Diagnosing Acute Heart Failure in the Pediatric Emergency Department Using Point-of-Care Ultrasound.

BACKGROUND: Acute heart failure (AHF) in children is associated with significant disease burden with high rates of morbidity, mortality, and resource utilization. These children often present to the emergency department with clinical features that mimic common childhood illnesses. Cardiac point-of-care ultrasound (POCUS) can be an effective tool for rapidly identifying abnormal cardiac function. CASE REPORTS: This case series documents 10 children presenting with AHF between 2016 and 2019 and demonstrates how pediatric emergency physicians used cardiac POCUS to expedite their diagnosis, management, and disposition. All cardiac POCUS was performed before comprehensive echocardiograms were completed. One case is described in detail; the other cases are summarized in a Table. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Early recognition of AHF is critical to reduce pediatric morbidity and mortality. With proper training, cardiac POCUS can be an effective adjunct and should be considered for the early diagnosis and treatment of infants and children with AHF.

Estrogen prevents cardiac and vascular failure in the 'listless' zebrafish (Danio rerio) developmental model.

The presence of a robust estrogen (E2) response system throughout heart and blood vessel tissues of vertebrates, including humans, has led to the speculation that this ubiquitous hormone may play a prominent role in the health and maintenance of the adult cardiovascular system (CVS). We previously established an embryonic zebrafish model called 'listless', which results from the inhibition of E2 synthesis by treatment with aromatase enzyme inhibitors (AI). These fish have outward symptoms similar to the human condition of congestive heart failure and tamponade. E2 replacement therapy (1) reduced the severity of cardiac sac abnormalities, (2) protected heart function, (3) prevented reduction in heart size, and (4) reduced blood vessel deterioration. Nitric oxide may be a critical downstream mediator of these events. We also demonstrate that removal of fluid around the heart increases survival of AI-treated fish. These results strongly indicate the importance of E2 in the developing CVS of the zebrafish and offer a potential model for the study of its role in CVS development, maintenance, and disease conditions.

Ovarian Juvenile Granulosa Cell Tumor Case Report.

A 5-month-old female presented to the emergency department with worsening abdominal distention and postprandial emesis. Point-of-care ultrasound (POCUS) demonstrated extensive abdominal free fluid with a large, heterogeneous mass in the suprapubic region. This was confirmed on computed tomography (CT) of the abdomen and pelvis. The patient was urgently taken to the operating room for exploratory laparotomy where a ruptured tumor was discovered. The patient was eventually diagnosed with ovarian juvenile granulosa cell tumor. POCUS can be vital in guiding the recognition of rare pediatric conditions in the emergency department and should be considered in patients where there is concern for an acute abdomen. Topics: Abdominal pain, ascites, ovarian juvenile granulosa cell tumor, point-of-care ultrasound.

The effects of aromatase inhibitors and selective estrogen receptor modulators on eye development in the zebrafish (Danio rerio).

PURPOSE: It has been shown that the steroid hormone estrogen plays an important role in the development of the central nervous system. The purpose of these studies was to determine the effect of estrogen on zebrafish eye maturation. METHODS: In these experiments, the estrogen receptor blockers tamoxifen and clomiphene, selective estrogen receptor modulators (SERMs), were used to determine the role of estrogen in the developing eye by morphometric microscopic techniques. Also, in this study the synthesis of estrogen was inhibited with aminoglutethimide or 4-hydroxyandrostenedione treatments, both of which are aromatase inhibitors (AIs). RESULTS: After these various treatments, the zebrafish were analyzed for eye maturation and growth rates, which were significantly diminished with both AI and SERM treatments. In a competition assay, where tamoxifen and excess estrogen were added at the same time normal eye development and body growth took place, indicating that estrogen out-competed tamoxifen and that these phenomena were most likely exerted at the level of the estrogen receptor. Specifically, morphometric analysis revealed a significantly diminished thickness in most retinal layers, and, most particularly, in the two plexiform layers where synaptic contacts are established. CONCLUSIONS: These studies have demonstrated that the presence of estrogen in the early developing embryo is critical for retinal development and overall body growth.