Clinical profile and one-year outcomes of patients with mural infective endocarditis: - A tertiary care centre study based on data from a seven-year registry.

BACKGROUND: Infective endocarditis patients present very rarely with vegetations on the mural endocardium. Only very few studies are available comparing Mural infective endocarditis with commoner valvular or device related infective endocarditis. AIM: To analyse the clinical features, microbiological profile and clinical course of mural endocarditis in comparison to valvular endocarditis. METHODS: This was a retrospective analysis of data from a registry of infective endocarditis. Patients enrolled between April 2012 and April 2019 were included. Patients who were reported to have vegetations on the mural endocardial surface were taken as a group and compared with rest of the patients. Clinical profile, laboratory parameters including culture and outcomes were compared between the two groups. RESULTS: Out of 278 patients in the study, 15 (5.38%) had vegetations on the mural endocardium. Of them, only 4 patients had structural heart diseases. All the patients with mural endocarditis were NYHA class II or below at presentation. Ventricles were the commonest sites of vegetations. Inflammatory markers like ESR and CRP were low in mural endocarditis compared to rest. Culture positivity was high in mural endocarditis and Staphylococcus Aureus was the commonest organism. Mural endocarditis patients had similar in hospital mortality to rest of the patients. Cardiac complications were not reported in mural endocarditis, but they had similar incidence of embolic complications including neurological events. CONCLUSION: Mural endocarditis is a rare clinical entity with similar morbidity and mortality to that of endocarditis with valvular vegetation.

Primary Antiphospholipid Antibody Syndrome Presenting as Acute Myocardial Infarction.

A 46-year-old woman with no significant past history presented to the emergency department with history of sudden-onset central chest discomfort and diaphoresis. With a preliminary diagnosis of acute myocardial infarction, she was subjected to coronary angiography, which showed occlusion of the distal left anterior descending artery with otherwise normal epicardial coronary arteries. Aspiration was performed in the vessel and yielded pinkish friable tissue. The histopathological examination revealed fibrin-rich thrombus. The patient was treated with enoxaparin and switched to oral anticoagulation with warfarin. On follow-up, the nodular mass on the mitral valve reduced considerably in size and she was advised that life-long anticoagulation was necessary.

Th1 skewed immune response of whole virion inactivated SARS CoV 2 vaccine and its safety evaluation.

We report the development and evaluation of safety and immunogenicity of a whole virion inactivated (WVI) SARS-CoV-2 vaccine (BBV152), adjuvanted with aluminum hydroxide gel (Algel), or TLR7/8 agonist chemisorbed Algel. We used a well-characterized SARS-CoV-2 strain and an established Vero cell platform to produce large-scale GMP-grade highly purified inactivated antigen. Product development and manufacturing process were carried out in a BSL-3 facility. Immunogenicity and safety were determined at two antigen concentrations (3µg and 6µg), with two different adjuvants, in mice, rats, and rabbits. Our results show that BBV152 vaccine formulations generated significantly high antigen-binding and neutralizing antibody titers (NAb), at both concentrations, in all three species with excellent safety profiles. The inactivated vaccine formulation contains TLR7/8 agonist adjuvant-induced Th1-biased antibody responses with elevated IgG2a/IgG1 ratio and increased levels of SARS-CoV-2-specific IFN-γ+ CD4+ T lymphocyte response. Our results support further development for phase I/II clinical trials in humans.

Spontaneous chondrosarcoma in Wistar rat: a case report.

In rats, chondrosarcomas have been reported to occur both spontaneously and secondary to chemical induction. In a rare case, a spontaneous chondrosarcoma was identified in the deformed femur of a young male Wistar rat. After gross examination of the femur and knee joint, tissue was collected and preserved. The formalin-fixed tissue was decalcified, embedded in paraffin, sectioned, and stained with hematoxylin and eosin. Microscopic examinations revealed a large, highly proliferative, noncapsulated growth of chondrocytic or chondroblastic origin in the femoral bone, with proliferating chondrocytes invading the bone and surrounding tissues in an infiltrative growth pattern. Based on its histomorphological features, the lesion was diagnosed as a malignant cartilaginous neoplasm of spontaneous origin.

Ultra Long Stent in an Aberrant Right Coronary Artery.

The prevalence of anomalous origin of right coronary artery from the left sinus is about 0.92%. A percutaneous coronary intervention (PCI) in such a vessel is challenging especially when maneuvering long stents. We report a case of 75-year old female patient with recent acute coronary syndrome. The angiogram showed significant lesions in the left anterior descending coronary artery and the left circumflex coronary artery with an aberrant RCA originating from the left sinus close to the origin of LMCA with multiple tight lesions. The aberrant RCA was stented with a 50 mm long stent. To the best of our knowledge, the placement of such a long stent in an aberrant coronary artery has hitherto never been reported in the literature.