First report of Enterocytozoon bieneusi in Erinaceus europaeus and Hemiechinus auritus hedgehogs from recovery centers of Portugal.

Enterocytozoon bieneusi microsporidia are emerging pathogens infecting a wide range of vertebrate and invertebrate hosts, known to have zoonotic features since they infect both wild and domestic animals, and humans. Despite their significance, there is very limited epidemiological data on microsporidia in hedgehogs, especially European hedgehogs (Erinaceus europaeus) and long-eared hedgehogs (Hemiechinus auritus), the former known as synantropic hedgehogs, and the latter suited as pets. As such, the present study aimed to assess the presence of E. bieneusi in hedgehogs from Portugal. For this purpose, fecal samples from 110 hedgehogs of three species-E. europaeus (n = 106), H. auritus (n = 1), and Atelerix albiventris (n = 3)-were collected and tested for E. bieneusi by PCR targeting the internal transcribed spacer region and the flanking small and large subunits of the rRNA. We found an overall occurrence of 22.7% (25/110; 95% confidence interval [CI]: 15.28-31.70), with 22.6% (24/106; 95% [CI]: 15.08-31.79) in E. europaeus, 100% (1/1) in H. auritus, and 0% in A. albiventris. Interestingly, three novel genotypes were identified, all belonging to the potentially zoonotic Group 1. Our findings highlight the importance of hedgehogs as potential reservoirs for E. bieneusi and emphasize the need for further research to understand their role in transmission dynamics and assess the associated risks to public and veterinary health.

Synanthropic hedgehogs were tested for Enterocytozoon bieneusi, the main cause of human microsporidiosis. Results showed 22.7% of hedgehogs were shedding E. bieneusi spores, with three new genotypes from the zoonotic Group 1. Hedgehogs may transmit to humans/animals, warranting more research.

Diatoms Reduce Decomposition of and Fungal Abundance on Less Recalcitrant Leaf Litter via Negative Priming.

Heterotrophic microbial decomposers colonize submerged leaf litter in close spatial proximity to periphytic algae that exude labile organic carbon during photosynthesis. These exudates are conjectured to affect microbial decomposers' abundance, resulting in a stimulated (positive priming) or reduced (negative priming) leaf litter decomposition. Yet, the occurrence, direction, and intensity of priming associated with leaf material of differing recalcitrance remains poorly tested. To assess priming, we submerged leaf litter of differing recalcitrance (Alnus glutinosa [alder; less recalcitrant] and Fagus sylvatica [beech; more recalcitrant]) in microcosms and quantified bacterial, fungal, and diatom abundance as well as leaf litter decomposition over 30 days in absence and presence of light. Diatoms did not affect beech decomposition but reduced alder decomposition by 20% and alder-associated fungal abundance by 40% in the treatments including all microbial groups and light, thus showing negative priming. These results suggest that alder-associated heterotrophs acquired energy from diatom exudates rather than from leaf litter. Moreover, it is suggested that these heterotrophs have channeled energy to alternative (reproductive) pathways that may modify energy and nutrient availability for the remaining food web and result in carbon pools protected from decomposition in light-exposed stream sections.

Brewer's Spent Yeast Cell Wall Polysaccharides as Vegan and Clean Label Additives for Mayonnaise Formulation.

Brewer's spent yeast (BSY) mannoproteins have been reported to possess thickening and emulsifying properties. The commercial interest in yeast mannoproteins might be boosted considering the consolidation of their properties supported by structure/function relationships. This work aimed to attest the use of extracted BSY mannoproteins as a clean label and vegan source of ingredients for the replacement of food additives and protein from animal sources. To achieve this, structure/function relationships were performed by isolating polysaccharides with distinct structural features from BSY, either by using alkaline extraction (mild treatment) or subcritical water extraction (SWE) using microwave technology (hard treatment), and assessment of their emulsifying properties. Alkaline extractions solubilized mostly highly branched mannoproteins (N-linked type; 75%) and glycogen (25%), while SWE solubilized mannoproteins with short mannan chains (O-linked type; 55%) and (1→4)- and (ß1→3)-linked glucans, 33 and 12%, respectively. Extracts with high protein content yielded the most stable emulsions obtained by hand shaking, while the extracts composed of short chain mannans and ß-glucans yielded the best emulsions by using ultraturrax stirring. ß-Glucans and O-linked mannoproteins were found to contribute to emulsion stability by preventing Ostwald ripening. When applied in mayonnaise model emulsions, BSY extracts presented higher stability and yet similar texture properties as the reference emulsifiers. When used in a mayonnaise formulation, the BSY extracts were also able to replace egg yolk and modified starch (E1422) at 1/3 of their concentration. This shows that BSY alkali soluble mannoproteins and subcritical water extracted ß-glucans can be used as replacers of animal protein and additives in sauces.

