Epicardial Research Articles

Presentation, diagnosis, management and outcome of complicated hydatid cyst of the lung

Introduction: Introduction: The complicated hydatid cyst of the lung is defined as any cyst ruptured in the bronchi tree or in the pleural cavity, infected, and rarely in the pericardial cavity. The aim of this study was to evaluate the problems of complicated pulmonary hydatid cyst, including presentation, diagnosis choice of surgical methods. and complication of delay in surgical treatment of pulmonary hydatid cysts. Methods: Between 2016 and 2021, 192 operations operated for pulmonary hydatid cysts, 42 of these patients were complicated hydatid cyst. Presentations were cough, chest pain and dyspnea.Diagnosis tools were CXR and CT-scan of chest. surgical approach was a posterolateral thoracotomy and anterolateral thoracotomyin all patients; a phrenotomy in eight patients and one-stage bilateral thoracotomy in six patients. Results: In 18 patients (67.5%), there were single hydatid cysts; whereas 4 patients (32.5%) had multiple cysts.12 patients had bilateral cyst and 8 had both lung and liver and others organs, 6 patients had preoperative hydatid cyst history. Iatrogenic rupture of an intact hydatid cyst occurred in 4 patients. Extrathoracic involvement was apparent in 6 patients (27%). Intrathoracic but extrapulmonary involvement was apparent in 4 patients (16%). Conclusion: Complicated hydatid cyst may present with different clinical and radiologically manifestations as a primary lung tumor , pleural effusion ,empyema hydropneumothorax. In patients with suspicious lung masses in endemic area or history of a hydatid cyst in patients a complicated pulmonary hydatid cyst may be in differential diagnosis.

Emerging disinfection byproducts 3-bromine carbazole induces cardiac developmental toxicity via aryl hydrocarbon receptor activation in zebrafish larvae

3-bromine carbazole (3-BCZ) represents a group of emerging aromatic disinfection byproducts (DBP) detected in drinking water; however, limited information is available regarding its potential cardiotoxicity. To assess its impacts, zebrafish embryos were exposed to 0, 0.06, 0.14, 0.29, 0.58, 1.44 or 2.88 mg/L of 3-BCZ for 120 h post fertilization (hpf). Our results revealed that ≥1.44 mg/L 3-BCZ exposure induced a higher incidence of heart malformation and an elevated pericardial area in zebrafish larvae; it also decreased the number of cardiac muscle cells and thins the walls of the ventricle and atrium while increasing cardiac output and impeding cardiac looping. Furthermore, 3-BCZ exposure also exhibited significant effects on the transcriptional levels of genes related to both cardiac development (nkx2.5, vmhc, gata4, tbx5, tbx2b, bmp4, bmp10, and bmp2b) and cardiac function (cacna1ab, cacna1da, atp2a1l, atp1b2b, atp1a3b, and tnnc1a). Notably, N-acetyl-L-cysteine, a reactive oxygen species scavenger, may alleviate the failure of cardiac looping induced by 3-BCZ but not the associated cardiac dysfunction or malformation; conversely, the aryl hydrocarbon receptor agonist CH131229 can completely eliminate the cardiotoxicity caused by 3-BCZ. This study provides new evidence for potential risks associated with ingesting 3-BCZ as well as revealing underlying mechanisms responsible for its cardiotoxic effects on zebrafish embryos.

A survey of ecto and endoparasites of Nile tilapia, Oreochromis niloticus (Linnaeus, 1758) fingerlings in Midmar reservoir, Adwa, northern Ethiopia

ABSTRACT Fishes are hosts to a range of taxonomically diverse parasites. This survey was intended to provide insight into the occurrence, distribution, prevalence, and intensity of parasites infesting the fingerlings of the tilapia, in Tigray. A total of 384 Oreochromis niloticus specimens were collected from Midmar consisting of 227 males and 157 females. External and internal organs were examined for parasite infection. Squash preparation of fish eyes was also examined to reveal the organisms through microscopic examination. The major groups of parasites were trematode, nematodes, protozoa and hirudinea. A total of 3762 genus Diplostomum were recorded affecting the health of 93% of fishes. Contracaecum species was the second most prevalent distributed majorly in the intestine (77.8%), pericardial cavity (19.1%), swim bladder (2.4%), gill (0.2%) and mouth (0.8%). The prevalence and mean intensity of Diplostomum spp., Contracaecum, Myxosporea, Clinostomum spp., Eustrongylides and Leeches was 93%(10.5), 62.2%(5.3), 39.3%(8.3), 2.1%(8.8),1.8%(5.7) and 1.6% (2.5), respectively. The mean temperature, dissolved oxygen, conductivity, and pH of the dam were 24.4°C, 7.55 mg/l, 849.5µs/cm, and 7.5, respectively. Therefore, responsible bodies in fisheries should perform a pre-stock assessment and provide fish farming extension services for optimum production and marketing of fish products with management and production enhancement methods.

