An Unusual Cause of Recurrent Syncope: Sinus of Valsalva Aneurysm.

Sinus of Valsalva aneurysm (SOVA) is a rare anomaly, commonly caused by the congenital absence of elastic and muscular tissue of the sinus aortic wall. This condition often becomes apparent at the time of rupture. The most recently reported case of syncope in unruptured SOVA was due to Tachy-Brady arrhythmia involving the conduction system. This type of aneurysm also presents with signs and symptoms of ventricular outflow tract obstruction, mimicking ventricular tumor. We report a case of recurrent syncope during exertion resulting from SOVA involving the right coronary cusp, without additional symptoms such as angina, malignant arrhythmias, or infection. The mechanisms remain unknown but may be either the consequence of transient left ventricular outflow tract obstruction or cardiac arrhythmia causing syncope during exertion. This case report presents an unusual cause of syncope and demonstrates a correlation between echocardiography and CT angiography images.

Author Correction: A Randomised Controlled Trial on the Effectiveness and Adherence of Modified Alternate-day Calorie Restriction in Improving Activity of Non-Alcoholic Fatty Liver Disease.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

A Rare Case of Purulent Pericardial TB.

Pericardial effusion is a common disease and tuberculosis (TB) accounts up to 4% of acute pericarditis with up to 7% of tamponade case. Accurate diagnosis is important while quick intervention can be life-saving. A case was reported involving a 73-year-old man who presented with reduced effort tolerance for one-month duration. During hospitalization, further workup revealed the presence of massive purulent pericardial effusion with evidence of tamponade. TB gene expert was positive in aspirated pericardial fluid and the patient was treated promptly using a combination of anti-TB drugs with the addition of steroid therapy.

A Randomised Controlled Trial on the Effectiveness and Adherence of Modified Alternate-day Calorie Restriction in Improving Activity of Non-Alcoholic Fatty Liver Disease.

Currently, there is no effective therapy for non-alcoholic fatty liver disease (NAFLD), although intensive calorie restriction is typically recommended but dietary adherence is an issue. The current study aimed to determine the effectiveness and adherence of eight weeks of modified alternate-day calorie restriction (MACR) in the control of NAFLD activity. This was a randomized controlled trial with MACR as the intervention and normal habitual diet as control. The outcome measures were body mass index (BMI), blood lipids, fasting blood sugar (FBS), liver enzymes (ALT and AST), and ultrasonographic measurements of liver steatosis and shear wave elastography (SWE). Per-protocol (PP) and intention-to-treat (ITT) analysis were performed within and between-groups with P < 0.05 as significant. 43 individuals with NAFLD satisfied study entry criteria, 33 were randomized to MACR and 10 to control group, and, 30 from MACR and 9 from control group completed PP. In between-group analysis of MACR vs. control, BMI were reduced in PP (P = 0.02) and ITT (P = 0.04). Only ALT was reduced in between-group analysis of MACR vs. control, both PP and ITT (P = 0.02 and 0.04 respectively). No reductions in all lipid parameters and FBS were found in between-group analyses (PP and ITT, all P > 0.22). Both liver steatosis grades and fibrosis (SWE) scores were reduced in between-group analyses of MACR vs. controls (PP and ITT, all P < 0.01). Adherence level remained between 75-83% throughout the study. As conclusion, 8 weeks of MACR protocol appears more effective than usual habitual diet in the control of NAFLD activity and with good adherence rate.