Fatal Methanol Poisoning Caused by Drinking Industrial Alcohol: Silesia Region, Poland, April-June 2022.

Methanol poisonings caused by drinking industrial alcohol remain a severe problem worldwide. Education on types of alcohol and their harmfulness and legal regulations limiting the industrial alcohol trade seem to be the keys to reducing the number of poisonings. Methanol distribution in different tissues after absorption is not well understood. This research aimed to quantify the methanol and formic acid distribution in body fluids and tissue material in post-mortem samples collected from 19 fatal victims of massive intoxication with industrial alcohol in the Silesia Region (Poland) who died between April and June 2022. The samples were analyzed using a gas chromatography-flame ionization detector (GC-FID), and correlation coefficients for methanol and formic acid were determined. The results show a wide distribution of methanol and formic acid in human post-mortem biological fluids (blood, urine, vitreous humor, bile, and cerebrospinal fluid) and tissues (muscle, kidney, liver, spleen, lung, and brain). The strongest correlation for methanol concentration in blood and body fluids/tissues was obtained in the cerebrospinal fluid (r = 0.997) and for formic acid in muscle tissue (r = 0.931). The obtained results may be a valuable tool in toxicological analysis and improve medical standards of early diagnosis and targeted treatment.

Microbiological Safety of Food of Animal Origin from Organic Farms.

The organic food sector and consumer interest in organic products are growing continuously. The safety and quality of such products must be at least equal to those of conventional equivalents, but attaining the same standards requires overcoming a particular problem identified in organic food production systems: the occurrence of bacterial pathogens such as Salmonella, Campylobacter, Listeria monocytogenes, Staphylococcus aureus and pathogenic Escherichia coli. These food-borne microorganisms were detected in the production environments of such food. The prevalence of pathogenic bacteria in organic livestock and products may be higher, but may also be the same as or lower than in like material from conventional farms. Furthermore, the incidence of antimicrobial-resistant bacteria was more often detected in conventional than in organic production. The aim of this review was to present the recent information on the microbiological safety of food of animal origin produced from raw materials from organic farms.

Presence of the Vieussens valve on cardiac computed tomography.

BACKGROUND: The Vieussens valve is a venous valve often found between the coronary sinus ostium and the great cardiac vein. AIMS: This study aimed to analyze the Vieussens valve in vivo using cardiac computed tomography (CT). METHODS: A total of 325 patients (120 women; mean [SD] age, 58 [11] years) were included into the study. Retrospective scanning using 64 slices of 0.5 mm in thickness was performed and multiplanar reformatted reconstructions and 3­dimensional volume renderings were used. As the Vieussens valve is difficult to find in standard reconstructions owing to its very small thickness, we decided to prepare and use indirect analyses in order to determine the presence of the valve. The basis for the analysis was the fact that even a very thin valve is an obstacle to the flow of the contrast agent in the same way as the much larger valves are. RESULTS: The Vieussens valve was present on CT in 141 of the 325 study patients (43.38%). No sex differences were found (P = 0.83): the valve was present in 88 of 205 men (42.92%) and in 53 of 120 women (44.17%). The mean (SD) distance between the Vieussens valve and the coronary sinus ostium was 38.89 (7.47) mm. We determined 3 types of the Vieussens valve: varicose, diminutive, and Marshall vein type. CONCLUSIONS: It is possible to visualize the Vieussens valve on CT. Due to the usually small size of the valve, the best way to find it is to analyze the distribution (density) of a contrast agent in the coronary sinus. Differentiating the proposed valve types can facilitate further analysis.

Usefulness of the Coronary Artery Calcium Score in Predicting Subsequent Coronary Interventions-A Ten-Year Single-Center Perspective.

