Background: Cardiovascular magnetic resonance (CMR) imaging is commonly used to diagnose acute myocarditis. However, the natural history of CMR-based tissue markers and their association with left ventricular recovery is poorly explored. We prospectively investigated the natural history of CMR-based myocardial injury and chamber remodeling over 12 months in patients with suspected acute myocarditis. Methods: One hundred patients with suspected acute myocarditis were enrolled. All underwent CMR evaluations at baseline and 12 months, inclusive of T2 and late gadolinium enhancement. Blinded quantitative analyses compared left ventricular chamber volumes, function, myocardial edema, and necrosis at each time point using predefined criteria. The predefined primary outcomes were improvement in left ventricular ejection fraction ≥10% and improvement in the indexed left ventricular end diastolic volume ≥10% at 12 months. Results: The mean age was 39.9±14.5 years (82 male) with baseline left ventricular ejection fraction of 57.1±11.2%. A total of 72 patients (72%) showed late gadolinium enhancement at baseline with 57 (57%) having any T2 signal elevation. Left ventricular volumes and EF improved significantly at 12 months. Global late gadolinium enhancement extent dropped from 8.5±9.2% of left ventricular mass to 3.0±5.2% ( P =0.0001) with prevalence of any late gadolinium enhancement dropping to 48%. Reductions in global T2 signal ratio occurred at 12 months (1.85±0.3 to 1.56±0.2; P =0.0001) with prevalence of T2 ratio ≥2.0 dropping to 7%. Neither marker provided associations with the primary outcomes. Conclusions: In clinically suspected acute myocarditis, significant reductions in tissue injury markers occur during the first 12 months of convalescence. Neither the presence nor extent of the investigated CMR-based tissue injury markers were predictive of our pre-defined function or remodeling outcomes at 12 months in this referral population.

Summarybackground Leishmania-tuberculosis co-infection is not uncommon in clinical practice in East Africa, but little is known about the epidemiology of this problem at population level. A cross-sectional household survey was carried out in an active visceral leishmaniasis (VL) focus in Eastern Sudan in February 2002.methods All inhabitants of Marbata village in Atbara River Area, Gedarif State, who gave informed consent, underwent both a leishmanin skin test (LST) and a tuberculin test for infection with L. donovani and Mycobacterium tuberculosis. All subjects were clinically screened for VL and tuberculosis (TB).results About 66% (252 of 382) were LST-positive, 26% (100 of 382) were tuberculin-positive and 20% (77 of 382) were positive for both tests. By the age of 15, more than 60% of inhabitants were LSTpositive, but <20% were tuberculin-positive. By the age of 30, these percentages increased to 100 and 50%. No association was found at the individual level between leishmanial and tuberculous infection after controlling for age.conclusion In this community study, we found no association between the risk of infection with L. donovani and M. tuberculosis. However, the progression to active VL disease might be different in M. tuberculosis-infected than in non-infected persons and vice versa. Prospective studies are needed to document the prognosis of TB/VL co-infection.keywords visceral leishmaniasis, epidemiology, leishmanin skin test, tuberculin, survey, Sudan

The combination of steroid and antiviral treatment increases the possibility of recovery in moderately severe to complete acute Bell's palsy.

The aim was to evaluate the use of Montgomery tracheal T-tube stenting as a single first-line treatment for postintubation laryngotracheal stenosis (LTS), addressing the outcomes, its main complications, and how to manage them. Materials and methods From March 2012 to April 2017, 25 patients with postintubation LTS had contraindication(s) for laryngotracheal surgery and were treated by Montgomery tracheal T-tube stenting as a single first-line treatment. The preoperative, operative, and postoperative follow-up data were collected retrospectively and analyzed. Results Successful outcome was reported in 16 (64%) patients, whereas seven (28%) patients had recurrent stridor after T-tube removal. It was reinserted in two of them, and the rest were subjected to other surgical procedures. Mortality was reported in two patients. Complications of different nature, severity, and durations were reported, and most of them were detected and managed successfully by applying close follow-up protocols. Conclusion Montgomery tracheal T-tube stenting is a very valuable modality in the treatment of LTS as a single first-line treatment when surgical option is contraindicated. It has a relatively low incidence of treatable complications; however, false sense of security must be avoided to ensure good outcome.