Assessing the efficacy of simulation-based education for paramedics in extended focused assessment with sonography for trauma under physician guidance

We investigated the effectiveness of simulation-based education in Focused Assessment with Sonography for Trauma (FAST) to increase the number of Emergency Medical Technicians (EMTs) capable of performing ultrasound examinations in vehicles under the guidance of a physician. Twenty-eight paramedics watched a 14-min video on the features of the ultrasound system, its use, and the scanning method for each part of the body. Each participant performed four FAST examinations using a portable ultrasound device, and the task performance was rated using the Task Specific Checklist (TSC) and Global Rating Scale (GRS). The time required for visualizing each examination site and each FAST was assessed. The mean time required for the first and fourth FAST was 144.6 ± 52.4 s and 90.5 ± 31.0 s, respectively. The time required for each test significantly decreased with repeated testing (p < 0.001). The time to complete FAST was significantly shortened for the pericardial cavity (33.4 ± 23.1/15.3 ± 10.6 s, p < 0.01), right thoracic cavity (25.2 ± 11.8/12.1 ± 8.3 s, p < 0.01), Morrison fossa (19.1 ± 10.8/10.8 ± 6.3 s, p < 0.05), and left thoracic cavity (19.0 ± 8.3/15.6 ± 8.3 s, p < 0.05). TSC and GRS scores were elevated, and all EMTs could obtain valid images. The combination of a brief video lecture and hands-on training significantly reduced the time required for FAST performance. Moreover, repeated practice enabled the EMTs to efficiently obtain accurate and clinically useful images.

A Rare Case of Left Ventricle Free Wall Rupture at two sites Secondary to Myocardial Infarction: An Autopsy Case

Background: About 40–50% of occurrences of sudden death are due to cardiovascular reasons, with acute myocardial infarction (AMI) being the most common cause. Case Details: The subject was 57 years male having alleged history of sudden fell down at his house and was unresponsive since then. He was brought to the Emergency Department of H.N.B Base hospital Srinagar, Garhwal, Uttarakhand. Autopsy Findings: On opening pericardium, 190 grams of clotted blood was present in the pericardial cavity. Grossly enlarged heart. Weight of heart: 560 grams. Epicardial fat covers approx. 2/3rd of the heart’s surface. It is present over the right ventricle especially along the right border, anterior surface and at the apex and along the distribution of coronary arteries. Discussion: A myocardial rupture is the rupturing of one or more heart valves, the papillary muscles or chordae tendineae, the interatrial or interventricular septum, or the ventricles or atria of the heart.

Chylopericardium following esophagectomy: a case report and systematic review

BackgroundChylopericardium is a rare condition characterized by the accumulation of chyle in the pericardial space. It is most commonly caused by thoracic duct injury. Chylopericardium following esophagectomy is extremely rare but can cause life-threatening complications. This report presents a case of chylopericardium post-esophagectomy, resulting in cardiac tamponade and cardiac arrest. A systematic literature review was also conducted to facilitate the understanding of this rare condition.Case presentationA 41-year-old male was admitted to our hospital with intermediate to highly differentiated squamous cell carcinoma of the mid-thoracic esophagus (clinical T4NxM0). He underwent thoracoscopic-laparoscopic esophagectomy with cervical anastomosis. On postoperative day 1, patient had a cardiac arrest secondary to cardiac tamponade, requiring emergency ultrasound-guided drainage. The drained fluid was initially serous but became chylous after the administration of enteral nutritional emulsion. As a result of significant daily pericardial drainage, patient subsequently underwent thoracic duct ligation. The amount of drainage was substantially reduced post-thoracic duct ligation. Over a period of 2 years and 7 months, patient recovered well and tolerated full oral diet. A comprehensive literature review was conducted and 4 reported cases were identified. Among these cases, three patients developed pericardial tamponade secondary to chylopericardium post-esophagectomy.ConclusionChylopericardium is a rare but serious complication post-esophagectomy. Prompt echocardiography and thorough pericardial fluid analysis are crucial for diagnosis. Thoracic duct ligation has been shown to be an effective management approach for this condition.

