Concurrent Cerebral Amyloid Angiopathy (CAA) and Atrial Fibrillation are becoming an increasingly common dilemma in clinical practice due to the aging population and the comorbidities associated with it. In such patients, the physician must appreciate and strike the difficult balance between the risk of ischemic strokes from atrial fibrillation on one hand, and that of intracerebral hemorrhage from coexisting CAA on the other. Anticoagulation is necessary for the former but potentially deleterious for the latter. In this case report, we present the case of a 67-year-old woman with a long history of atrial fibrillation on rivaroxaban who recently began to experience recurrent transient neurological deficits that were later diagnosed as amyloid spells related to concomitant CAA. While there is no clear-cut consensus in published literature on how to best manage these patients regarding the use of anticoagulation, it is recommended to involve a multidisciplinary team for optimal management of these patients.

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Multicopper oxidases (MCOs) represent a diverse family of enzymes that catalyze the oxidation of either an organic or a metal substrate with concomitant reduction of dioxygen to water. These enzymes contain variable numbers of cupredoxin domains, two, three or six per subunit, and rely on four copper ions, a single type I copper and three additional copper ions organized in a trinuclear cluster (TNC), with one type II and two type III copper ions, to catalyze the reaction. Here, two crystal structures and the enzymatic characterization of Marinithermus hydrothermalis MCO, a two-domain enzyme, are reported. This enzyme decolorizes Congo Red dye at 70°C in the presence of high halide concentrations and may therefore be useful in the detoxification of industrial waste that contains dyes. In two distinct crystal structures, MhMCO forms the trimers seen in other two-domain MCOs, but differs from these enzymes in that four trimers interact to create a dodecamer. This dodecamer of MhMCO forms a closed ball-like structure and has implications for the sequestration of bound divalent metal ions as well as substrate accessibility. In each subunit of the dodecameric structures, a Trp residue, Trp351, located between the type I and TNC sites exists in two distinct conformations, consistent with a potential role in facilitating electron transfer in the enzyme.

Objective The study aims to review the literature regarding abnormalities predisposing to Sudden Cardiac Death (SCD) in young Middle Eastern and African competitive athletes between the years 2009–2019 and aims to assess cardiac pre-participation screening methods. Methods A PubMed search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search targeted articles that reported the prevalence of cardiac abnormalities found in Middle Eastern and African athletes, and it also focused on comparing cardiac screening methods for assessment of athletes. Results our studies fell within the inclusion criteria and were included in the study. Results identified a shortage in the literature regarding prevalence rates of SCD in the Middle East and Africa. Additionally, there seems to be a lack of ethnicity-specific cardiac pre-participation screening programs in the region. Nevertheless, the prevalence of SCD-related abnormalities (HCM, ARVC, etc …) ranged from 0.47 to 4.29%. Included studies conveyed only male athletes with no reports on the female athletic population. Conclusion The present study highlights a need to develop an efficient cardiac pre-participation screening program specific to Arab and African athletes due to their high false-positive rates in contrast to Caucasian athletes. Significant evidence proves that an adequate cardiac screening program can prevent SCD in young competitive athletes. Therefore, it is imperative that future studies highlight the prevalence of abnormalities directly related to SCD in order to create a valid screening program that can be implemented in the region to mitigate the risk of shocking events.

Objectives: The novel Coronavirus (SARS-CoV2) adversely affects cardiac status and may cause arrhythmias. The objective of this study is to describe the case of a 41 year-old female presenting to the emergency department with Right ventricular outflow tract (RVOT) ventricular tachycardia; as well as to appraise and compare etiologies proposed in the literature with our case. Methods: The study design is a case report and review of the literature. A PubMed/Medline search was conducted including studies published in peer-reviewed journals between December, 2019 and November, 2020. Papers discussing the relationship between COVID-19 and cardiac arrhythmias were included, excluding the pediatric population and papers with major confounding factors to the predisposition of cardiac arrhythmias. Results: 6 papers were included in the qualitative synthesis. These papers discussed different mechanisms by which COVID-19 can cause arrhythmias. These results were compared with the findings in our case in an attempt to better understand the etiology behind our case of RVOT-VT. Proposed etiologies included ACE2-mediated direct damage of cardiomyocytes, raised serum CRP levels, and raised systemic inflammatory markers and activation of the Ca2+/Calmodulin protein kinase I. Conclusion: The lack of associated comorbidities and risk factors in our patient highlights the unique challenge of identifying the clinical sequelae of COVID-19. Proposed pathophysiologies in the literature were not applicable to our case, highlighting the need for clinical monitoring in patients, and the need for further research on the topic.