Unilateral presentation of postpartum cardiomyopathy misdiagnosed as pneumonia.

A 34-year-old woman presented to the emergency department with severe dyspnoea 10 days following a normal-course caesarean delivery. She had been experiencing shortness of breath throughout the third trimester of pregnancy accompanied by tachycardia (110 bpm); however, her evaluation did not include ECG or chest radiography to elucidate the cause. Following delivery, chest radiography was performed demonstrating predominantly unilateral findings interpreted as pneumonia. ECG revealed T-wave inversion in leads V(4)-V(6), which was unaddressed. Overnight she deteriorated and a chest CT angiography was performed demonstrating heart enlargement and pulmonary oedema. An echocardiogram established a diminished ejection fraction (EF) of 15-20%, suggesting the diagnosis of peripartum cardiomyopathy. She was treated with angiotensin-converting enzyme inhibitors, spirinolactone and furosemide, and was free of symptoms the following month with an EF of 40-45%. Though uncommon, heart failure is a potentially fatal cause of peripartum dyspnoea, often misdiagnosed, meriting further attention.

Proapoptotic and chemosensitizing effects of selective serotonin reuptake inhibitors on T cell lymphoma/leukemia (Jurkat) in vitro.

While selective serotonin reuptake inhibitors (SSRIs) are commonly used for psychiatric indications, evidence implies them to possess anti-cancerous properties as well. We evaluated such in vitro effects in malignant T cells (Jurkat), finding that exposure to high concentrations of sertraline (IC(50)=9.5 microM) or paroxetine (IC(50)=18 microM) yielded a considerable reduction in cellular viability, exceeding equimolar doses of the chemotherapeutics vincristine and cyclophosphamide (P<0.015). The cytotoxic effects included both inhibition of proliferation and induction of apoptosis, demonstrated by decreased [3H] thymidine incorporation and increased activity of the caspase-3 enzyme, as well as a decrease in the expression of the Bcl-2 proto-oncogene. No effect on c-Jun or ERK was observed, rendering the complete mechanism yet to be fully elucidated. When combined with chemotherapy, sertraline (7.5 microM) markedly enhanced the effects of both vincristine and doxorubicin, suggesting SSRI antidepressants as potential new chemosensitizers in chemotherapeutic regimens, pending further in vivo research.