A case report on ultrasound-guided pericardiocentesis with a right parasternal approach: a novel in-plane lateral-to-medial technique

IntroductionEmergency pericardiocentesis is a life-saving procedure that is performed to aspirate fluid from the pericardial space in patients who have severe pericardial effusion that is causing hemodynamic compromise. The current gold standard for pericardial fluid aspiration is ultrasound-guided pericardiocentesis. Echocardiography with a low-frequency transducer has generally been used in pericardiocentesis, but this method lacks real-time visualization of the needle trajectory, leading to complications. Therefore, we describe a case involving an ultrasound-guided pericardiocentesis method using a novel in-plane technique with a lateral-to-medial approach via the right parasternal and a high-frequency probe. The method was performed for an infant with cardiac tamponade.Case presentationWe present a case of a 14-month-old male infant who was brought to the emergency room with a history of cough, shortness of breath, and fever following recurrent chest infections. Despite prior treatments, his condition deteriorated, and signs of cardiac tamponade were evident upon examination. Cardiopulmonary point-of-care ultrasound confirmed the presence of a large pericardial effusion with tamponade. Emergency pericardiocentesis was performed using the novel in-plane technique, resulting in successful fluid aspiration and stabilization of the patient’s condition.Technique descriptionThe proposed technique involves positioning a high-frequency ultrasound probe over the right parasternal area to obtain real-time visualization of the needle trajectory and surrounding structures, including the sternum, right internal thoracic vessels, pleural sliding end point, pericardial effusion, and myocardium. The needle is inserted laterally to medially at a 45-degree angle, ensuring safe passage between the pleural sliding endpoint and the right internal thoracic vessels while reaching the pericardial effusion.ConclusionThe presented technique provides real-time visualization of the needle and surrounding structures, which may potentially help to avoid complications and improve accuracy. The proposed technique may potentially enable access for emergency pericardiocentesis and for loculated pericardial effusion that has formed around the right atrium. Nevertheless, further studies with large patient populations are needed.

Recipient Pericardial Apolipoprotein Levels Might Be an Indicator of Worse Outcomes after Orthotopic Heart Transplantation.

End-stage heart failure (ESHF) leads to hypoperfusion and edema formation throughout the body and is accompanied by neurohormonal and immunological alterations. Orthotopic heart transplantation (HTX) has been used as a beneficial option for ESHF. Due to the shortage of donor hearts, the ideal matching and timing of donors and recipients has become more important. In this study, our aim was to explore the relationship between the clinical outcomes of HTX and the cytokine and apolipoprotein profiles of the recipient pericardial fluid obtained at heart transplantation after opening the pericardial sac. The clinical data and the interleukin, adipokine, and lipoprotein levels in the pericardial fluid of twenty HTX recipients were investigated. Outcome variables included primer graft dysfunction (PGD), the need for post-transplantation mechanical cardiac support (MCS), International Society for Heart and Lung Transplantation grade ≥2R rejection, and mortality. Recipient risk scores were also investigated. Leptin levels were significantly lower in patients with PGD than in those without PGD (median: 6.36 (IQR: 5.55-6.62) versus 7.54 (IQR = 6.71-10.44); p = 0.029). Higher ApoCII levels (median: 14.91 (IQR: 11.55-21.30) versus 10.31 (IQR = 10.02-13.07); p = 0.042) and ApoCIII levels (median: 60.32 (IQR: 43.00-81.66) versus 22.84 (IQR = 15.84-33.39); p = 0.005) were found in patients (n = 5) who died in the first 5 years after HTX. In patients who exhibited rejection (n = 4) in the first month after transplantation, the levels of adiponectin (median: 74.48 (IQR: 35.51-131.70) versus 29.96 (IQR: 19.86-42.28); p = 0.039), ApoCII (median: 20.11 (IQR: 13.06-23.54) versus 10.32 (IQR: 10.02-12.84); p = 0.007), and ApoCIII (median: 70.97 (IQR: 34.72-82.22) versus 26.33 (IQR: 17.18-40.17); p = 0.029) were higher than in the nonrejection group. Moreover, the pericardial thyroxine (T4) levels (median: 3.96 (IQR: 3.49-4.46) versus 4.69 (IQR: 4.23-5.77); p = 0.022) were lower in patients with rejection than in patients who did not develop rejection. Our results indicate that apolipoproteins can facilitate the monitoring of rejection and could be a useful tool in the forecasting of early and late complications.