Leaf Species-Dependent Fungicide Effects on the Function and Abundance of Associated Microbial Communities.

Microbially-mediated leaf litter decomposition is a critical ecosystem function in running waters within forested areas, which can be affected by fungicides. However, fungicide effects on leaf litter decomposition have been investigated almost exclusively with black alder leaves, a leaf species with traits favourable to consumers (i.e., low recalcitrance and high nutrient content). At the same time, little is known about fungicide effects on microbial colonisation and decomposition of other leaf species with less favourable traits. In this 21 day lasting study, we explore the effects of increasing fungicide sum concentrations (0-3000 µg/L) on microbial colonisation and decomposition of three leaf species (black alder, Norway maple and European beech) differing in terms of recalcitrance and nutrient content. Leaf litter decomposition rate, leaf-associated fungal biomass and bacterial density were quantified to observe potential effects at the functional level. Beech, as the species with the least favourable leaf traits, showed a substantially lower decomposition rate (50%) in absence of fungicides than alder and maple. In the presence of high fungicide concentrations (300-3000 µg/L), beech showed a concentration-related decrease not only in microbial leaf litter decomposition but also fungal biomass. This suggests that favourable traits of leaf litter (as for alder and maple) enable leaf-associated microorganisms to acquire leaf-bound energy more easily to withstand potential effects induced by fungicide exposure. Our results indicate the need to deepen our understanding on how leaf species' traits interact with the impact of chemical stressors on the leaf decomposition activity of microbial communities.

Delayed early life effects in the threespine stickleback.

Early life conditions can have a decisive influence on viability later in life. However, the influence of embryo density within a nest or body cavity on subsequent viability has received little attention within an ecological setting. This is surprising given that embryos often compete for limited resources, such as nutrients and oxygen, and this could influence their viability later in life through carry-over and compensatory effects. We show that the density of fertilized eggs within the nests of threespine stickleback males (Gasterosteus aculeatus) influences their viability after hatching. Embryos from larger broods hatch earlier and at a smaller size than those from smaller broods, which reduces their survival until the age of four weeks. This indicates a trade-off between the number and viability of offspring that males can raise to the hatching stage, which could explain the high incidence of partial egg cannibalism in nest-brooding fishes-as a strategy to improve the survival of remaining offspring. These results highlight the importance of considering conditions at the embryonic stage when evaluating the impact of early life conditions on viability and the adaptive value of reproductive decisions.

Correction: A homozygous KAT2B variant modulates the clinical phenotype of ADD3 deficiency in humans and flies.

[This corrects the article DOI: 10.1371/journal.pgen.1007386.].

A homozygous KAT2B variant modulates the clinical phenotype of ADD3 deficiency in humans and flies.

Recent evidence suggests that the presence of more than one pathogenic mutation in a single patient is more common than previously anticipated. One of the challenges hereby is to dissect the contribution of each gene mutation, for which animal models such as Drosophila can provide a valuable aid. Here, we identified three families with mutations in ADD3, encoding for adducin-γ, with intellectual disability, microcephaly, cataracts and skeletal defects. In one of the families with additional cardiomyopathy and steroid-resistant nephrotic syndrome (SRNS), we found a homozygous variant in KAT2B, encoding the lysine acetyltransferase 2B, with impact on KAT2B protein levels in patient fibroblasts, suggesting that this second mutation might contribute to the increased disease spectrum. In order to define the contribution of ADD3 and KAT2B mutations for the patient phenotype, we performed functional experiments in the Drosophila model. We found that both mutations were unable to fully rescue the viability of the respective null mutants of the Drosophila homologs, hts and Gcn5, suggesting that they are indeed pathogenic in flies. While the KAT2B/Gcn5 mutation additionally showed a significantly reduced ability to rescue morphological and functional defects of cardiomyocytes and nephrocytes (podocyte-like cells), this was not the case for the ADD3 mutant rescue. Yet, the simultaneous knockdown of KAT2B and ADD3 synergistically impaired kidney and heart function in flies as well as the adhesion and migration capacity of cultured human podocytes, indicating that mutations in both genes may be required for the full clinical manifestation. Altogether, our studies describe the expansion of the phenotypic spectrum in ADD3 deficiency associated with a homozygous likely pathogenic KAT2B variant and thereby identify KAT2B as a susceptibility gene for kidney and heart disease in ADD3-associated disorders.