There is no consensus as to whether the Coronary Artery Calcium Score (CACS) results can affect the therapeutic approach that is selected for coronary artery disease. The aim of this study was to follow patients' management over a period of ten years after application of the CACS. Methods: The research was conducted as a prospective, single-center, long-distance study. In 174 asymptomatic patients (78M; aged 58.9 ± 7.86), a CACS examination using 64-slice computed tomography was performed between 2008 and 2009. The patients were divided into three subgroups according to the CACS results using Agatston Units (AU)-G1: CACS = 0 AU (52 pts); G2: CACS = 1-399 AU (64 pts) and G3: CACS ≥ 400 AU (58 pts). During the ten years of follow-up, the classical cardiovascular risk factors, drugs, diseases, and information about the therapeutic approach that was used (PCI-Percutaneous Coronary Intervention; CABG-Coronary Artery Bypass Graft) were also analyzed. Results: The average time until a percutaneous intervention (PCI) was 825.2 ± 1111.7 and for CABG, it was 529.0 ± 833.6. PCI was performed in 5.8% (G1), 4.7% (G2) and 32.6% (G3) of the cases, respectively; p = 0.0000. CABG was performed in 0% (G1), 1.6% (G2) and 18.9% (G3) of the cases, respectively; 0.0035 Yates. The area under the curve in PCI was 0.783 (95% CI: 0.714-0.841); in CABG, it was 0.825 (95% CI: 0.760-0.878) and the average for both groups was 0.838 (95% CI: 0.774-0.889). Conclusions: The coronary artery calcium score can potentially help to predict the best therapeutic approach for coronary artery disease in a ten-year perspective.

Antimicrobial resistance and genotypic characteristics of Listeria monocytogenes isolated from food in Poland.

The aim of the study was to determine antimicrobial resistance and genotypic characteristics of L. monocytogenes isolated from food of animal origin from different parts of Poland during years 2013-2016. A total of 146 isolates were tested using a microbroth dilution method, whereas virulence genes and molecular serogroups were identified by PCR. Pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) methods were used to analyze the genotypic relationship of the strains. Altogether, 102 pulsotypes grouped into 7 clusters and 24 sequence types, including 3 new types, were identified. Most of the strains clustered into individual patterns were originated from different food products and were isolated in different geographical regions at various time. L. monocytogenes was mostly resistant to oxacilin (90.4% strains), clindamycin (54.1%) and ceftriaxone (49.3%). A multiresistance patterns, mainly to ceftriaxone, oxacillin together with other antimicrobials, were observed among 27.4% strains. Antimicrobial resistance and presence of virulence genes suggest that food of animal origin contaminated with L. monocytogenes may present a risk for public health.

Visualisation of the oblique vein of the left atrium (vein of Marshall) using cardiac computed tomography: is the game worth the candle?

BACKGROUND: The vein of Marshall (VoM) is a small vessel that descends obliquely on the back of the left atrium and ends in the coronary sinus near the area where the great cardiac vein continues into the coronary sinus. AIM: The aim of the study was to examine the frequency of occurrence and anatomical aspects as well as the possibility of visualising the VoM, including an evaluation of the quality of the visualisation, on computed tomography (CT). METHODS: Three hundred patients aged 58.8 ± 11.5 years (111 women) were included into this single-centre study. Cardiac CT was performed in all patients. The search for the VoM was performed by two experienced researchers using two- and three-dimensional techniques. A dedicated Likert-based scale was used to evaluate the quality of the visualisations. RESULTS: The VoM was found in 61 (20.33%) of 300 patients. Its average diameter was 1.72 ± 0.69 mm with no sex-related differences (men: 1.71 ± 0.69 mm; women: 1.73 ± 0.57 mm; p = 0.91). The average length of the vessel was 9.24 ± 7.58 mm. The VoM was more frequently (p = 0.01) visualised in the systolic phases (68.85% of cases) compared to the diastolic phases (27.86% of cases). Occasionally it was visualised in other phases (3.29%). CONCLUSIONS: Although it was possible to visualise the VoM using cardiac CT in about 20% of the population, this method of visualisation requires that special attention be paid to the quality of the images, especially in the systolic phases. Visualisation may be useful before certain electrophysiology procedures.

Three-dimensional visualisation of coronary sinus ostium from the inside right atrium perspective.