Genotypic characterization of Escherichia coli isolated from infected chicken in Basrah, Iraq

This study aimed to detect the presence of Escherichia coli in broiler and layer hens in the Basrah province, Iraq using macroscopic and microscopic diagnosis and bacterial isolation that causes infection insome internal organs (liver and heart), and by polymerase chain reaction. Randomly chosen samples were taken from different places within Basrah province for further investigation (poultry fields in Al-Qurnah and Al-Hartha). The bacteriological analysis revealed that the presence of Escherichia coli is responsible for causing fibrinous pericarditis and perihepatitis in birds. The macroscopic examination revealed hemorrhagic lesions and a significant buildup consisting of a white fibrous accumulation in the pericardial sac of the infected birds' hearts. The livers of infected birds exhibited significant deposition of white fibrous exudate on the liver surface, along with hepatomegaly. The afflicted heart displays a microscopic appearance marked by a notable aggregation of inflammatory cells in the pericardial sac and the release of fibrinous exudate. Additionally, there is an accumulation of edematous exudate in the cardiac muscle fibers, accompanied with congestion of blood vessels in the myocardium. The microscopic examination of the infected liver revealed the existence of a significant infiltration of inflammatory cells in the liver capsule, as well as the presence of a thick fibrinous exudate encapsulated on the liver surface and congestion of the central vein. The histological analysis of the affected heart and liver revealed a significant buildup of collagen and fibrin fibers, which exhibit a prominent dark bluish staining. This buildup is widely distinguished in the pericardial and hepatic capsules. The study indicated that fibrinous pericarditis and perihepatitis affected birds, as indicated by the examination of bacterial results. Escherichia coli emits endotoxins that induce vascular damage in the heart and liver, resulting in an elevated presence of fibrin exudate around the affected tissue. The histological analysis supported this conclusion. Keywords: Fibrinous, Pericarditis, Perihepatitis, Pathology, Biological.

Functional features of the myocardium in school-age children with chronic somatic pathology according to echocardiographic examination

The peculiarity of the modern pathology of childhood is the increasing frequency of transition of acute forms of diseases into recurrent and chronic ones and increasing primary chronic pathology. Systematic loads on «endurance» during training determine the necessity to study the possibilities of heart remodelling in school-age children against the background of chronic somatic pathology. Objective: to reveal structural and functional changes of myocardium in schoolchildren with chronic somatic pathology according to echocardiogram examination data. Materials and methods. We analysed 32 echocardiogram results in children aged from 7 to 17 years. The main group (n=16) - children with chronic somatic pathology out of exacerbation, control group (n=16) - children of the 2nd health group. Distribution of chronic somatic pathology in the main group: CNS diseases (n=4), kidney and urinary tract (n=5), GI (n=2), glands of internal secretion (n=3), vascular malformations (n=2). All children underwent echocardiogram examination with analysis of left ventricular ejection fraction systolic and diastolic myocardial function, left ventricular end-diastolic dimension, myocardial wall thickness, valve apparatus, presence/absence of physiological transudate in the pericardial cavity, and presence of small anomalies of cardiac development. Clinical and anamnestic data of the subjects, echocardiogram method and conventional statistical processing of the obtained results using STATISTICA for Windows software system were used to achieve the set goal and solve the research tasks. Results of the study. In the main group left ventricular ejection fraction was 61,8±1,57%, in the control group - 68,25±1,86% (p≤0,05). Left ventricular end-diastolic dimension was normal in both groups (p≥0.05). Concentric myocardial remodelling and increased myocardial wall thickness were found only in the main group in 18.8% (n=3) and 37.5% (n=6) of cases, respectively (p≤0.05). Valve pathology in the main and control groups was 43.8% (n=7) and 18.8% (n=3) of cases. Physiological transudate in the pericardial cavity was noted equally in both groups in 12.5% of cases. Small anomalies of cardiac development were detected in the main and control groups in 31.3% (n=5) and 18.8% (n=2) cases, respectively. Conclusion. Low values of left ventricular ejection fraction and increased myocardial wall thickness indicate a decrease in left ventricular function of the heart and a negative impact of metabolic disorders in children with chronic somatic pathology.

