Ventricular bigeminy characterization in 24-h Holter monitoring from Andersen-Tawil patients: An initial proof of concept versus patients with ischemic heart disease.

AIM: To characterize ventricular bigeminy from 24-h Holter recordings of Andersen-Tawil syndrome (ATS) patients, a first comparison with a large database of post-myocardial infarction (post-MI) patients with frequent premature ventricular complexes (PVC) was performed. METHODS: Baseline Holter recordings from 6 ATS1 patients and 618 post-MI patients were analyzed to assess total number of PVC, quantification of coupling intervals (CI), total number of bigeminy episodes, and percentage of PVC in bigeminy. RESULTS: A non-significant difference in total number of PVCs, mean CI and CI standard deviation was found. The median number of episodes of bigeminy (1038 vs 1; p = 0.004) and of PVC in bigeminy (51.1 vs 0.1%; p = 0.002) was significantly higher in ATS1 patients. Having ≥42 episodes of bigeminy or ≥ 36.1% of PVC in bigeminy distinguish PVC from ATS from post-MI patients with a sensitivity and specificity >80%. CONCLUSION: In this first approach, patients with ATS had a characteristic burden of episodes of ventricular bigeminy, compared with post-MI patients.

Mefloquine causes selective mast cell apoptosis in cutaneous mastocytosis lesions by a secretory granule-mediated pathway.

Mastocytosis is a KIT-related myeloproliferative disease characterised by abnormal expansion of neoplastic mast cells (MC) in the skin or virtually any other organ system. The cutaneous form of adult-onset mastocytosis is almost invariably combined with indolent systemic involvement for which curative therapy is yet not available. Here we evaluated a concept of depleting cutaneous MCs in mastocytosis lesions ex vivo by targeting their secretory granules. Skin biopsies from mastocytosis patients were incubated with or without mefloquine, an antimalarial drug known to penetrate into acidic organelles such as MC secretory granules. Mefloquine reduced the number of dermal MCs without affecting keratinocyte proliferation or epidermal gross morphology at drug concentrations up to 40 µM. Flow cytometric analysis of purified dermal MCs showed that mefloquine-induced cell death was mainly due to apoptosis and accompanied by caspase-3 activation. However, caspase inhibition provided only partial protection against mefloquine-induced cell death, indicating predominantly caspase-independent apoptosis. Further assessments revealed that mefloquine caused an elevation of granule pH and a corresponding decrease in cytosolic pH, suggesting drug-induced granule permeabilisation. Extensive damage to the MC secretory granules was confirmed by transmission electron microscopy analysis. Further, blockade of granule acidification or serine protease activity prior to mefloquine treatment protected MCs from apoptosis, indicating that granule acidity and granule-localised serine proteases play major roles in the execution of mefloquine-induced cell death. Altogether, these findings reveal that mefloquine induces selective apoptosis of MCs by targeting their secretory granules and suggest that the drug may potentially extend its range of medical applications.

Clear Cell Proliferations of the Skin: A Histopathologic Review.

ABSTRACT: Cutaneous clear cell proliferations encompass a heterogenous group of several primary cutaneous neoplasms and metastatic tumors with different histogenesis. Many of these clear cell proliferations may seem strikingly similar under the microscope resulting in challenging diagnosis. In many of these clear cell lesions, the reason for the clear or pale appearance of proliferating cells is unknown, whereas in other ones, this clear cell appearance is due to intracytoplasmic accumulation of glycogen, mucin, or lipid. Artifacts of tissue processing and degenerative phenomenon may also be responsible for the clear cell appearance of proliferating cells. Awareness of the histopathologic findings as well as histochemical and immunohistochemical techniques are crucial to the accurate diagnosis. This review details the histopathologic features of clear cell cutaneous proliferations, classifying them according their type of differentiation and paying special attention to the histopathologic differential diagnosis among them.

Screening food-borne and zoonotic pathogens associated with livestock practices in the Sumapaz region, Cundinamarca, Colombia.

Hazardous practices regarding antibiotics misuse, unsanitary milking procedures, and the commercial sales of raw milk and unpasteurized dairy products are currently being practiced by livestock farmers in the Sumapaz region (Colombia). The purpose of this study was to screen for food-borne and zoonotic pathogens associated with local livestock practices. We evaluated 1098 cows from 46 livestock farms in the Sumapaz region that were selected by random. Of the total population of cattle, 962 animals (88%) were tested for bovine TB using a caudal-fold tuberculin test and 546 (50%) for brucellosis by a competitive ELISA. In the population tested, 23 cows were positive for Brucella sp. representing a 4.2% seroprevalence and no cases of bovine tuberculosis were found. In addition, food-borne contamination with Escherichia coli and Staphylococcus aureus was assessed together with antibiotic susceptibility for ten different antibiotics in milk samples from 16 livestock farms. We found that 12 of the farms (75%) were contaminated with these food-borne pathogens. Noteworthy, all of the isolated pathogenic strains were resistant to multiple antibiotics, primarily to oxytetracycline and erythromycin. Our findings suggest that livestock products could be a source of exposure to Brucella and multidrug-resistant E. coli and S. aureus strains as a result of unhygienic livestock practices in the Sumapaz region. Training in good farming practices is the key to improving safety in food production.

