Unsolved Controversies in Management of Infective Endocarditis.

Infective endocarditis (IE) is defined as an infection in the cardiac endothelium. It is triggered by both bacteremia and endothelial dysfunction and poses many risks to the health of the patient. Many organisms can cause IE with Staphylococcus aureus being the major cause. Signs and symptoms may vary according to age and agent but almost all cases are presented with fever, fatigue, and a maculopapular rash. Although pediatric IE is very rare, risk factors such as congenital heart defects have been identified, with some of the cases remaining a mystery. We present a case of a 19-year-old patient, previously healthy and developing subacute IE with sepsis and septic embolic showers in multiple organs. IE cannot be taken for granted as mortality is high, hence a multidisciplinary approach is prompt and necessary for the survival of the patient.

Endovascular treatment of major abdominal arteriovenous fistulas: a systematic review.

PURPOSE: To review the different outcomes of the endovascular repair of major abdominal arteriovenous fistulas (AVFs). METHODS: An online systematic review of the literature was undertaken to identify all reported cases of endovascular repair of major AVFs, covering 9 major databases as well as relevant journals up to September 2013. Our own case was included. The primary outcome was technical success and mortality, the secondary outcome was the rate of complications and the operators' recommendations. RESULTS: Forty-eight articles were reviewed totaling a number of 54 patients including our own. The most common fistula site was the aortocaval segment. Aortic stent grafts were used in 78% of patients. Technical success was 94%. Intraoperative mortality was 0% with a 90-day mortality of 10%, half of which were not related to the primary pathology. Of the successful procedures, 12% of patients had major complications. One died before reintervention. All others had uneventful recoveries; 21% had minor complications treated conservatively. The majority of authors were in favor of this treatment modality.

mtDNA lineages reveal coronary artery disease-associated structures in the Lebanese population.

Population origins and ancestry have previously been found to be important determinants of coronary artery disease (CAD). This study investigates associations of Lebanese mitochondrial DNA lineages with CAD and studies their correlation with other populations, exploring population structures that may infer mitochondria functional associations and reveal population movements and origins. Sequencing the mitochondrial hypervariable sequence 1 (HVS-1) of 363 controls and 448 cases revealed that haplogroup W was more frequent (P = 0.013) in cases compared to controls, and was associated with increased risk of CAD (OR = 5.50, 95% CI = 1.50-35.30, P = 0.026) among Lebanese samples. Haplogroup A was only found in controls (P = 0.029). We have detected stronger geographic correlation between haplogroup W and CAD (Pearson's r = 0.316, P < 0.001) than between haplogroup A and CAD (r = 0.149, P < 0.001). HVS-1 phylogenetic network of haplogroup W shows controls are restricted to European clusters while cases belong mostly to Middle Eastern natives. The network of haplogroup A shows that the controls belong to a cluster dominated by Central Asians. Our results show evidence of a gene flow into Lebanon, creating CAD-associated population structures that are similar to those in the source populations, maintained by limited admixture, and probably encompassing variations on the nuclear and/or the mitochondrial genome that are correlated with the disease.

Critical appraisal of C-reactive protein throughout the spectrum of cardiovascular disease.

Clinicians involved in the care of patients with cardiovascular conditions have recently been confronted with an important body of literature linking inflammation and cardiovascular disease. Indeed, the level of systemic inflammation as measured by circulating levels of C-reactive protein (CRP) has been linked to prognosis in patients with atherosclerotic disease, congestive heart failure, atrial fibrillation, myocarditis, aortic valve disease and heart transplantation. In addition, a number of basic science reports suggest an active role for CRP in the pathophysiology of cardiovascular diseases. This article explores the potential role of CRP in disease initiation, progression, and clinical manifestations and reviews its role in the prediction of future events in clinical practice. Therapeutic interventions to decrease circulating levels of CRP are also reviewed.