BACKGROUND: There is no in vivo method of coronary sinus visualisation from the right atrium perspective. AIM: The objective of the study was to create a cardiac computed tomography (CT) angiography-based method of visualising the coronary sinus ostium and the Thebesian valve from the inside right atrium perspective. METHODS: In 78 consecutive patients, a cardiac CT angiography (Aquilion 64, Toshiba) with retrospective gating (slice 0.5 mm) was performed. Raw data were reconstructed on Vitrea 2 workstations (Vital Images). In order to create the three-dimensional (3D) coronary sinus visualisation from the "inside view" perspective, patented "Fly Through" algorithms were used, and the anatomical positions on the multiplanar reconstruction images were marked. A dedicated, Likert-based five-point scale was developed and used to evaluate the quality of the visualisations. RESULTS: The average quality of the visualisations of the coronary sinus ostium in two-dimensional multiplanar reconstruction images was good (4.17 ± 0.85 points) and was clinically interpretable in all cases. The image quality of the "inside view" 3D images was 3.61 ± 1.12 points. In 57.7% of cases we obtained high scores (4 and 5 points). The main diameter was 10.72 ± 2.48 mm, and the entrance angle of the coronary sinus into the right atrium was 103.76 ± 10.71°. CONCLUSIONS: Cardiac CT angiography is a useful method that permits the coronary sinus ostium and Thebesian valve to be visualised in vivo from the inside of the right atrium in a comparable manner.

Gender-related differences in coronary venous anatomy: a potential basis for various response to cardiac resynchronisation therapy.

BACKGROUND AND AIM: We hypothesised that small differences in the anatomy of the coronary venous tree might be one of the factors responsible for the differences in the response for cardiac resynchronisation depending on a patient's gender. METHODS: Cardiac computed tomography scans with retrospective gating were performed on 315 subjects (aged 58.3 ± 11.6 years; 117 women) according to the clinical criteria. The standard protocol for coronary arteries was used during scanning. Additional reconstructions that were focused on the coronary veins during post processing were used to analyse the data. Gender-related anatomical variants were identified. RESULTS: The average of 3.6 ± 1.4 veins per case were visualised. The posterolateral vein was visualised more frequently in men than in women (p < 0.05). Eight variants were identified as being more frequent - they were found in 237 out of 315 cases (75.24%). Those variants occurred in 95 (81.19%) of the women and in 142 (71.72%) of the men, p = 0.080. Six variants occurred more frequently in women; however, the differences were not significant. CONCLUSIONS: In women a more frequent presence of favourable coronary vein variants in the target area for cardiac resynchronisation can be seen. Anatomical findings may help to explain why women more frequently respond to cardiac resyn-chronisation therapy compared to men.

Prognostic value of coronary artery calcium score in patients with symptoms suggestive of coronary artery disease. Results from the Silesian Calcium Score (SILICAS) study.

INTRODUCTION    The prognostic value of coronary artery calcium score (CACS) in symptomatic patients with a suspicion of coronary artery disease (CAD) has been poorly defined. OBJECTIVES    The aim of the study was to assess the predictive value of the CACS in the incidence of major adverse coronary events (MACEs) in patients with an intermediate probability of CAD and establish its usefulness as the first-line risk assessment tool. PATIENTS AND METHODS    This single-center, observational, prospective study enrolled consecutive symptomatic patients without a previous diagnosis of CAD, referred to our center for CACS assessment with non-contrast-enhanced cardiac computed tomography (CT). CACS measurements were performed using an electrocardiogram-gated 64-row CT scanner. The CACS measurement was treated as the first­line noninvasive test. Patients with positive CACS values were divided into 4 subgroups: <100 Agatston units (AU), 100 to 399 AU; 400 to 999 AU; and ≥1000 AU. The incidence of MACEs was analyzed in 2 ways: negative versus positive CACS and by the CACS subgroups. RESULTS    We included 588 patients (mean age, 61.1 ±9.7 years; women, 64%). The median follow-up period was 707 days. There were 239 patients (49.3%) with no coronary calcium. In these patients, no MACEs were observed, while in those with positive CACS values, they occurred in 108 patients (30.9%) (P <0.001). The incidence of MACEs was dependent on the CACS values, reaching 91% in those with a CACS of 1000 or higher AU. CONCLUSIONS    In selected symptomatic patients with an intermediate probability of CAD, the CACS measurement may be used as the first-line test to assess the risk of MACEs.

