Acute dissection of a syphilitic saccular aneurysm of the ascending aorta and arch in a hypertensive patient - a rare phenomenon.

We report the case of a 77-year-old male who suffered from hypertension and died suddenly. At autopsy, he was found to have hypertensive cardiomegaly and a dissecting syphilitic saccular aneurysm of the ascending aorta and arch with tamponade. Chronic aortic regurgitation, which is often seen in syphilitic aortitis, produces an additive effect to the concentric left ventricular hypertrophy seen in hypertension.

Acute dissection of a syphilitic saccular aneurysm of the ascending aorta and arch in a hypertensive patient - a rare phenomenon

ABSTRACT We report the case of a 77-year-old male who suffered from hypertension and died suddenly. At autopsy, he was found to have hypertensive cardiomegaly and a dissecting syphilitic saccular aneurysm of the ascending aorta and arch with tamponade. Chronic aortic regurgitation, which is often seen in syphilitic aortitis, produces an additive effect to the concentric left ventricular hypertrophy seen in hypertension.

COVID-19: a closer look at the pathology in two autopsied cases. Is the pericyte at the center of the pathological process in COVID-19?

We performed autopsies on two cases of COVID-19. The microcirculations of all organs were the site of the pathological findings. Thrombotic microangiopathy was found in the brain and also the kidneys. Vasculitis was also a feature of the autopsy findings, together with portal triaditis of the liver. The major pathological findings in both cases were fibrin deposits. Within the lung, the fibrin deposits were observed in the alveolar microcirculation in sub-endothelial locations of capillaries, arterioles, post capillary venules, and the adventitia of larger vessels. These fibrin deposits in the lungs occurred at the sites where pericytes are located in these vessels. The pericyte with its high concentration of ACE-2 receptors and its procoagulant state may represent one of the primary sites of action of SARS-CoV-2. A review of pericytes in health and disease is undertaken. COVID-19 is a disease of the microcirculation.

Coronavirus 229E with Rhinovirus co-infection causing severe acute respiratory distress syndrome with thrombotic microangiopathy and death during Covid-19 pandemic: lessons to be learnt.

We report on a 3-month old infant male who had a seven-days history of fever and rhinorrhea associated with wheezing prior to his death, during the Covid-19 pandemic. Viral testing for Covid-19 (SARS-CoV-2) was negative but was positive for Coronavirus 229E and RP Human Rhinovirus. The pulmonary histological examination showed diffuse alveolar damage along with thrombotic microangiopathy affecting alveolar capillaries. Also, thrombotic microangiopathy was evident in the heart, lungs, brain, kidneys and liver. Thrombotic microangiopathy is a major pathologic finding in Acute Respiratory Distress Syndrome and in the multiorgan failure. This is the first report that illustrates thrombotic microangiopathy occurring in lung, heart, liver, kidney and brain in Acute Respiratory Distress Syndrome with Coronavirus 229E with Rhinovirus co-infection. The clinical presentation and pathological findings in our case share common features with Covid-19.

Reducing acute poisoning in developing countries--options for restricting the availability of pesticides.

Hundreds of thousands of people are dying around the world each year from the effects of the use, or misuse, of pesticides. This paper reviews the different options to reduce availability of the most hazardous chemicals, focusing on issues in developing countries. Emphasis is placed on the fatal poisoning cases and hence the focus on self-harm cases. Overall, it is argued here that restricting access to the most hazardous pesticides would be of paramount importance to reduce the number of severe acute poisoning cases and case-fatalities and would provide greater opportunities for preventive programmes to act effectively. The aim should be to achieve an almost immediate phasing out of the WHO Classes I and II pesticides through national policies and enforcement. These short-term aims will have to be supported by medium- and long-term objectives focusing on the substitution of pesticides with safe and cost-effective alternatives, possibly guided by the establishment of a Minimum Pesticide List, and the development of future agricultural practices where pesticide usage is reduced to an absolute minimum. Underlying factors that make individuals at risk for self-harm include domestic problems, alcohol or drug addiction, emotional distress, depression, physical illness, social isolation or financial hardship. These should be addressed through preventive health programmes and community development efforts.

