Brain Tissue-Derived Extracellular Vesicle Mediated Therapy in the Neonatal Ischemic Brain.

Hypoxic-Ischemic Encephalopathy (HIE) in the brain is the leading cause of morbidity and mortality in neonates and can lead to irreparable tissue damage and cognition. Thus, investigating key mediators of the HI response to identify points of therapeutic intervention has significant clinical potential. Brain repair after HI requires highly coordinated injury responses mediated by cell-derived extracellular vesicles (EVs). Studies show that stem cell-derived EVs attenuate the injury response in ischemic models by releasing neuroprotective, neurogenic, and anti-inflammatory factors. In contrast to 2D cell cultures, we successfully isolated and characterized EVs from whole brain rat tissue (BEV) to study the therapeutic potential of endogenous EVs. We showed that BEVs decrease cytotoxicity in an ex vivo oxygen glucose deprivation (OGD) brain slice model of HI in a dose- and time-dependent manner. The minimum therapeutic dosage was determined to be 25 µg BEVs with a therapeutic application time window of 4-24 h post-injury. At this therapeutic dosage, BEV treatment increased anti-inflammatory cytokine expression. The morphology of microglia was also observed to shift from an amoeboid, inflammatory phenotype to a restorative, anti-inflammatory phenotype between 24-48 h of BEV exposure after OGD injury, indicating a shift in phenotype following BEV treatment. These results demonstrate the use of OWH brain slices to facilitate understanding of BEV activity and therapeutic potential in complex brain pathologies for treating neurological injury in neonates.

The new face of rheumatic heart disease in South West Nigeria.

PURPOSE: To determine the current prevalence of rheumatic heart disease (RHD), clinical features, types of valvular lesions, complications and mortality, at Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital, Osogbo, South West Nigeria. METHODS: We conducted a retrospective, descriptive study of all the cases of RHD seen in the medical outpatient clinics and wards of LAUTECH for 9 years, from January 2003 to December 2011. Statistical analysis of data obtained was done using SPSS 16. RESULTS: The total number of attendees of all the medical outpatient clinics during the 9-year period was 67,378, with a subset of 9423 attending the cardiology clinic. There were 11 cases of RHD, which translates to a prevalence of 0.16/1000 and 1.2/1000 for medical outpatient clinics and the cardiology clinic respectively. The mean age of the patients was 25.64 ± 9.65 years, age range 14-40 years and male to female ratio of 1:1.2. The most common valve affected was mitral (90.9%), followed by the aortic (36.4%), and the tricuspid (18.2%). Mitral and aortic lesions coexisted in 18.2% of the patients, and late presentation was common in all RHD cases. Heart failure was the most common complication (90.9%). Other complications were secondary pulmonary hypertension (36.4%), infective endocarditis (27.3%), atrial fibrillation (27.3%), cardioembolic cerebrovascular disease (18.2%), and atrial flutter (9.1%). Mortality was 9.1%, while only one patient (9.1%) had definitive surgery. Financial constraints precluded others from having definitive surgery. CONCLUSION: The prevalence of RHD has declined considerably as a result of improvements in the primary health care delivery system, with widespread use of appropriate antibiotic therapy for sore throats resulting in the prevention of rheumatic fever and RHD. However, late presentation is still very common, hence we advocate a more aggressive drive to make the Drakensberg declaration on the control of rheumatic fever and rheumatic heart disease functional in our practice area.

Two-dimensional and Doppler echocardiographic evaluation of patients presenting at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria: a prospective study of 2501 subjects.

BACKGROUND: Echocardiography remains a key noninvasive cardiac investigative tool in the management of patients, especially in a developing economy like Nigeria. In this study, we investigated the indications for transthoracic echocardiography and spectrum of cardiac disease found in patients referred to our cardiac unit for echocardiography. METHODS: A prospective two-dimensional, pulsed, continuous, and color-flow Doppler echocardiographic evaluation was done using the transthoracic approach in 2501 patients over an eight-year period. Univariate data analysis was performed for mean age, gender, clinical indications, and diagnoses. RESULTS: The subject age range was less than 12 months to 97 years (mean 52.39 years). There were 1352 (54.06%) males and 1149 (45.94%) females. The most common indication for echocardiography was hypertension (52.1%) followed by congestive cardiac failure (13.9%). Others were for screening (6.1%), arrhythmias (5%), cerebrovascular disease (5%), chest pain (3.3%), chronic kidney disease (3.2%), congenital heart disease (2.6%), cardiomyopathy (1.8%), rheumatic heart disease (1.7%), diabetes mellitus (1.3%), thyrocardiac disease (1.2%), ischemic heart disease (1.2%), and pericardial disease (1.1%). The echocardiographic diagnosis was hypertensive heart disease in 59.4% of subjects and normal in 14.1%. Other echocardiographic diagnoses included rheumatic heart disease (3.1%), congenital heart disease (2.1%), cardiomyopathy (1.7%), pericardial disease (1.1%), and ischemic heart disease (0.1%). CONCLUSION: Hypertension and its cardiac complications is the most common echocardiographic indication and diagnosis at our unit.

Atrial septal aneurysm mimicking a cor triatriatum sinister: a case report and review of the literature.

An atrial septal aneurysm (ASA) is a rare but well-recognized abnormality of uncertain clinical relevance. It is a localized bulging of the inter-atrial septum into either or both atria during the cardiac cycle. ASA has been reported as an unexpected finding during autopsy but may also be diagnosed in living patients by echocardiographic techniques.We present a 37-year-old woman with a recurrent atypical chest pain of one-year duration. She was found to have a congenital atrial septal aneurysm on evaluation. The echocardiographic images mimicked a left sided cor triatriatum sinister. She had no other symptoms and had no co-morbidities. There was no audible murmur.ASA can mimic cor-triatriatum and echocardiographic examination should be performed from multiple views before any echocardiographic diagnosis is made.