Frailty Syndrome in Heart Failure Patients who are Receiving Cardiac Resynchronization.

BACKGROUND: We hypothesized that patients with de novo cardiac resynchronization therapy (CRT) implantation had a more intense frailty syndrome when compared to the patients who qualified for a system upgrade. METHODS: One hundred and six patients aged ≥65 years were included. They were divided into two groups: de novo CRT implantation--74 patients and upgrade from standard right heart pacing--32 patients. A CRT was finally implanted in all of the patients. Frailty was evaluated using the Canadian Study of Health and Aging Clinical Frailty Scale (CSHA-CFS). RESULTS: The average results in CSHA-CFS were statistically higher (5.3 ± 0.8) in the de novo patients when compared to the patients who qualified for a system upgrade (4.9 ± 0.8); P = 0.027. Frailty syndrome was recognized in 81.1% of the patients in the de novo group and in 68.7% of the patients in the upgrade group; P = 0.164. Only one patient of the 106 had no attributes of frailty (or exposed ones) syndrome. CONCLUSIONS: Frailty syndrome is a common phenomenon in patients with heart failure and over 65 years of age. The syndrome is most often recognized in patients who are de novo qualified for cardiac resynchronization.

The Thebesian valve and coronary sinus in cardiac magnetic resonance.

PURPOSE: There is no complex research exploring usefulness of cardiac magnetic resonance in the evaluation of the coronary sinus including Thebesian valve, which can be useful before selected electrophysiology procedures. METHODS: One hundred twenty-two patients aged 49.2 ± 17.2 (42 women) were included in the study; 4 of them were excluded. A steady-state free-precession (SSFP) sequence was the basis of the visualization and analysis of the coronary sinus as well as Thebesian valve. In selected cases, dedicated coronary sinus sequences were created. All data were evaluated by experienced cardiac magnetic resonance investigators. RESULTS: We were able to visualize the coronary sinus by using basic SSFP sequence in all patients, however in four cases in suboptimal quality. Average length of the coronary sinus was 39.73 ± 16.9 mm, average diameter was 9.81 ± 9.3 mm, and average angle of the entrance of the coronary sinus into the right atrium was 111.37 ± 13.8°. The Thebesian valve as the gate of the coronary sinus was found in 56 cases (45.9%). In 21 patients (17.2% of all), the valve was porous or almost totally covered the coronary sinus ostium, which can potentially create problems during CS cannulation. CONCLUSIONS: In most of the cases, it is possible to visualize and measure the coronary sinus using cardiac magnetic resonance with SSFP sequence. In selected cases, it is necessary to perform additional dedicated short sequences. Thebesian valve was visualized in almost 50% of patients.

Variation in Cardiac Vein System is Associated with Coronary Artery Calcium - A Venous-Atherosclerosis Paradox?

BACKGROUND: The factors that determine the different patterns of venous anatomy are not well understood. This study was designed to evaluate the relationship between variation in the cardiac vein system and the extent of coronary artery calcium score (CACS). METHODS: We reviewed the results of 64-slice CTs of 226 subjects (age 57.2 ± 11.2; 133M) enrolled in our study. The subjects were divided into 3 groups based on coronary artery calcium: 92 patients. with CACS = 0 AU (Agatston Unit, AU); 56 with CACS = 1-100 AU; and 78 patients with CACS > than 100 AU. The cardiac venous system was reconstructed during the optimal phase of the cardiac cycle in each subject. RESULTS: Subjects with a higher CACS had a better quality of vein images (p < 0.01). The number of visible veins differed between the groups. Eight subjects (8.7%) in the group with CACS = 0 AU, 7 (12.5%) in the group with CACS = 1-100 AU, and 23 (29.5%) in the group with CACS > 100 AU had five or more visible veins (p < 0.001), whereas the proportion of subjects with less than three visible veins was 56 (60.8%), 31 (55.4%) and 30 (38.4%), respectively (p < 0.05). The number of visible veins correlated with CACS (r = 0.28; p < 0.05). In a multivariate regression analysis, which included age, gender, CACS, LV ejection fraction, myocardial volume and heart rate, the CACS was found to be an independent determinant of the number of visible veins (p < 0.05). CONCLUSIONS: The results of our study suggested that there is a link between a variation in the cardiac venous system and the extent of atherosclerosis. KEY WORDS: Coronary artery calcium score (CACS); Computed tomography; Coronary veins.