Intra-cardiac motion detection catheter for the early identification of acute pericardial tamponade during invasive cardiac procedures.

To develop and test an intra-cardiac catheter fitted with accelerometers to detect acute pericardial effusion prior to the onset of hemodynamic compromise. Early detection of an evolving pericardial effusion is critical in ensuring timely treatment. We hypothesized that the reduction in movement of the lateral heart border present in developing pericardial effusions could be quantified by positioning an accelerometer in a lateral cardiac structure. A "motion detection" catheter was created by implanting a 3-axis accelerometer at the distal tip of a cardiac catheter. The pericardial space of 5 adult sheep was percutaneously accessed, and pericardial tamponade was created by infusion of normal saline. The motion detection catheter was positioned in the coronary sinus. Intracardiac echocardiography was used to confirm successful creation of pericardial effusion and hemodynamic parameters were collected. Statistically significant reduction in acceleration from baseline was detected after infusion of only 40 ml of normal saline (p < 0.05, ANOVA). In comparison, clinically significant change in systolic blood pressure (defined as >10% drop in baseline systolic blood pressure) occurred after infusion of 80 ml of normal saline (107 ± 22 mmHg vs. 90 ± 12 mmHg p = 0.97, ANOVA), and statistically significant change was recorded only after infusion of 200 ml (107 ± 22 mmHg vs. 64 ± 5 mmHg, p < 0.05, ANOVA). An intra-cardiac motion detection catheter is highly sensitive in identifying acute cardiac tamponade prior to clinically and statistically significant changes in systolic blood pressure, allowing for early detection and treatment of this potentially life-threatening complication of all modern percutaneous cardiac interventions.

Comparison of cardiotoxicity induced by alectinib, apatinib, lenvatinib and anlotinib in zebrafish embryos

Four tyrosine kinase inhibitors, alectinib, apatinib, lenvatinib and anlotinib, have been shown to be effective in the treatment of clinical tumors, but their cardiac risks have also raised concerns. In this study, zebrafish embryos at 6 h post fertilization (hpf) were exposed to the four drugs at concentrations of 0.05–0.2 mg/L until 72 hpf, and then the development of these embryos was quantified, including heart rate, body length, yolk sac area, pericardial area, distance between venous sinus and balloon arteriosus (SV-BA), separation of cardiac myocytes and endocardium, gene expression, vascular development and oxidative stress. At the same exposure concentrations, alectinib and apatinib had little effect on the cardiac development of zebrafish embryos, while lenvatinib and anlotinib could induce significant cardiotoxicity and developmental toxicity, including shortened of body length, delayed absorption of yolk sac, pericardial edema, prolonged SV-BA distance, separation of cardiomyocytes and endocardial cells, and downregulation of key genes for heart development. Heart rate decreased in all four drug treatment groups. In terms of vascular development, alectinib and apatinib did not inhibit the growth of embryonic intersegmental vessels (ISVs) and retinal vessels, while lenvatinib and anlotinib caused serious vascular toxicity, and the inhibition of anlotinib in vascular development was more obvious. Besides, the level of reactive oxygen species (ROS) in the lenvatinib and anlotinib treatment groups was significantly increased. Our results provide reference for comparing the cardiotoxicity of the four drugs.

Toxic effects of the insecticide tolfenpyrad on zebrafish embryos: Cardiac toxicity and mitochondrial damage.