Right bundle brunch block in patients with acute myocardial infarction is associated with a higher in-hospital arrhythmic risk and mortality, and a worse prognosis after discharge.

INTRODUCTION: Recently, the presence of right bundle brunch block (RBBB) in patients with persistent ischaemic symptoms has been suggested as an indication for emergent coronary angiography. OBJECTIVE: The aim of this study was to assess the prognostic impact of RBBB in patients with acute myocardial infarction (AMI) before the implementation of the recent recommendations. METHODS: We retrospectively studied consecutive patients admitted with AMI between 2011 and 2013. Patients with left bundle brunch block, pacemaker, or nonspecific intraventricular conduction delay were excluded. Patients with RBBB were compared with those without RBBB. Clinical characteristics, in-hospital evolution, and major adverse cardiovascular events (MACE) during follow-up, defined as cardiovascular death, sustained ventricular arrhythmias, acute heart failure syndromes, recurrent myocardial infarction, or acute stroke, were analysed. RESULTS: The analysis included 481 patients. Thirty two patients (6.7%) had RBBB. Patients with RBBB were older. During hospital admission, RBBB patients had a higher rate of sustained ventricular tachycardia and death. Survival curve analysis showed that patients with RBBB had a lower in-hospital survival rate (Log-rank, p = 0.004). After discharge, during a mean follow-up time of 24.3 ± 11.6 months, 53 patients (12%) died. Survival curve analysis showed a lower survival rate free of MACE for those patients with RBBB (Log-rank, p = 0.011). RBBB was independently associated with MACE occurrence (HR 2.17, 95% CI 1.07-4.43; p = 0.033), after adjusting for demographic data, coronary angiography findings, treatment performed, echocardiographic evaluation, and medical therapy. CONCLUSION: Patients with RBBB had a higher rate of in-hospital mortality and arrhythmic events, and an increased risk of MACE during follow-up.

Natural Ingredients Common in the Trás-os-Montes Region (Portugal) for Use in the Cosmetic Industry: A Review about Chemical Composition and Antigenotoxic Properties.

The natural cosmetics market has grown since consumers became aware of the concept of natural-based ingredients. A significant number of cosmetics have an ecological impact on the environment and carry noxious and chemically potent substances. Thus, the use of natural and organic cosmetics becomes increasingly important since it is clear that topical treatment with cosmeceuticals can help improve skin rejuvenation. A substantial investigation into the benefits that fruits and plants can bring to health is required. Studies have shown that antigenotoxic properties are linked to anti-aging properties. Several studies have shown potential antigenotoxicity in natural ingredients such as Almonds (Prunus dulcis), Elderberry (Sambucus nigra), Olives (Olea europaea), and Grapes (Vitis vinifera). This review presents an overview of research conducted on these natural ingredients, the most common in the Northeast of Portugal. This region of Portugal possesses the most organic farmers, and ingredients are easily obtained. The Northeast of Portugal also has climatic, topographic, and pedological differences that contribute to agricultural diversity.

Premature ventricular contractions of the right ventricular outflow tract: is there an incipient underlying disease? New insights from a speckle tracking echocardiography study.

CONTEXT: Premature ventricular contractions (PVCs) originating in the right ventricular outflow tract (RVOT) are traditionally considered idiopathic and benign. Echocardiographic conventional measurements are typically normal. AIMS: To assess whether right ventricle longitudinal strain, determined by two-dimensional speckle tracking echocardiography, differ between RVOT PVCs patients (treated with catheter ablation) and healthy controls. METHODS: We retrospectively selected patients with PVCs from the RVOT who underwent electrophysiological study and catheter ablation between 2016 and 2019. Patients with documented structural heart disease were excluded. Transthoracic echocardiography was performed and right ventricle global longitudinal strain (RV-GLS), free wall longitudinal strain (RVFW-LS) and left ventricle global longitudinal strain (LV-GLS) were determined as well as conventional ultrasound measurements of RV and LV function. RESULTS: We studied 21 patients with RVOT PVCs and 13 controls. Patients with PVCs from the RVOT had lower values of RV-GLS and RVFW-LS compared with the control group (-19.4% versus -22.5%, P = 0.015 and -22.1% versus -25.5, P = 0.041, respectively). They also had lower values of LV-GLS, although still within the normal range (-19.1% versus -20.9%, P = 0.047). Regarding RVOT PVCs patients only, RV-GLS and RVFW-LS had no correlation with the PVCs burden prior to catheter ablation and they did not differ between the patients in whom the catheter ablation was successful and those in whom it was not. RV-GLS also had a positive correlation with RVOT proximal diameter (r = 0.487, P = 0.025). CONCLUSIONS: In this group of RVOT PVCs patients, we found worse RV longitudinal strain values (and therefore sub-clinical myocardial dysfunction) when compared to healthy controls.

