Cardiac Angiosarcoma Presenting as Recurrent Pericardial Effusion and Constrictive Pericarditis

Background Malignancy accounts for 15-20% of moderate to large pericardial effusions. Among these, cardiac angiosarcomas are extremely rare. Case A 30-year-old male presented with dyspnea and fatigue, 9 months after COVID-19 infection. He had sinus tachycardia (117 beat/min). Chest X-ray showed cardiomegaly. Echocardiogram demonstrated a large circumferential pericardial effusion with right ventricular collapse. Decision-making Pericardiocentesis yielded 850 ml of bloody fluid, with symptomatic relief. He was discharged on colchicine and indomethacin with a presumptive diagnosis of post-viral pericarditis. A month later, he had recurrent symptoms and re-accumulation of large circumferential effusion. CT chest revealed multiple pulmonary nodules and bilateral pleural effusions. He underwent subxiphoid pericardial window and pleural biopsy. Fluid analysis and biopsy results were inconclusive. Over 3 weeks, he had worsening symptoms, despite a daily pericardial drain output of ~200 ml. Repeat echocardiogram showed loculation of the effusion with signs of constrictive pericarditis. He underwent pericardiectomy. Pathology revealed cardiac angiosarcoma. FDG PET scan showed thoracic metastasis. Anakinra was initiated. Conclusion Idiopathic and post-viral etiologies are the most common causes of pericardial effusion. Although rare, cardiac angiosarcoma should be on the differential diagnosis for recurrent pericardial effusion. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

Role of Hyaluronic acid in various diseases with special emphasis on Periodontal inflammation - A review

Hyaluronic acid is a naturally occurring polysaccharide of extracellular matrix of connective tissues, synovial fluid, and other body tissues. It has an important role in regulating interactions intra and extracellularly between different growth factors, in addition to regulating osmotic pressure, maintaining tissue volume and lubrication. Periodontitis is an multifactorial inflammatory disease that affects teeth supporting structures which results in teeth loss. It is considered a wide world cause of teeth loss in adults. In addition to its local effect, teeth loss, it can have systemic impacts on many systemic organs. Although its main cause is bacteria, exaggerated host response and risk factors such as smoking, diabetes mellitus, HIV/AIDS, family history, and certain medications increase the disease progress. Hence teeth supporting structures are connective tissues and hyaluronic acid is a main component of connective tissues, a correlation of both in health and disease is explained in this article. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Telementoring education and mentorship for newborn providersin Kenya, Pakistan, and Tanzania

Background Many countries, including Kenya, Pakistan, and Tanzania, have integrated the Every NewbornAction Plan guidelines into their national health strategies. Within this framework, UNICEF, in partnership with the American Academy of Pediatrics (AAP), and the three countries above, launched a novel collaborativetelementoring project with the primary aim to investigate the feasibility and utility of internationaltelementoring to improve newborn care practices. The objectives were to: 1) collect data regarding baselinenewborn care at participating sites, 2) construct a newborn telementoring curriculum based on the speciceducational needs of each site, and 3) create an adaptable and interactive forum for remote educationavailable for scale-up within each country, with the global goal of increasing individual knowledge of newborncare practices and establishing connections for ongoing educational sharing between countries. MethodsParticipating facilities (Kenya-2, Tanzania-2, Pakistan-12) were identied by UNICEF. Initial site visits wereconducted in September/October 2019 and included collection of baseline data, classication of available resources, and observations of deliveries and general care practices. The telementoring curriculum was constructed based on in-depth discussion with frontline staff and facility leadership during these visits. ResultsA 12-session telementoring curriculum was created for the East African (EA) hospitals based on theiroverlapping educational needs while a unique curriculum was created for Pakistan [Table 1]. The sessions arerun via Zoom teleconferencing software and include a case presentation by participants, a facultypresentation, and a discussion. Where possible, demonstrations and practice with newborn simulatorscomplement discussion. To create a toolkit for later use, each session is recorded for later viewing andcomplemented with links to additional resources and a shared online spreadsheet where participants canpost discussion questions. To date, six sessions have been conducted in EA and seven in Pakistan, andsessions will continue through July 2020. Several lessons have been learned, including the importance of incorporating simulation and technical aspects related to improving communication during the live sessions.Further, as the COVID-19 pandemic occurred in the midst of the project, a panel discussion aboutmanagement of COVID-19 particular to each geographic area was organized, an example of the agility of thistype of educational method. Conclusion This novel telementoring program provides longitudinal education tofrontline newborn staff at sixteen facilities in three countries. Employing techniques to increase interactivityinclude video conferencing, case discussions, skills-based activities, and the use of online question boardsallow participants to maximize their learning experience. Next steps include completion of the curriculum bysummer 2020 and further evaluation, including knowledge assessment and focus group discussions. Ifsuccessful, this project has potential for scale-up in countries with elevated newborn mortality rates, particularly during times when physical distancing is the norm.