Tolfenpyrad, a highly effective and broad-spectrum insecticide and acaricide extensively utilized in agriculture, presents a potential hazard to nontarget organisms. This study was designed to explore the toxic mechanisms of tolfenpyrad on zebrafish embryos. Between 24 and 96 h after exposure of the fertilized embryos to tolfenpyrad at concentrations ranging from 0.001 to 0.016 mg/L (96 h-LC50 = 0.017 mg/L), lethal effects were apparent, accompanied with notable anomalies including pericardial edema, increased pericardial area, diminished heart rate, and an elongated distance between the venous sinus and the arterial bulb. Tolfenpyrad elicited noteworthy alterations in the expression of genes pertinent to cardiac development and apoptosis, with the most pronounced changes observed in the cardiac development-related genes of bone morphogenetic protein 2b (bmp2b) and p53 upregulated modulator of apoptosis (puma). The findings underscore that tolfenpyrad induces severe cardiac toxicity and mitochondrial damage in zebrafish embryos. This data is imperative for a comprehensive assessment of tolfenpyrad risks to aquatic ecosystems, particularly considering the limited knowledge regarding its detrimental impact on aquatic vertebrates.

Pericardial effusion in children at tertiary national referral hospital, Addis Ababa, Ethiopia: a 7-year institution based review

BackgroundPericardial effusion (PE) is a rare yet an important cause of child mortality due to collection of excess fluid in pericardial space. The study aimed to describe the PE profile in the national cardiac referral hospital, Addis Ababa, Ethiopia.MethodsThe study employed cross-sectional study design for a 7-year review of childhood PE in Tikur Anbessa Specialized Hospital. Descriptive and analytic statistics were applied.ResultsThere were 17,386 pediatric emergency/ER admissions during the study period, and PE contributed to 0.47% of ER admissions. From 71 included subjects, 59% (42) were males with mean age of 7.8 ± 3.3 years. Cough or shortness of breath,73.2% (52) and fever or fast breathing, 26.7% (19), were the common presenting symptoms. The median duration of an illness before presentation was 14days (IQR: 8–20). The etiologies for pericardial effusion were infective (culture positive–23.9%, culture negative–43.6%, tuberculous-4.2%), hypothyroidism (4.2%), inflammatory (12.7%), malignancy (7%) or secondary to chronic kidney disease (1. 4%). Staphylococcus aureus was the most common isolated bacteria on blood culture, 12.7% (9) while the rest were pseudomonas, 7% (5) and klebsiella, 4.2% (3). Mild, moderate and severe pericardial effusion was documented in 22.5% (16), 46.5% (33), and 31% (22) of study subjects, respectively. Pericardial tamponade was reported in 50.7% (36) of subjects. Pericardial drainage procedure (pericardiocentesis, window or pericardiotomy) was performed for 52.1% (37) PE cases. The case fatality of PE was 12.7% (9). Pericardial drainage procedure was inversely related to mortality, adjusted odds ratio 0.11(0.01–0.99), p 0.049).ConclusionPE contributed to 0.47% of ER admissions. The commonest PE presentation was respiratory symptoms of around two weeks duration. Purulent pericarditis of staphylococcal etiology was the commonest cause of PE and the case fatality rate was 12.7%. Pericardial drainage procedures contributed to reduction in mortality. All PE cases should be assessed for pericardial drainage procedure to avoid mortality.

Delivery of liquid metal particles and tanshinone IIA into the pericardial cavity for myocardial infarction treatment.

Owing to their inherent flexibility and excellent biocompatibility, liquid metals (LMs) have been explored at the frontiers of clinical therapy. Herein, a LM and tanshinone IIA (TA) drugs were dispersed into sodium alginate (SA) solution by ultrasonication to prepare SA/LM/TA, which is an injectable biomaterial for stable drug release and intrapericardial injection for the treatment of myocardial infarction (MI). The SA/LM/TA has a low viscosity and can be injected smoothly using a syringe. In rat models of MI, we demonstrated that SA/LM/TA injection in the pericardial cavity is a biosafe and effective method to deliver a carrier containing LM particles and TA drugs for MI treatment. After injection, the drug release is slow and stable in the pericardial cavity, increasing the cardiac retention of drugs. After surgery and treatment for 7 days, the cardiac function of rats improved compared with the control group and the TA direct injection group. The intrapericardial injection of SA/LM/TA improves cardiac functions and mitigates cardiac remodeling post myocardial infarction of rats. Overall, the present study establishes a therapeutic strategy for treatment of myocardial infarction by intrapericardial injection of SA/LM/TA and expands the application categories of LM biomaterials in disease treatments.