Imaging Methodology for Hip Preservation: Techniques, Parameters, and Thresholds.

The concept of hip impingement and hip-preserving surgery has been appreciated in more detail since 2001 when a new surgical approach was reported and a hypothesis linking femoroacetabular impingement (FAI) with osteoarthritis was presented. Paralleling the introduction of hip arthroscopy, these events led to an increasing interest in the hip, and the number of publications has risen rapidly over the past 15 years, despite limited evidence levels and inconsistent methodology. Accordingly, etiology, diagnosis, prognosis, and the effects of treatment for FAI are still elusive due to a number of uncertainties and a lack of clear diagnostic criteria.Future research must focus on developing high-quality scientific studies, so thorough and reproducible methodology is needed. This review provides researchers, radiologists, and clinicians with a comprehensive approach to hip imaging with a focus on strategies to help guide the clinical diagnosis. Using evidence from current literature and knowledge from experienced clinicians, some of the imaging methodology challenges are deciphered.

A lower left atrial appendage peak emptying velocity in the acute phase of cryptogenic stroke predicts atrial fibrillation occurrence during follow-up.

BACKGROUND: Silent atrial fibrillation is a frequent etiology of cryptogenic stroke. Spontaneous conversion of atrial fibrillation to sinus rhythm results in atrial stunning. OBJECTIVE: To evaluate if the presence of a lower left atrial appendage peak emptying velocity (LAAV) after a cryptogenic stroke is associated with the occurrence of atrial fibrillation (AF). METHODS: We retrospectively selected consecutive patients with an acute ischemic stroke that had a transoesophageal echocardiogram (TEE) performed in the first 30 days of the acute event. Documented AF or potential cardioembolic sources in the TEE were considered exclusion criteria. We assessed the LAAV. During follow-up, we evaluated the occurrence of new-onset AF and the combined endpoint of death or new ischemic stroke. RESULTS: We studied 73 consecutive patients, during a mean follow-up period of 54.9 ± 19.3 months. Seven developed AF, and 13 had the combined endpoint. LAAV was independently associated with AF occurrence (HR: 0.93, 95% CI: 0.88-0.99; P = .016). Patients with a LAAV ≤ 46.5 cm/s (AUC: 0.766, 95% CI: 0.579-0.954; P = .021) had a lower survival rate free from AF occurrence (Log-rank, P < .001) and free from the combined endpoint of death or ischemic stroke (Log-rank, P = .010). CONCLUSION: A lower LAAV was associated with AF occurrence and the combined endpoint of death or ischemic stroke after an initial episode of cryptogenic stroke. Patients with this finding could eventually benefit from long-term cardiac rhythm monitoring.

Detection of Simonsiella spp. in the Vagina of Lions and Leopard in Oestrus.

Reports of the vaginal flora of wild cats such as lions or leopards are scarce. The micro-organisms most commonly found in the vagina of clinically healthy cats are aerobic bacteria such as coagulase-negative Staphylococcus, Streptococcus canis, and Escherichia coli. Simonsiella spp are large Gram-negative bacteria belonging to the Neisseriaceae family, typically found in the oral cavity and upper respiratory tract of many species. To date, there are no reports of the detection of Simonsiella spp in the vaginal flora of any felid. For a period of six months, daily behaviour monitoring was performed on six captive lionesses at a South African conservation centre, in parallel with the collection of vaginal swabs and interpretation of the resultant vaginal cytologies every other day. Oestrus was identified by typical female reproductive behaviours, as well as by enlarged and separated vulvar lips, and a predominant proportion of superficial cornified cells, clearing of the background, and high bacterial presence in the vaginal smear. Simonsiella spp were identified by their characteristic morphology in 58% (60 of 103) of the vaginal samples collected during oestrus. They were also found in oral swabs of three out of three lions tested. Additionally, Simonsiella spp were opportunistically found in a vaginal smear from a zoo housed female Sri Lankan leopard in oestrus, during a routine reproduction assessment. The finding of Simonsiella spp may be more common than previously suspected, transitory, and without detectable clinical relevance. A connection between occurrence of these bacteria and oestrus was apparent.

