Group B streptococcal (GBS) bacteremia with mycotic thoracic aortic aneurysm and suppurative pericardial effusion.

Mycotic aortic aneurysm associated with suppurative pericardial effusion is a rare and serious clinical phenomenon that is linked with significant morbidity and mortality. We report a case of a 78-year-old man who presented with purulent pericardial effusion with tamponade physiology in association with a progressively enlarging, transverse aortic arch, mycotic aneurysm due to group B streptococci. To our knowledge, this is only the second reported case of this nature. Despite advances in the current era of antibiotics and surgical techniques, early diagnosis and aggressive treatment remain sentinel to successful management of the cardiovascular complications of group B streptococcus bacteremia.

Variable conduction system disorders in takotsubo cardiomyopathy: a case series.

Takotsubo cardiomyopathy is an acute cardiac condition characterized by transient systolic dysfunction of the left ventricular apex and mid-ventricle. Documented EKG presentations for Takotsubo cardiomyopathy include ST-segment elevation or T-wave inversion. These EKG presentations are included in the diagnostic requirements for Takotsubo cardiomyopathy. This paper presents two cases of atypical EKG presentations, both conduction system disorders, and their possible mechanisms. Changes to the diagnostic criteria for Takotsubo cardiomyopathy should be considered to include these variant EKG presentations.

Lower glial metabolite levels in brains of young children with prenatal nicotine exposure.

Many pregnant women smoke cigarettes during pregnancy, but the effect of nicotine on the developing human brain is not well understood, especially in young children. This study aims to determine the effects of prenatal nicotine exposure (PNE) on brain metabolite levels in young (3-4 years old) children, using proton magnetic resonance spectroscopy ((1)H MRS). Twenty-six children with PNE and 24 nicotine-unexposed children (controls) were evaluated with a structured examination, a battery of neuropsychological tests, and MRI/(1)H MRS (without sedation). Concentrations of N-acetyl compounds (NA), total creatine (tCR), choline-containing compounds (CHO), myo-inositol (MI), and glutamate+glutamine (GLX) were measured in four brain regions. Children with PNE had similar performance to controls on neuropsychological testing. However, compared to controls, the PNE group had lower MI (repeated measures ANOVA-p = 0.03) and tCr levels (repeated measures ANOVA-p = 0.003), especially in the basal ganglia of the girls (-19.3%, p = 0.01). In contrast, GLX was elevated in the anterior cingulate cortex of the PNE children (+9.4%, p = 0.03), and those with the highest GLX levels had the poorest performance on vocabulary (r = -0.67; p < 0.001) and visual motor integration (r = -0.53; p = 0.01). The amount of prenatal nicotine exposure did not correlate with metabolite concentrations. These findings suggest that PNE may lead to subclinical abnormalities in glial development, especially in the basal ganglia, and regionally specific changes in other neurometabolites. These alterations were not influenced by the amount of nicotine exposure prenatally. However, the effects of PNE on energy metabolism may be sex specific, with greater alterations in girls.

Screening for sickle trait among potential live kidney donors: policies and practices in US transplant centers.

Sickle cell trait is common in the United States (US) and associated with abnormalities of renal function. Little is known, however, about the potential risk of sickle cell trait to live kidney donors. Using an original questionnaire, we assessed the policies and practices of US renal transplant centers with regard to screening for sickle trait among potential live kidney donors. Fifty-four percent (137/252) of centers responded. Eighty-three percent (113/137) of transplant centers had no policy to screen donors for sickle trait. Thirty-four percent (46/135) of centers reported actually screening donors for sickle trait in practice. Thirty-seven percent (39/105) of centers reported excluding donors with sickle trait always or most of the time. High volume centers (>100 live donor transplants/year) were more likely to screen for sickle trait (Fisher's exact, P = 0.03), but not more likely to exclude potential donors with sickle trait from donating. Most US renal transplant centers do not screen donors for sickle trait. Wide variation is evident in center practice regarding exclusion of donors on the basis of sickle trait. Research into the potential impact of sickle trait on renal function after donation is needed to guide transplant clinicians.