Isolation and molecular characterization of fowl adenovirus from inclusion body hepatitis cases in Western India during 2019-2021.

Inclusion body hepatitis (IBH) resulted in a substantial economic loss in Western India during 2019 to 2021. The study aimed to characterize fowl adenovirus (FAdV) from field outbreaks. The study was conducted on 290 liver samples from 66 poultry flocks. The samples were subjected to histopathology and molecular detection, followed by phylogenetic typing of the partial hexon gene of the virus. Spiking mortality (14%) was recorded from day 21 to day 35 with peak mortality at the 28th day of age. The necropsy showed a pale and enlarged liver with hemorrhagic and yellowish necrotic foci, accumulation of straw-colored transudate in the pericardial sac which resulted in a flabby appearance of the heart, heart enlargement, and hemorrhages on the spleen, enlarged and congested kidneys. The virus inoculation resulted in stunting and poor feathering with hepatomegaly, hemorrhages and yellowish necrotic foci on the liver as well as greenish discoloration, and kidney swelling in SPF embryonated chicken eggs. Out of 29, 16 liver samples yielded 1219 bp amplicons specific to hexon gene fragments. The sequence and phylogenetic analysis identified 14 isolates as FAdV species E serotype 11 and two as species D serotype 8b. Conclusion: The results indicated that FAdV-8b and FAdV-11 strains are involved in disease outbreaks in western India.

Pericardial Effusion

Background: Pericardial effusion is defined as the accumulation of fluid in the pericardial sac, this can lead to life-threatening cardiac complications if not promptly diagnosed and managed effectively. This radiographic case study aims to demonstrate the crucial role of imaging techniques in diagnosing pericardial effusion, providing valuable insights into its characteristics, and guiding appropriate clinical interventions.&#x0D; Methods: This is a case study of a 37yr old patient with suspected cardiac failure who underwent diagnostic imaging, including chest X-rays and echocardiography. The imaging findings were analyzed to assess the extent and severity of the disease and to help in the treatment decisions.&#x0D; Results: The radiographic evaluation revealed a moderate pericardial effusion with characteristic findings on chest X-rays and echocardiography. The size, location, and hemodynamic impact of the effusion were assessed, informing the clinical team's decision to proceed with pericardiocentesis for therapeutic relief.&#x0D; Conclusion: This case study underscores the pivotal role of radiographic imaging, particularly echocardiography and chest X-rays, in diagnosing and characterizing pericardial effusion. Timely and accurate diagnosis is essential for appropriate management and the prevention of life-threatening complications. Radiographic imaging serves as an indispensable tool in guiding clinical decisions and improving patient outcomes.

Aneurisma biventricular em um cão

ABSTRACT: An aneurysm is defined as a localized dilation of a blood vessel or heart. It may have either a congenital or an acquired origin and occurs in both humans and animals. Cardiac aneurysms are rare, and are characterized by sacculations of the cardiac wall. The present case report describes the macroscopic and microscopic findings of an aneurysm affecting both ventricles of the heart in a dog. A 7-year-old mixed-breed female dog with osteosarcoma on the left pelvic limb was euthanized and submitted to the veterinary pathology laboratory for necropsy. Macroscopically, besides the lesions in the link, the pericardial sac was adhered to the pericardial surface of the heart and there were two sacculations in both ventricles which communicated widely with the respective ventricle. Microscopically, fibrous tissue adhered to the pericardium, atrophy and necrosis of the cardiomyocytes with replacement by adipocytes were observed in addition to hyperplasia of the tunica media of arterioles and thrombosis. A diagnosis of acquired biventricular cardiac aneurysm was made based on the necropsy findings and microscopic lesions in the heart. We emphasize the importance of performing a necropsy and examining tissues histologically for the diagnosis of this rare condition. Ventricular aneurysms should be included in the differential diagnosis of cardiovascular disease in dogs.

