Simulating Subject-Specific Aortic Hemodynamic Effects of Valvular Lesions in Rheumatic Heart Disease.

Rheumatic heart disease (RHD) is a neglected tropical disease despite the substantial global health burden. In this study, we aimed to develop a lower cost method of modeling aortic blood flow using subject-specific velocity profiles, aiding our understanding of RHD's consequences on the structure and function of the ascending aorta. Echocardiography and cardiovascular magnetic resonance (CMR) are often used for diagnosis, including valve dysfunction assessments. However, there is a need to further characterize aortic valve lesions to improve treatment options and timing for patients, while using accessible and affordable imaging strategies. Here, we simulated effects of RHD aortic valve lesions on the aorta using computational fluid dynamics (CFD). We hypothesized that inlet velocity distribution and wall shear stress (WSS) will differ between RHD and non-RHD individuals, as well as between subject-specific and standard Womersley velocity profiles. Phase-contrast CMR data from South Africa of six RHD subjects with aortic stenosis and/or regurgitation and six matched controls were used to estimate subject-specific velocity inlet profiles and the mean velocity for Womersley profiles. Our findings were twofold. First, we found WSS in subject-specific RHD was significantly higher (p < 0.05) than control subject simulations, while Womersley simulation groups did not differ. Second, evaluating spatial velocity differences (ΔSV) between simulation types revealed that simulations of RHD had significantly higher ΔSV than non-RHD (p < 0.05), these results highlight the need for implementing subject-specific input into RHD CFD, which we demonstrate how to accomplish through accessible methods.

Coombs-Negative Haemolytic Anaemia, Direct Hyperbilirubinaemia and Splenomegaly: A Rare Amalgam.

INTRODUCTION: Epstein-Barr virus (EBV) is notorious for its varied presentation in adults. Reactivation of EBV can occur at any time and is often due to weakened cellular immunity. CASE DESCRIPTION: Here we report the case of a young woman with no previous medical history who presented with cholestatic hepatitis, Coombs-negative haemolytic anaemia and splenomegaly. Due to the initial disjointed picture with no other localizing symptoms, she underwent extensive work-up for the same. DISCUSSION: EBV has been associated with many malignancies, autoimmune diseases and chronic fatigue syndrome. EBV causes elevated liver enzymes; however, cholestatic hepatitis is exceedingly rare, with only a few cases reported. Haemolytic anaemia is a common complication of EBV infection and is often Coombs positive. CONCLUSION: EBV testing should be considered before more invasive and expensive work-up in a patient presenting with multi-systemic abnormalities. LEARNING POINTS: Epstein-Barr virus (EBV) can have myriad manifestations in all age groups.Coombs-negative haemolytic anaemia can occur as a complication of EBV.EBV testing should be considered prior to more expensive work-up in anyone presenting with abnormalities in the reticuloendothelial system.

Morbilliform Rash: An Uncommon Herald of SARS-CoV-2.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus first detected in Wuhan, China in 2019 after an outbreak of flu-like illness. The disease came to be known as the coronavirus disease of 2019 (COVID-19). It has spread quickly, spanning many countries, and has become a global pandemic. As this is a novel virus, its varied manifestations and symptomatology are coming to light daily. Although most threatening to the respiratory system, this virus has the propensity to affect multiple organ systems quickly leading to multi-organ dysfunction. Many dermatologic manifestations have been reported with no clear pattern. Most data have been anecdotal.  Here we present a 78-year-old male who tested positive for SARS-CoV-2 with no usual symptoms that would alert one of the possibilities of COVID-19. He did, however, have a diffuse morbilliform rash most notable on the trunk and back. He went on to develop fever thereafter but did not develop any respiratory complications. The rash was short-lived and was treated with topical steroids and oral antihistamines. It is important to know and report new findings of novel diseases not only for diagnosis and treatment but also to place appropriate isolation precautions and containment. Rash may be the initial and sometimes the only manifestation of COVID-19.

Fatal Cerebral Edema in a Young Adult with Diabetic Ketoacidosis: Blame the Bicarbonate?

Cerebral edema is a devastating complication of DKA which is extremely rare in adults but is the leading cause of diabetes-related death in the pediatric population. Newly diagnosed diabetes, younger age, first episode of DKA, severity of DKA at presentation, and administration of bicarbonate are predictive of cerebral edema in DKA. We present a case of a young adult with DKA as the presenting symptom of diabetes, whose clinical course was complicated by renal failure, refractory shock, and cerebral edema. This case addresses the controversy surrounding bicarbonate therapy in DKA and its possible role in the development of a rare fatal complication of DKA.