Severe aplastic anaemia - complete response to antilymphocyte globulin and cyclosporin

Severe aplastic anaemia is uniformly fatal unless treated with immunosuppressive therapy or bone marrow transplantation. The latter is curative in 65 percent of patients and is the treatment of choice in children and young adults. Antilymphocyte globulin (ALG) and cyclosporin may be used successfully in the absence of an HLA matched sibling donor. We report the case of a twelve year old boy with severe aplastic anaemia who received immunosuppressive with ALG and cyclosporin and is alive and well three years an six months post treatment.(AU)

Forensic analysis of acute fatal poisonings in the southern districts of Trinidad

A prospective autopsy study was undertaken at General Hospital in San Fernando, Trinidad, to analyze deaths that occurred form poisoning during 1996 and 1997. During that period 105 deaths occurred from acute poisoning. The major poisons used were: paraquat (80 cases), organophosphate/carbamate insecticides (10 cases), and anti-psychotic drugs (6 cases). Much less frequently, battery acid, ETHREL [Ethephon; (2-chlorethyl) phosphonic acid], phenols, ethanol, kerosene and flavine were the agents of choice. Suicide accounted for 99 (94.29 percent) deaths. Of these, 44.44 percent occurred in the 10-29 y-age-group. Ingestion of paraquat seems almost always fatal, since the large volumes ingested make treatment universally ineffective. Aspiration pneumonitis (100 percent of cases), were remarkable autopsy findings in those dying from paraquat poisoning, while asphyxia due to respiratory paralysis was the mode of death from pesticide ingestion. Efforts to prevent suicide by poisoning may be more useful than treatment protocols.(Au)

High rates of paraquat-induced suicide in southern Trinidad

The suicide rate in Trinidad and Tobago is much greater than that of its English-speaking Caribbean neighbors. Many of these suicides are paraquat induced. This research reviewed the deaths due to suicide in the area with the greatest agricultural activity in Trinidad for 1996 and identified, for further demographic and etiological investigation, cases in which paraquat was ingested as the agent of suicide. Of 48 cases of suicide for the year, 39 (81.3 percent) were due to paraquat poisoning. The incidence of paraquat-induced suicide was 8.0 per 100,000. Among the males, 47.8 percent were in the age group 25-34 (p< 0.001), and among the females 50.0 percent were in the 15-4 age group (p < 0.05). Family-of-origin disputes were the most frequently cited precipitant, folllowed by marital problems. Individuals of East Indian origin accounted for 89 percent of the suicide victims (p < 0.001). When compared with suicide by other methods in the country, these findings confirm that paraquat poisoning is a significant means of suicide in Trinidad and that young East Indian individuals are particularly vulnerable.(AU)

Paraquat induced suicide in Southern Trinidad

The rate of suicide in Trinidad and Tobago is much greater than in most of its Caribbean neighbours and self poisoning is the most common form of suicidal gesture. Paraquat poisoning in particular has been identified as one of the main agents of completed suicide. We therefore reviewed the deaths due to suicide in 1996 in South Trinidad, which is the area of Trinidad with the greatest agricultural activity, in an attempt to characterize paraquat induced suicide in terms of demographic and aetiological features. Case notes and clinical interviews were reviewed in all deaths due to deliberate self harm for the year 1996 at the General Hospital, San Fernando, Trinidad. There were 48 cases of completed suicide for the year and 39 (81 percent) of these were due to paraquat poisoning, giving an incidence of 8 per 100,000 population. Among the males, 48 percent were in the 25-34 year age group (p<0.001) and among the females 50 percent were in the 15-24 year age group (p<0.05). Family of origin disputes and marital problems were the most cited precipitants (p<0.003). Individuals of East Indian descent accounted for 89 percent of the cases (p<0.001). Psychiatric diagnoses were made in 20 percent of the cases with depression being the most frequently identified condition. While the ingestion of paraquat was often accompanied by heavy alcohol dependence. These findings confirm that paraquat poisoning continues to be a very significant problem and that young East Indian individuals seem particularly likely to attempt suicide by this means.(AU)

