Left ventricular pseudoaneurysm associated with infective endocarditis: an autopsy case report.

Background: Infective endocarditis (IE) is a bacterial infection of the heart valves or endocardium, with complications such as valve perforation, ring abscess, fistula, or damage to the subaortic structures. This case report aims to illustrate an atypical complication of IE which is a pseudoaneurysm depicting a periannular hemorrhage. Case presentation: We describe a case of a 19-year-old male youth who presented with fever and cough a few days prior to his demise. There was no known risk factor for IE. The autopsy revealed a bulging anterior surface, upper part of the left ventricle which was soft and slightly fluctuant. Cut section of the heart revealed large vegetations affecting the right and left coronary cusps of the aortic valve. The vegetations at the left coronary cusp were mobile, with necrotic and hollow area underneath, appearing like a cavity and containing blood clots. The course of the cavity was determined to be at the periannular region and contained within the myocardium. These findings were consistent with left ventricular pseudoaneurysm. Culture of the vegetations specimen yielded growth of Granulicatella adiacens sp. anti-streptolysin O titre (ASOT) was 400 IU/mL and reported as positive. Conclusions: IE secondary to Granulicatella sp is rare and may result in catastrophic complications. Therefore, this case report is intended to highlight the autopsy findings of the disease as well as to create awareness of its subtle clinical symptoms.

Manifestation of Coronary Atherosclerosis in Klang Valley, Malaysia: An Autopsy Study.

AIMS: The present study aimed to determine the epidemiological aspects of medico-legal autopsies and manifestation of coronary atherosclerosis. METHODS: This was a cross sectional study involving 222 cases recruited from National Institute of Forensic Medicine (NIFM) Hospital Kuala Lumpur (HKL) and Department of Forensic Medicine Hospital Sungai Buloh (HSgB) for a period of 15 months, from December 2012 to April 2014. Sociodemographic and autopsy findings, including the cause and manner of death were documented. RESULTS: Male and female subjects aged 18-70 years were recruited. Males contributed to 86% of the total subjects and comprised 61% of young adults. Road traffic accidents were the primary cause of death, contributing almost 50% of the subjects. One third of the cases comprised of death due to natural causes, wherein almost 75% of the subjects within this category succumbed to sudden cardiac death. Coronary artery disease (CAD) contributed to 60% of the sudden cardiac death (SCD). Single and double-vessel diseases were the most common pattern of atherosclerosis. In almost 80% of CAD cases, atherosclerosis affected the left anterior descending artery (LAD). CONCLUSION: Cardiovascular diseases were the most significant natural cause of sudden death with a staggering figure of 75%. CAD was the single most commonly encountered pathology within the SCD. Most cases presented with single and double-vessel diseases, observed in all subjects, as well as the young adult population.

Effects of ischemic preconditioning of different intraoperative ischemic times of vascularized bone graft rabbit models.

BACKGROUND: Ischemic preconditioning has been shown to improve the outcomes of hypoxic tolerance of the heart, brain, lung, liver, jejunum, skin, and muscle tissues. However, to date, no report of ischemic preconditioning on vascularized bone grafts has been published. METHODS: Sixteen rabbits were divided into four groups with ischemic times of 2, 6, 14, and 18 hours. Half of the rabbits in each group underwent ischemic preconditioning. The osteomyocutaneous flaps consisted of the tibia bone, from which the overlying muscle and skin were raised. The technique of ischemic preconditioning involved applying a vascular clamp to the pedicle for 3 cycles of 10 minutes each. The rabbits then underwent serial plain radiography and computed tomography imaging on the first, second, fourth, and sixth postoperative weeks. Following this, all of the rabbits were sacrificed and histological examinations were performed. RESULTS: The results showed that for clinical analysis of the skin flaps and bone grafts, the preconditioned groups showed better survivability. In the plain radiographs, except for two non-preconditioned rabbits with intraoperative ischemic times of 6 hours, all began to show early callus formation at the fourth week. The computed tomography findings showed more callus formation in the preconditioned groups for all of the ischemic times except for the 18-hour group. The histological findings correlated with the radiological findings. There was no statistical significance in the difference between the two groups. CONCLUSIONS: In conclusion, ischemic preconditioning improved the survivability of skin flaps and increased callus formation during the healing process of vascularized bone grafts.

Gender differences in responses towards anti-smoking messages and policy implementation among future doctors in Malaysia.

BACKGROUND: Medical students' views may provide some direction for future policy considerations. AIM: The aim of this study was to assess gender differences in future doctors' receptiveness to currently implemented anti-smoking messages and the effectiveness of those messages. MATERIALS AND METHODS: We administered a questionnaire to all students at a medical university in Malaysia, asking how frequently they noted anti- smoking policies, anti-smoking campaigns, and anti-smoking messages in schools. In addition, the questionnaire investigated most effective methods to convey these messages. RESULTS: A total of 522 (59.7%) students responded. Students were least likely to approve of total bans on cigarettes and increasing the price of cigarettes, and most likely to approve of bans on use of cigarettes in public places and sales to individuals less than 16 years old. Approval of total bans on cigarettes was more common in female students than in males OR=0.39 (95%CI: 0.18- 0.86). Furthermore, compared to the female students, the male students thought that printed media; OR=2.32 (95%CI: 1.31-4.10), radio; OR=1.93 (95%CI: 1.15-3.22) and the internet; OR=1.96 (95%CI: 1.15-3.33) were very effective at delivering anti-smoking messages. CONCLUSIONS: Gender differences existed in the future doctors' perception of the effectiveness of anti-smoking initiatives. Taking this gender difference into account may increase the receipt of anti-smoking messages in adolescents.