papillosus causes sudden death in weaned calves on New York dairies

CASE DESCRIPTION Outbreaks of sudden death in apparently healthy weaned dairy calves due to Strongyloides papillosus parasitism were diagnosed on 2 separate and independent New York (NY) dairies. CLINICAL FINDINGS Most calves were found dead; however, 1 calf observed while dying showed signs of tachycardia, tachypnea, vocalization, and convulsions shortly before death. In 6 affected heifers that underwent post-mortem examination, precocious bilaterally symmetric mammary gland enlargement was seen. A portion of their parasitized living cohorts also demonstrated similar mammary gland enlargement. A diagnosis of S papillosus hyperinfection was made based upon the presence of high numbers of S papillosus ova in feces, and confirmation by S papillosus–specific PCR assays. Consistent histopathological findings in affected calves included generalized mammary gland vascular congestion, interstitial edema and hemorrhage with ductal hyperplasia. Mild multifocal cardiomyocyte degeneration was found in 5 of 14 calves examined. Factors believed to contribute to the parasite’s environmental amplification and host hyperinfection included group housing on wood shavings and high environmental temperatures and humidity. TREATMENT AND OUTCOME Treatment of calves with doramectin pour-on stopped mortality and resolved the udder enlargement. CLINICAL RELEVANCE Similar outbreaks have previously been described in Japan and South Bohemia (Czech Republic), where researchers hypothesized that sudden death may be due to fatal arrhythmia caused by a parasite-associated cardiotoxin. This report highlights the importance of including S papillosus among the differential diagnoses for sudden death alone or together with precocious udder enlargement in calves kept in confinement housing.

P-EGS26 Outcomes of Surgical Treatment for Perforated Peptic Ulcer in a non-Upper Gastrointestinal Surgery Centre

Background Perforated peptic ulcer (PPU) remains a common surgical emergency worldwide requiring surgical intervention. Although commonly performed, morbidity and mortality rate remained high. This study aimed to analyze the factors that contribute to the outcome of PPU surgery in a non-upper gastrointestinal surgery center in Malaysia. Methods Data were collected by retrospective review of all PPU surgeries done throughout the year 2020, looking into various preoperative, intraoperative, and postoperative details. Results In this study, we have a total of 24 PPU patients underwent surgery resulted in 7 (29.2%) deaths. Majority of our subjects were elderly (median age 65 years, IQR 48.5 – 73.0) with 4 (16%) being of ASA (American Society of Anesthesiologist) category 3 - 4. The most common cause of death was uncontrolled systemic infection in 4 patients (57.1%), followed by 2 (28.6%) fatal arrhythmia and 1 (14.3%) massive upper gastrointestinal bleed. Our analysis found that size of perforation ≥ 30mm (OR = 0.18, 95%CI 0.08 - 0.44), and postoperative complications (OR = 12.5, 95%CI 1.6 – 97.6) were significantly associated with a higher postoperative death. Low serum albumin level (mean 34.3 ± 9.1g/L), negative base excess level (mean -3.28 ± 4.89), and prolonged interval between admission and commencement of surgery (median 750 mins, IQR 258 – 2218) were all significantly associated with increased mortality post PPU surgeries. Conclusions This study highlighted to us various perioperative factors which could potentially be modifiable thus necessary measures can be taken in the future to ensure a better operative outcome of PPU surgery.

QTc interval in Acute Severe Asthma

Background Prolonged QTc interval in children may be congenital or acquired. It could be fatal if it induces tachyarrhythmias and cardiac arrest. Objectives This work studied the QTc interval in acute asthma attacks and its relation to the severity of the attack and the bronchodilators used. Patients and Methods This is a descriptive prospective study of 30 children with moderate and severe asthma. Patients were divided according to GINA guidelines 2016: Group 1:10 patients with moderate acute attack, Group Il: 20 patients with severe acute attack. 12 lead ECG was done before start of medication, then repeated daily till discharge. QTc interval measured in lead V5 using Bazett Formula was considered prolonged if > 445msec. Results Our study showed that 4 patients (13%) developed prolonged QTc interval; 3 (75%) had severe attack and one (25%) had moderate attack. QTc interval increased with number of bronchodilators used, but not reaching statistical significance. On day2, QTc was 340—435msec in patients on 2 medications and 350—460msec in patients on 3 medications. However, on 3rd day QTc interval was between 348-410msec,346—420msec,350—446msec in patients having 1, 2, 3 medications respectively. Also, there was no relation between theophylline and prolonged QTc interval. Conclusion Prolonged QTc interval can occur in 13% of children with moderate and severe asthma. QTc interval increased with number of bronchodilators used yet not reaching statistical significance. Bronchodilators must be used judiciously since they might be potentially arrhythmogenic drugs that induce fatal arrhythmia .

Hemosiderin, a possible biomarker for sudep?