Coronary venous system in cardiac computer tomography: Visualization, classification and role.

The role of the coronary venous system was underestimated for many years. In the last 20 years, a few percutaneous cardiology techniques in which the anatomy of the coronary venous system was significant were developed and are in use. The most important seems to be cardiac resynchronization therapy, which is an invasive method for the treatment of heart failure. Unfortunately, one of the major problems is the significant anatomical variability of the coronary venous system. The description of the selected anatomical structures is only useful in selected cases such as, for example, the obstruction of selected vessels, a huge Thebesian valve, etc. The 3D images can add significant value; however, their usefulness is limited due to the different points of view that are obtained during intra-operational fluoroscopy. After summarizing all of the articles and guidelines, it can be recommended that the visualization of the coronary venous system be performed in certain patients before cardiac resynchronization. The best option is to use tomography with retrospective gating with the optimal reconstruction of cardiac veins that occurs during the diastolic phases.

Effect of coronary artery calcium score on the reduction of global cardiovascular risk.

INTRODUCTION: There are no studies evaluating an association between different coronary artery calcium scores (CACS) and reduction of traditional cardiovascular risk. OBJECTIVES: The aim of the study was to evaluate the effect of coronary calcium scoring on the reduction of global cardiovascular risk. PATIENTS AND METHODS: This was a prospective single-center study including 180 subjects (mean age, 58.8 years). Calcifications on computed tomography were calculated by 2 experts using the Agatston scale. Selected cardiovascular risk factors and medical procedures used in subjects were analyzed. RESULTS: Invasive coronary angiography was performed in 60 patients (33.2%). It did not show significant coronary lesions in 26 patients (43.3%), while in the other 26 patients (43.3%), coronary angioplasty (stent implantation, balloon angioplasty) was performed. Eight subjects (13.3%) were referred for coronary artery bypass grafting (CABG), and the procedure was performed only in patients with a CACS of 400 AU and higher. Angioplasty was performed 10 times more often in these patients compared with patients with a CACS of 1 to 399 AU. A significant correlation between the CACS and cardiovascular risk was observed in relation to age, weight, and systolic and diastolic blood pressure. CONCLUSIONS: Coronary calcium scoring allows to identify patients requiring invasive coronary angioplasty, or, in some cases, CABG, with greater precision. This can strengthen the role of the CACS as a complement to a classic evaluation of cardiovascular risk factors.

Every patient with atrial fibrillation has his (her) own optimal heart rate.

Heart rate control is an important part of atrial fibrillation (AF) treatment and the recommendation for the target rate has become lenient in the recent guideline. Since heart rhythm of AF patients is irregularly irregular with great rate variation, the number of effective ventricular contractions may be different within a given time period among patients with similar heart rates and it may further lead to different levels of cardiac output. Therefore, we propose that every AF patient has his (her) own optimal heart rate, or to say that, the target for rate control in each AF patient should be individualized. This optimal heart rate can be defined by pulse counting, echocardiography or cardiopulmonary exercise test. With this new target, patients will achieve higher cardiac output with better exercise tolerance and life quality, even an improved prognosis.

Traditional, forgotten and new left ventricular systolic function parameters on a 64-row multidetector cardiac computed tomography: a reproducibility study.

