We encountered two autopsy cases of huge cardiomegaly with over 1000g in weight. Histochemical characteristics were examined using conventional staining including HE and Azan stains and immunohistochemical staining using antibodies against Complement Component 9 (CC9), RNA Binding Protein Motif 3(RBM3), Endothelial Type NO Synthase (eNOS) and Hypoxic Inducible Factor1α (HIF1). The reactive area with anti CC9 antibody, which presumed to be a marker of hypoxic change of myocardium, overlapped with eosinophilic area by HE and basophilic one by Azan. Although the reactive area with anti CC9 antibody showed relatively weak in the cytoplasm by anti eNOS antibody and no in the nucleus of cardiocytes with anti RBM3 antibody, outside of the reactive area with anti CC9 antibody there were intensive reactivity with anti eNOS antibody in cytoplasm and in a nucleus with anti RBM3 antibody. Anti HIF1 antibody showed weak reactivity with cytoplasm of endocardial cardiocytes and no with cytoplasm of cardiocytes in another area. The results obtained from the present cases revealed that the hypoxic change was equivalent even though the cause of cardiomegaly was deferred between two cases, and conventional staining such as HE and Azan utilized to detect hypoxic change in the heart and immunohistochemical studies seemed to be a useful tool for clarifying the cascade of hypoxic changes in the myocardium.

We present the case of a 23-year-old female who was 23 weeks pregnant and presented to the emergency room of our Obstetric Department in nausea and vomiting that had been worsening over the course of 2 months with loss of eight kilograms in clinical presentation compatible with hyperemesis.

A 45-year-old woman with multiple sclerosis was admitted to our hospital after out of hospital cardio-pulmonary resuscitation. The first ECG showed ventricular fibrillation. Following direct current defibrillation and mechanical reanimation, spontaneous circulation was restored and the ECG unremarkable without any signs of ischemia. Coronary angiography showed unobstructed coronary arteries Figure 1, (Panel A). Left ventriculography revealed apical wall obstruction, suggestive of apical aneurysm (Panel B, supplementary videos). Transthoracic echocardiography and Cardiac Magnetic Resonance Imaging (CMR) eventually lead to the diagnosis of a rare case of Apical Hypertrophic Cardiomyopathy (AHC) with ace of spades-form (Panel C,D). The patient underwent Cardioverter-Defibrillator Implantation (ICD) and amiodarone medical therapy for secondary prophylaxis. Patient’s family history and screening for HCM were unsuspicious.

The Sodium-Glucose Cotransporter2 (SGLT2) inhibitors are a novel class of drugs for the treatment of Type2 Diabetes Mellitus (T2DM), and members of this class (canaglfloxin, dapaglifloxin, and empaglifloxin) have been approved by the FDA for the treatment of T2DM. These drugs are effective by the lowering of blood glucose and HbA1c in patients with Type2 DM through inhibition of glucose reabsorption from the proximal renal tubule of the kidney. In addition, they lower Blood Pressure (BP) and body weight and have demonstrated beneficial cardiovascular effects. However, their use has been associated with several cases of leg and toe amputations and acute kidney injury according to analysis of data by the FDA. These are preliminary warnings for physicians and their use of has not been stopped for more confirmatory reports. The SGLT2 inhibitors present a significant addition to our armamentarium for the treatment of Type2 DM, since treatment with the currently available drugs is suboptimal. These promising beneficial cardiovascular and blood pressure effects have been derived from short-term clinical trials. Hopefully, the ongoing long-term clinical outcomes studies will provide the needed information about the log-term benefits and safety of these drugs.

Pulmonary hypertension in children has many diverse etiologies. Although current treatment strategies lead to symptomatic improvement, the final outcome remains dismal. It is likely that increasingly sensitive screening biomarkers will allow for early clinical detection. Likewise, a greater understanding in molecular and biochemical mediating processes may lead to pathway specific therapeutic approaches. Hopefully, a breakthrough in treatment may not be too distant in the future.

Although the micturating cystourethrogram is included in the radiological evaluation of Jamaican children with urinary tract infections, there has never been a formal local study evaluating abnormal findings from this investigation. The aim of this paper is to document in a cohort of Jamaican children < age 12 years with urinary tract infections, the pattern of urological pathology identified by the micturating cystourethrogram. Radiological reports of micturating cystourethrogram findings in children with urinary tract infection investigated at the Bustamante Hospital for Children between October 2008 and January 2012 were identified and information on age, sex, and urological pathology recorded. Of the 523 children undergoing micturating cystourethrography, 458 fulfilled inclusion criteria. Males outnumbered females both in number (male: female 2.5:1) and in the frequency of abnormalities (13% of males and 7% of females). MCUG were abnormal in 54 children (11.8%). The commonest pathologies were vesicoureteric reflux (29%) followed by bladder /urethral abnormalities (28%). Posterior urethral valves were identified in 4 patients (1.2% of all males). In this study of a predominantly black population of children, the frequency of abnormal MCUG was less than in international studies, primarily due to the low frequency of VUR. However, the incidence of posterior urethral valves and bladder abnormalities is similar. As posterior urethral valves remain a major cause of chronic renal failure in Jamaican children, the micturating cystourethrogram is an important investigation. Financial constraints mandate local clinical research to establish more selective criteria for micturating cystourethrography.

Urinary Tract Infection (UTI) is one of the most prevalent conditions worldwide. Typically, bacteria invade by ascending from the peri-anal region. Though bacteria within the bladder can be asymptomatic and self-resolve, it can also cause symptoms including irritation, urgency, frequency and dysuria.