Epilepsy is one of the neurological diseases of complex etiology that affects around 50 million people worldwide and is characterized by abnormal electrical activity and recurrent seizures. Uncontrolled generalized repetitive tonic-clonic seizures (GTCS) are the main causes of unexpected sudden death in epilepsy (SUDEP). Hypoxic stress induced by seizure results in neurocardiogenic dysfunctions, including iron overload and cardiomyopathy (IOC) which is related to severe lipid peroxidation caused by the production of reactive oxygen species (ROS). ROS induces recurrent seizure activity, favoring the overexpression of P glycoprotein (P-gp) in the heart. P-gp plays a depolarizing role in cardiomyocyte membranes and potassium (Kir) channels control cellular excitability regarding the repolarization of the cardiac action potential. All these events result in a possible appearance of severe bradycardia and fatal arrhythmia. Several studies have sought evidence for different possible biomarkers for potential prediction of the risk of SUDEP avoiding its fatal outcome.

Sudden Cardiac Death Caused by a Fatal Association of Hypertrophic Cardiomyopathy (MYH7, p.Arg719Trp), Heterozygous Familial Hypercholesterolemia (LDLR, p.Gly343Lys) and SARS-CoV-2 B.1.1.7 Infection

Hypertrophic cardiomyopathy (HCM) and heterozygous familial hypercholesterolemia (HeFH), two of the most common genetic cardiovascular disorders, can lead to sudden cardiac death. These conditions could be complicated by concomitant severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection as in the case herein described. A young amateur soccer player died in late October 2020 after a fatal arrhythmia and the autopsy revealed the presence of HCM with diffuse non-obstructive coronary disease. The molecular autopsy revealed a compound condition with a first mutation in the MYH7 gene (p.Arg719Trp) and a second mutation in the LDLR gene (p.Gly343Cys): both have already been described as associated with HCM and HeFH, respectively. In addition, molecular analyses showed the presence of SARS-CoV-2 lineage B.1.1.7 (UK variant with high titer in the myocardium. Co-segregation analysis within the family (n = 19) showed that heterozygous LDLR mutation was maternally inherited, while the heterozygous MYH7 genetic lesion was de novo. All family member carriers of the LDLR mutation (n = 13) had systematic higher LDL plasma concentrations and positive records of cardiac and vascular ischemic events at young age. Considering that HCM mutations are in themselves involved in the predisposition to malignant arrhythmogenicity and HeFH could cause higher risk of cardiac complications in SARS-CoV-2 infection, this case could represent an example of a potential SARS-CoV-2 infection role in triggering or unmasking inherited cardiovascular disease, whose combination might represent the cause of fatal arrhythmia at such a young age. Additionally, it can provide clues in dating the presence of the SARS-CoV-2 lineage B.1.1.7 in Northern Italy in the early phases of the second pandemic wave.

Detection of Ventricular Fibrillation Based on Ballistocardiography by Constructing an Effective Feature Set

Ventricular fibrillation (VF) is a type of fatal arrhythmia that can cause sudden death within minutes. The study of a VF detection algorithm has important clinical significance. This study aimed to develop an algorithm for the automatic detection of VF based on the acquisition of cardiac mechanical activity-related signals, namely ballistocardiography (BCG), by non-contact sensors. BCG signals, including VF, sinus rhythm, and motion artifacts, were collected through electric defibrillation experiments in pigs. Through autocorrelation and S transform, the time-frequency graph with obvious information of cardiac rhythmic activity was obtained, and a feature set of 13 elements was constructed for each 7 s segment after statistical analysis and hierarchical clustering. Then, the random forest classifier was used to classify VF and non-VF, and two paradigms of intra-patient and inter-patient were used to evaluate the performance. The results showed that the sensitivity and specificity were 0.965 and 0.958 under 10-fold cross-validation, and they were 0.947 and 0.946 under leave-one-subject-out cross-validation. In conclusion, the proposed algorithm combining feature extraction and machine learning can effectively detect VF in BCG, laying a foundation for the development of long-term self-cardiac monitoring at home and a VF real-time detection and alarm system.

Diuretic-induced hypokalaemia: an updated review

Diuretic-induced hypokalaemia is a common and potentially life-threatening adverse drug reaction in clinical practice. Previous studies revealed a prevalence of 7%–56% of hypokalaemia in patients taking thiazide diuretics. The clinical manifestations of hypokalaemia due to diuretics are non-specific, varying from asymptomatic to fatal arrhythmia. Diagnosis of hypokalaemia is based on the level of serum potassium. ECG is useful in identifying the more severe consequences. A high dosage of diuretics and concomitant use of other drugs that increase the risk of potassium depletion or cardiac arrhythmias can increase the risk of cardiovascular events and mortality. Thiazide-induced potassium depletion may cause dysglycaemia. The risk of thiazide-induced hypokalaemia is higher in women and in black people. Reducing diuretic dose and potassium supplementation are the most direct and effective therapies for hypokalaemia. Combining with a potassium-sparing diuretic or blocker of the renin–angiotensin system also reduces the risk of hypokalaemia. Lowering salt intake and increasing intake of vegetables and fruits help to reduce blood pressure as well as prevent hypokalaemia.