Bacterial cellulose as a support for the growth of retinal pigment epithelium.

The feasibility of bacterial cellulose (BC) as a novel substrate for retinal pigment epithelium (RPE) culture was evaluated. Thin (41.6 ± 2.2 µm of average thickness) and heat-dried BC substrates were surface-modified via acetylation and polysaccharide adsorption, using chitosan and carboxymethyl cellulose. All substrates were characterized according to their surface chemistry, wettability, energy, topography, and also regarding their permeability, dimensional stability, mechanical properties, and endotoxin content. Then, their ability to promote RPE cell adhesion and proliferation in vitro was assessed. All surface-modified BC substrates presented similar permeation coefficients with solutes of up to 300 kDa. Acetylation of BC decreased it's swelling and the amount of endotoxins. Surface modification of BC greatly enhanced the adhesion and proliferation of RPE cells. All samples showed similar stress-strain behavior; BC and acetylated BC showed the highest elastic modulus, but the latter exhibited a slightly smaller tensile strength and elongation at break as compared to pristine BC. Although similar proliferation rates were observed among the modified substrates, the acetylated ones showed higher initial cell adhesion. This difference may be mainly due to the moderately hydrophilic surface obtained after acetylation.

Preliminary Insights into the Antigenotoxic Potential of Lemon Essential Oil and Olive Oil in Human Peripheral Blood Mononuclear Cells.

Lemon essential oil, derived from Citrus limon, possesses diverse health-promoting properties, including antioxidant, antimicrobial, and mood-enhancing effects. Despite its traditional use in aromatherapy and complementary medicine, there is a need for comprehensive investigations into its therapeutic potential, particularly in mitigating DNA damage and supporting health in palliative care settings. This study aimed to evaluate the antigenotoxic effects of lemon essential oil in human peripheral blood mononuclear cells and to explore its potential applications in palliative care. Treatment with lemon essential oil significantly reduced DNA damage, with 1% w/v with 3.13% DNA in tail demonstrating greater efficacy. Furthermore, lemon essential oil attenuated streptonigrin-induced DNA damage, suggesting a potential protective effect against oxidative stress, especially at 3% w/v, with 11.81% DNA in tail. Compared to olive oil treatment, the DNA damage was significantly lower with streptonigrin treatment alone, which had 47.06% DNA in tail, while the olive oil treatment resulted in 36.88% DNA in tail. These results can be attributed to the main constituents: limonene in lemon essential oil and oleic acid in olive oil. These results suggest a potential role in mitigating oxidative stress and supporting genomic stability. Further research is warranted to elucidate the mechanisms of action and clinical applications in palliative care.

Exploring Aromatherapy as a Complementary Approach in Palliative Care: A Systematic Review.

Background: Palliative care, a cornerstone of comprehensive healthcare, prioritizes quality of life for individuals with life-threatening illnesses. Aromatherapy, with its holistic approach and patient-reported benefits, emerges as a promising complementary therapy for managing symptoms and enhancing well-being in palliative care. Objective: The objective of this systematic review is to assess the efficacy of aromatherapy interventions in symptom management, with a focus on pain, anxiety, nausea, and sleep disturbances among palliative care patients. Design: A comprehensive search was conducted across various databases to identify relevant studies. Eligibility criteria were applied, resulting in the inclusion of eight studies for analysis. The review assessed the efficacy of aromatherapy interventions, primarily through massage, in symptom management. Variations in intervention procedures and outcome measures were noted, necessitating a critical examination of the findings. Results: The review's findings suggest promising outcomes associated with aromatherapy in palliative care. Aromatherapy interventions demonstrated significant efficacy in reducing pain, anxiety, nausea, and improving sleep quality among patients. However, considerable heterogeneity was observed across studies, highlighting the need for standardized methodologies and larger-scale trials. Conclusion: This systematic review underscores the potential of aromatherapy as a complementary intervention in palliative care. While the findings support its efficacy in symptom management, methodological inconsistencies across studies warrant further research. Standardized approaches and larger trials are essential to validate the tailored effectiveness of aromatherapy for different symptoms encountered in palliative care, ultimately enhancing its clinical utility and integration into therapeutic practices.