Aids and cocaine addiction: review and research findings

Deep seated mycoses were the most common findings in cocaine addicts who died of AIDS in Trinidad, West Indies with Candida species, Histoplasma capsulatum and Aspergillus species being the most common. Contaminated smoke either from crack cocaine, marijuana or hemp was the suspected risk factor for the acquisition of Histoplasma capsulatum and Aspergillus infection. Pneumocysitis carinii was seen in 50 percent of cases. Pulmonary infections were a feature in all cases in the study and massive hepato-splenomegaly were the most common pathological findings in Histoplasmosis. In regions where Histoplasma capsulatum is endemic, the findings of massive Hepatosplenomegaly in patients should alert the physicians to the possibility of the Acquired Immune Deficiency Syndrome as a differential diagnosis. Efforts should be made to expeditiously identify and treat these organism since they contribute significantly to the morbidity and mortality of cocaine addicts afflicted with AIDS. Prophylaxis for these specific infectious organisms should also be considered (AU)

Fatal metastatic calcification in a patient with HTLV-I-associated lymphoma

Metastic calcification of the heart, lungs and kidneys is described in a 42-year-old male who had an HTLV-I-associated lymphoma. This fatal complication of HTLV-I-associated lymphoma has been infrequently reported, and the case in question is the first to be recorded in the Caribbean, where HTLV-I is common. Aggressive therapy of hypercalcaemia should be instituted early in its genesis in these lymphomas, so as to avoid its fatal outcome (AU)

Fatal metastatic calcification in a patient with HTLV-I-associated lymphoma

Metastic calcification of the heart, lungs and kidneys is described in a 42-year-old male who had an HTLV-I-associated lymphoma. This fatal complication of HTLV-I-associated lymphoma has been infrequently reported, and the case in question is the first to be recorded in the Caribbean, where HTLV-I is common. Aggressive therapy of hypercalcaemia should be instituted early in its genesis in these lymphomas, so as to avoid its fatal outcome.

Acute myocarditis induced by scorpion sting: a report of five cases and a review of the literature - abstract

The clinical features in five cases (two fatal) of acute myocarditis induced by scorpion stings in Trinidad included hypovolaemic shock, restlessness, convulsions, cerebral oedema, pulmonary oedema, pancreatitis and myocarditis. The 2 fatal cases showed myocarditis (round cell perivascular infiltrate) and marked perivascular oedema of the endomysium, pulmonary oedema and marked cerebral oedema. The clinical course in these 5 patients suggests that generalized oedema occurred within minutes which would indicate that vascular endothelial damage occurred early, It is postulated that the venom complex of the scorpion, Tityus trinitatis, acts directly on endothelial cells leading to marked vascular permeability, and/or indirectly through agents such as serotonin and kinins to produce the same effect. Therapy should therefore be directed towards correction of the hypovolaemic shock, removal of oedematous fluid from the extravascular space, maintenance of adequate ventilation, reduction of cerebral oedema, digitalization and stabilization of the vascular endothelial membrane (AU)

Screening for HTLV-I in healthy blood donors in Trinidad and Tobago, West Indies

Of 1089 healthy blood donors screened for HTLV-I using ABBOTTS HTLV-I EIA: 18 (1.7 percent) were positive; and 16 (1.5 percent) were confirmed positive using HTLV-I/11 Cambridge Biothec Western Blot method. HTLV-I antibodies were found amongst the major ethnic groups, viz. Africans, 11 cases (68.75 percent) and East Indians 4 cases (25 percent). The mean age of the donors who tested positive for HTLV-I was 30.75 years; and the male to female ratio was 4.3:1. (AU)