Purpura fulminans, TEN, and disseminated herpes simplex: An unexpected combination.

Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and purpura fulminans (PF) are all rare conditions. A combination of these 3 conditions together with a viral infection is very rare. A 52-year-old, previously healthy woman which developed SJS, potentially due to a reaction to CT contrast, although this is still unknown. This developed into TEN on day 10 of the initial admission, the patient scored 3 points on SCORTEN. On day 12 from initial admission, she developed unexpected multiorgan failure and PF. The patient passed away 2 days later, the autopsy demonstrates herpes simplex virus in the bladder and lungs on immunohistological staining. Our clinical case encountered the challenge of differentiating TEN and PF. The microscopic and immunochemical examination confirmed the clinical suspicion of PF but also a disseminated herpes simplex infection. We speculate the clinical route of this case started SJS and TEN, leading to superimposed infection with three different types of bacteria, confirmed in blood cultures, and a disseminated viral infection. The combination of all these diagnoses are very rare, no similar case has been described in adults to the authors' knowledge. We recommend a prompt diagnosis and early recognition of both bacterial and viral infections to prevent the development of PF.

Fibroblastic Connective Tissue Nevus Mimicking Lipoma on Ultrasound: Case Report and Brief Review.

Fibroblastic connective tissue nevus (FCTN) is a rare, benign, and recently described dermal mesenchymal lesion characterized by CD34-positive spindle cells. We present a case of FCTN on the upper back of a 9-month-old boy who was diagnosed with a benign lipoma by ultrasound.

Resource use decrease after implementation of care bundles for treatment of postpartum hemorrhage.

OBJECTIVE: To evaluate whether the implementation of care bundles has an impact on resource utilization in the care of patients with postpartum hemorrhage (PPH). METHODS: Retrospective, cross-sectional, observational study of 404 patients with stage II or greater PPH. Periods 2011-2014 and 2015-2017, before and after the introduction of care bundles, were compared. Billing reports were analyzed, and all services provided to treat these events were extracted. Use of resources within the two periods was computed. RESULTS: The amount billed per episode decreased 18.66% from the first to the second period. Most PPH cases used fewer resources after introduction of care bundles. The greatest reduction was in the use of medications, with a decrease of charges by 56.3%. Diagnostic procedure charges decreased by 47.6% and consultation charges decreased by (37.7%). CONCLUSIONS: The use of PPH care bundles may be associated with lower resource use and fewer interventions.

Identificación y secuenciación de SARS-CoV-2 en una leona africana (Panthera leo), bajo el cuidado técnico profesional, en Colombia

Objetivo Identificar y caracterizar el virus SARS-CoV-2 en una leona africana (Panthera leo), hembra, de edad avanzada, que presentó por varios meses signos relacionados con enfermedad respiratoria atípica. Métodos Se tomaron muestras de hisopados nasales 23 días después de haber reportado secreción nasal inicial. Se realizó la detección del virus SARS-Cov2 mediante RT-qPCR y posteriormente se caracterizó el genoma completo mediante secuencia Illumina. Resultados Desde el punto de vista clínico, los resultados encontrados en las muestras de sangre no mostraron cambios evidentes que se pudieran relacionar con el virus o con todos los signos descritos desde el inicio del caso. Para la secuenciación genómica los análisis mostraron una alineación múltiple comparativa entre los tres genomas (muestra Leona, FIP u NC_045512 [Wu han]) por medio de Mauve, centrado en los genes Spike, E y M (archivo complementario, parte B). Se logró identificar 5 segmentos muy similares entre Leona y NC_045512 (Wuhan). Conclusiones Es necesario adelantar más investigaciones para estandarizar el diagnóstico de esta patología en los animales. Así mismo, se requieren estudios genómicos en estas especies. Además, se evidenció con la revisión del estado de la cuestión que existen muchos vacíos del conocimiento en la implicación zoonótica de la pandemia y en el conocimiento de este virus en animales domésticos y silvestres, lo que supone un reto importante para las investigaciones de aquí en adelante.

Objective To identify and characterize the SARS-CoV-2 virus in an elderly African lioness (Panthera leo) that presented signs related to atypical respiratory disease for several months. Methods Nasal swab samples were taken 23 days after infection. have reported initial nasal discharge. Results The SARS-Cov2 virus was detected by RT-qPCR and the complete genome was subsequently characterized by Illumina sequencing. The results found in the blood samples did not show obvious changes that could be related to the virus or to the signs described from the beginning of the case. For genomic sequencing the analyzes showed a comparative multiple alignment between the three genomes (sample Leona, FIP or NC_045512 (Wu han)) by means of Mauve, focusing on the Spike, E and M genes (Supplementary file, part B); 5 very similar segments between Leona and NC_045512 (Wuhan) was identified. Conclusions It is necessary to carry out more research to standardize the diagnosis of this pathology in animals and guarantee access to it. Also, genomic studies in these species. Additionally, it was evidenced with the literature review that there are many knowledge gaps in the zoonotic implication of the Pandemic and in the knowledge of this virus in domestic and wild animals, which represents an important challenge for research from now on.