BACKGROUND: Multidetector computed tomography angiography (MDCT) can provide data regarding cardiac function if a retrospective scanning is applied. We aimed at examination of the reproducibility of traditional and more sensitive parameters of the left ventricular (LV) contractility by means of a 64-row CT in order to establish errors of measurement and to determine limits that allow for a reliable detection of their changes. METHODS AND RESULTS: A random sample of 25 individuals, including 15 females (aged 64 ± 13 years) and 10 males (54 ± 13 years), who had MDCT examination were retrospectively included in this study. Data reconstructions were performed on a dedicated workstation. In each case, axial image series were created with a 10% step from 0% to 90% of the RR interval using a 2 mm slice thickness. LV volume was determined in each phase. Detailed LV volume changes within phases were analyzed to determine the largest difference between the neighbor phases (peak ejection volume, PEV, mL) during systole and to calculate the peak ejection rate (PER i.e. PEV/phase duration [1/10th of RR interval], mL/s). The derived parameters were calculated as the PER normalized for LVEDV (PER-V, 1/s), the PER normalized for LVM (PER-M, mL/g × s) and the PER normalized for LVEDV times the PER normalized for LVM product (PER-VM, ml/g × s2). Considering the errors percentages, the respective values for intra- and inter-observer errors were around 5% and 8% for standard LV systolic measures. The percentage intra-observer errors' ranged between -7.8% and -10.8%, and the inter-observer errors' ranged between -11.8% and -15.7% for both PEV and PER. For the same reader, the percentage errors ranged between -8.7% and +11.9% for PER-V, -10% and +12.7% for PER-M and -18.2% and +24% for PER-VM. For the independent reader the corresponding values were -15.2% and +15.5%, -12.3% and +16.3%, and -26.6% and +30.9%. The intra- -class coeffi cients for repeated measurements for both the same reader (intra-observer) or independent reader (inter-observer) did reach values above 0.9 and around 0.8, respectively. CONCLUSIONS: We concluded that traditional LV systolic parameters, as well as more sensitive measures of cardiac contractility could be determined reliably by means of a 64-row MDCT. The errors for global LV systolic function measures amount to about 5%, for PEV and PER about 15% and for the PER-derived parameters about 25%. The measurement errors established might help to assess the signifi cance of changes in repeated MDCT examinations.

Anatomical variants of left circumflex artery, coronary sinus and mitral valve can determine safety of percutaneous mitral annuloplasty.

BACKGROUND: The anatomical variants of the relations of the left circumflex artery (LCx) andthe coronary sinus (CS) determine the safety of percutaneous mitral annuloplasty (PMA) as an occlusion of the LCx and its consequences might occur in some cases. Thus, knowledge ofthe anatomy of cardiac anatomy and any variations are important for surgeons. METHODS: In 320 (126 women, age 59 ± 11) patients, a 64-slice computed tomography (MSCT) (Aquilion 64) was performed due to a suspicion of coronary artery disease. A scanwith ECG-gating was performed using a slice thickness of 0.5 mm during a breath-hold. The helical pitch was 12.8, rotation time: 0.4 s and average tube voltage: 135 kV at 380 mA.100 mL of non-ionic contrast agent was given in three phases at an average rate of 4.5 mL/s.In each case, ten 3D volume rendering and 2D multiplanar reconstructions of the vessels were created (Vitrea 2). RESULTS: The CS was visualized in all cases and the LCx in 315 (98.4%). In 302 (95.8%)cases, the CS was the dominant vessel; in 10 (3.17%) cases both vessels were equal and the LCxwas dominant in only 3 (0.9%) cases. 52 anatomical variants were identified; 3 of them werethe most common (in 164/315 cases; 50.8%). The CS usually lies above the atrioventricular(AV) sulcus (239-75.9%) and the LCx within the AV sulcus (173-54.9%). In 235 (74.6%)cases, the LCx was closer (than the CS) to the mitral valve. It was found that in 78 (24.7%) cases, the LCx was beneath the CS in selected phases (a risk of LCx occlusion by a PMA device).The LCx closer to the mitral valve, which is considered as a safe feature for PMA, was observed in only 75 (23.8%) of the cases. The most dangerous pattern was found in 19 cases(6.1%) - 2 or 3 CS/LCx crosses. CONCLUSIONS: The huge anatomical variability of the anatomy of the CS/LCx strengthens the role of MSCT before PMA implantation.

Can multi-slice computed tomography of the heart be useful in patients with epicardial leads?

New visualization methods are helpful in the noninvasive diagnosis of heart diseases. However, sometimes epicardial and endocardial leads can cause problems due to a large number of artifacts. Based on the presented case, we conclude that it is possible to perform multi-slice computed tomography of coronary arteries despite the coexistence of transvenous and epicardial leads.