A Study on Variations in Size and Shape of Left Atrial Appendage from Formalin-fixed Cadavers

Introduction: Atrial appendages were once considered vestigial structures with no significant role in atrial function. However, they are now recognized as significantly impacting various pathophysiological conditions, including cardiac thromboembolism and arrhythmias. The left atrial appendage (LAA), in particular, has been found to have significant variations in shape and size, and its relationship with nearby structures, such as the pulmonary veins (PVs), is crucial in planning interventional and surgical procedures in and around the LAA. Although most studies examining variations in the LAA are image-based, few have focused on anatomical studies. Materials and Methods: In this study, we examined heart specimens from 54 cadavers for anatomical dissection at a tertiary care teaching hospital. After removing the heart from the pericardial cavity, we opened the left atrium and examined its interior. Observations were made regarding the LAA orifice and PV orifices, and measurements were taken. Subsequently, we removed the LAA along with a portion of the left atrial wall, observed its shape and number of lobes, and took measurements. To classify the shape, we used a system proposed by Wang et al. based on resemblance to familiar objects. Categorical variables were expressed as percentages and continuous as mean and standard deviation. The institutional research committee and the institutional ethics committee approved the study. Results: The most common shape variant observed was the Chicken Wing type, followed closely by the Windsock type. Specimens with Cauliflower or Cactus morphology were rare, with the Cactus variant being the least common. The LAA orifice was round or oval shaped in most cases. In most cases, the LAA orifice was at the same or lower level as the left superior PV orifice, with a prominent ridge between the two orifices in most patients. We observed most of the appendages to be trilobed, with considerable variations in length and diameter. We found two specimens with unusual morphologies but no specimens with accessory appendages. Conclusions: Based on our study, there are significant differences in findings compared to some of the previous studies reporting the shape variations of LAA. However, our findings are matching with those of some other earlier studies. The variations in the shape and size of LAA orifices and their relationship to PV orifices are similar to those reported in earlier studies. The distribution of variations in the size of LAA was also similar to those reported in earlier studies. Conducting larger studies to explore these variations could aid in designing and developing therapeutic interventions in the LAA.

Epidemiological characteristics, etiological spectrum, and outcomes of adult patients with pericardial effusion at a Teaching Hospital in Somalia.

Pericardial effusion (PE) is an abnormal fluid volume in the pericardial space and is a common clinical entity. The incidence of PE is estimated diversely and depends on risk factors, etiologies, and geographic locations. This study aimed to assess the clinical characteristics, etiologic spectrum, echocardiographic features, and outcomes among patients with different types of PE. This retrospective observational study included 93 patients with confirmed PE. Their medical records were reviewed in the hospital information system of Mogadishu Somali Turkish Training and Research Hospital between April 2022 and September 2022. Patient demographics, clinical characteristics, chest X-rays, echocardiography, laboratory findings, management approaches, and outcome reports were reviewed and recorded. Out of the 3000 participants, 3.1% (n = 93/3000) met the definition of definitive PE. In this study, we included 51 females and 42 males. Among the patients, 86% (n = 80) had at least one comorbidity, with diabetes (38.7%) and hypertension (37.6%) being the most common. The most frequently reported clinical presentation findings were shortness of breath (67.7%), chest pain (49.4%), cough (47.3%), and palpitations (47.3%). Cardiac tamponade developed in 9.7% (n = 9) of the patients. Pericardial taps were performed in 64.5% of the cases. Our analysis showed that the most common cause of PE was cardiac disease (n = 33, 35.4%), followed by tuberculosis (TB) (n = 25, 26.8%), uremic pericarditis (n = 24, 25.8%), and hypothyroidism (n = 10, 10.7%). Regarding the severity of PE based on echocardiographic findings, nearly half of the patients (n = 46, 49.4%) had mild PE, whereas 26.8% (n = 25) had moderate PE, and 23.6% (n = 22) had severe PE. Two-thirds of the cases (66.6%) were managed with furosemide, 48 (51.6%) patients were treated with an anti-inflammatory, hemodialysis was performed in 24 (25.8%) patients and antituberculous medications were administered to 7 (7.5%) patients. Out of the 93 patients, 24 (25.8%) died during the hospital stay. It was determined that the mortality risk of patients with renal failure was 7.518 times higher than those without (p = 0.004), and the risk for those with TB was 5.554 times higher than those without (p = 0.011). Other variables were not influential on mortality (p > 0.050). Our study results demonstrate the epidemiological profile of PE in Somalia. The leading causes of PE were cardiac diseases, uremic pericarditis, TB, and hypothyroidism. PE is a significant cause of morbidity and mortality in Somalia, especially in individuals with renal failure and TB infection.