Clear Aligners and Miniscrews in a Scissor Bite Adult Treatment.

Scissor bite does not correct spontaneously. It gradually worsens by overeruption, negatively affecting masticatory function. It is intended with this manuscript to evaluate the different treatment strategies to correct this malocclusion in adult patients, exploring treatment with clear aligners, bite ramps, and MS (miniscrews), especially in this case of a patient with unilateral right scissor bite, with high dental compensation in the three planes of space, asymmetrical sagittal dental position, overeruption on the scissor bite condition, and a high mandibular arch constriction and maxillary expansion. A comprehensive literature research was performed from 2002 until March 2023. PubMed and BVS databases were used, with the following keywords: "scissor bite OR brodie bite" AND "malocclusion" AND "treatment OR correction OR therapeutics". Since correcting skeletal asymmetries after the growth completion is challenging, adult patient cases often involve a combined orthodontic-surgical approach. In the present clinical case, the severe limitations to decompensating tooth positions for a surgical treatment, with the necessity to perform lower asymmetric extraction and a must longer orthodontic treatment, were the major reasons to avoid the surgical approach, after the scissor bite correction. In spite of this, the efficiency of the clear aligners and auxiliaries like bite ramps, MS, and elastics in successfully correcting a complex scissor bite in an adult patient was demonstrated, with significant esthetic and functional commitment, demonstrated by the case reliability PAR (peer assessment rating) index.

Microbial community history and leaf species shape bottom-up effects in a freshwater shredding amphipod.

Arable land use and the associated application of agrochemicals can affect local freshwater communities with consequences for the entire ecosystem. For instance, the structure and function of leaf-associated microbial communities can be affected by pesticides, such as fungicides. Additionally, the leaf species on which these microbial communities grow reflects another environmental filter for community structure. These factors and their interaction may jointly modify leaves' nutritional quality for higher trophic levels. To test this assumption, we studied the structure of leaf-associated microbial communities with distinct exposure histories (pristine [P] vs vineyard run off [V]) colonising two leaf species (black alder, European beech, and a mixture thereof). By offering these differently colonised leaves as food to males and females of the leaf-shredding amphipod Gammarus fossarum (Crustacea; Amphipoda) we assessed for potential bottom-up effects. The growth rate, feeding rate, faeces production and neutral lipid fatty acid profile of the amphipod served as response variable in a 2 × 3 × 2-factorial test design over 21d. A clear separation of community history (P vs V), leaf species and an interaction between the two factors was observed for the leaf-associated aquatic hyphomycete (i.e., fungal) community. Sensitive fungal species were reduced by up to 70 % in the V- compared to P-community. Gammarus' growth rate, feeding rate and faeces production were affected by the factor leaf species. Growth was negatively affected when Gammarus were fed with beech leaves only, whereas the impact of alder and the mixture of both leaf species was sex-specific. Overall, this study highlights that leaf species identity had a more substantial impact on gammarids relative to the microbial community itself. Furthermore, the sex-specificity of the observed effects (excluding fatty acid profile, which was only measured for male) questions the procedure of earlier studies, that is using either only one sex or not being able to differentiate between males and females. However, these results need additional verification to support a reliable extrapolation.

The three stages of eosinophilic cardiac damage: A series of case reports.

Hypereosinophilic syndrome is a rare systemic condition characterized by eosinophil-mediated organ damage. Cardiac involvement is common and typically occurs in sequential stages. We present two cases that demonstrate these different stages and presentations of eosinophilia-mediated myocardial disease, where multimodality imaging was essential for the diagnosis. More importantly, they demonstrate, for the first time, the dissociation between the eosinophil count and patients' clinical evolution, suggesting the need for close follow up even after the eosinophilia has been controlled. Learning objective: Cardiac involvement in hypereosinophilic syndrome typically occurs in three stages - necrotic, thrombotic, and fibrotic. Although cardiac damage is mediated by eosinophils, the blood eosinophil count and patients' clinical evolution are dissociated. Therefore, eosinophil count on its own is not an adequate marker of clinical evolution, and cardiac follow up should be continued even after the eosinophilia has been controlled.