Fistula of the mitral-aortic intervalvular fibrosa in a patient with bacterial endocarditis: a case report and systematic literature review.

BACKGROUND: A fistulous tract in the mitro-aortic intervalvular fibrosa (MAIVF) is a rare entity, which presents as a complication of endocarditis or surgical trauma. Generally, it is associated to a pseudoaneurysm of the MAIVF (p-MAIVF) or aortic abscesses. MAIVF fistulas could potentially lead to devastating complications and a high mortality rate. This condition is managed surgically, either by a percutaneous closure or an open surgical approach. Herein we report the complex case of a patient with a MAIVF fistula secondary to bacterial endocarditis. Further clinical deterioration was caused by severe aortic valve insufficiency and hemodynamic compromise, requiring surgical intervention. CASE PRESENTATION: A 74-year-old male patient was admitted to a primary care center with complaints of malaise, asthenia, adynamia, hyporexia, and lower limb edema over the past eight days. His past medical history is positive for arterial hypertension and being monorenal. A transesophageal echocardiogram (TEE) was performed, exhibiting a 56% left ventricle ejection fraction (LVEF) and complicated aortic valve endocarditis. Surgical management through an open approach included vegetation resection, valve replacement, and closure of the MAIVF fistula. After completing antibiotic therapy, the patient was discharged without complications. During postoperative follow-up, the patient remained asymptomatic, and the control echocardiogram showed no signs of MAIVF fistula.4. CONCLUSIONS: The clinical case of a patient with a MAIVF fistula secondary to endocarditis by Streptococcus Anginous was presented. The fistulous tract was not associated to p-MAIVF or aortic abscess, findings which further deteriorate the patient's condition and increase the likelihood of fatality. This case reinforces the importance of a prompt diagnosis through cardiac imaging and timely surgical closure of the defect.

Effects of neonatal fentanyl on late adolescent opioid-mediated behavior.

Introduction: Because of the steady increase in the use of synthetic opioids in women of childbearing age, a large number of children are at risk of exposure to these drugs prenatally or postnatally through breast milk. While there is older literature looking at the effects of morphine and heroin, there are relatively few studies looking at the long-term effects of high-potency synthetic opioid compounds like fentanyl. Thus, in the present study, we assessed whether brief exposure to fentanyl in male and female rat pups during a period roughly equivalent to the third trimester of CNS development altered adolescent oral fentanyl self-administration and opioid-mediated thermal antinociception. Methods: We treated the rats with fentanyl (0, 10, or 100 µg/kg sc) from postnatal day (PD) 4 to PD 9. The fentanyl was administered daily in two injections given 6 h apart. After the last injection on PD 9, the rat pups were left alone until either PD 40 where they began fentanyl self-administration training or PD 60 where they were tested for morphine- (0, 1.25, 2.5, 5, or 10 mg/kg) or U50,488- (0, 2.5, 5, 10, or 20 mg/kg) induced thermal antinociception. Results: In the self-administration study, we found that female rats had more active nose pokes than male rats when receiving a fentanyl reward but not sucrose alone solution. Early neonatal fentanyl exposure did not significantly alter fentanyl intake or nose-poke response. In contrast, early fentanyl exposure did alter thermal antinociception in both male and female rats. Specifically, fentanyl (10 µg/kg) pre-treatment increased baseline paw-lick latencies, and the higher dose of fentanyl (100 µg/kg) reduced morphine-induced paw-lick latencies. Fentanyl pre-treatment did not alter U50,488-mediated thermal antinociception. Conclusions: Although our exposure model is not reflective of typical human fentanyl use during pregnancy, our study does illustrate that even brief exposure to fentanyl during early development can have long-lasting effects on mu-opioid-mediated behavior. Moreover, our data suggest that females may be more susceptible to fentanyl abuse than males.

"Don't Shoot, I Want to Grow Up": Findings of a Multicity Youth-led Health Assessment.

BACKGROUND: Youth of color are one of the fastest growing segments of the U.S. POPULATION: Collaborative equitable approaches to research and action present potential avenues to engage youth of color meaningfully in health research and action initiatives. OBJECTIVES: This article explores community-based participa-tory research (CBPR) as an approach that presents valuable opportunities to engage youth and young adults of color in leadership in public health initiatives to create healthy communities. METHODS: Integrating a CBPR approach, we partnered with grassroots leaders and community organizations across five cities to engage youth and young adults of color (n = 35) in identifying health assets and threats to young people's well-being using mixed-methods including surveys, photovoice, field observations, and interviews. RESULTS: This article focuses on presenting three major themes that emerged from the youth-led health assessment across five cities: 1) relations with police, 2) stress, and 3) safety. Findings indicate youth are well aware of the role that interlocking structures play in individual and collective health and well-being. CONCLUSIONS: CBPR presents promising approaches to engage youth meaningfully in health promotion initiatives providing the opportunities for youth researchers to document accurately nuanced understandings of social determinants of health impacting the health and well-being of youth of color.