bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bacterial Endosymbionts Identified From Leafhopper (Hemiptera: Cicadellidae) Vectors of Phytoplasmas
Authors: Cooper William Rodney , Walker William B , Angelella Gina M , Swisher Grimm Kylie D , Foutz Jillian J , Harper Scott J , Nottingham Louis B , Northfield Tobin D , Wohleb Carrie H , Strausbaugh Carl A 
Published: March 2023

Abstract
Insects often harbor bacterial endosymbionts that provide them with nutritional benefit or with protection against natural enemies, plant defenses, insecticides, and abiotic stresses. Certain endosymbionts may also alter acquisition and transmission of plant pathogens by insect vectors. We identified bacterial endosymbionts from four leafhopper vectors (Hemiptera: Cicadellidae) of ‘Candidatus Phytoplasma’ species by direct sequencing 16S rDNA and confirmed endosymbiont presence and identity by species-specific conventional PCR. We examined three vectors of Ca. Phytoplasma pruni, causal agent of cherry X-disease [Colladonus geminatus (Van Duzee), Colladonus montanus reductus (Van Duzee), Euscelidius variegatus (Kirschbaum)] – and a vector of Ca. Phytoplasma trifolii, the causal agent of potato purple top disease [Circulifer tenellus (Baker)]. Direct sequencing of 16S identified the two obligate endosymbionts of leafhoppers, ‘Ca. Sulcia’ and ‘Ca. Nasuia’, which are known to produce essential amino acids lacking in the leafhoppers’ phloem sap diet. About 57% of C. geminatus also harbored endosymbiotic Rickettsia. We identified ‘Ca. Yamatotoia cicadellidicola’ in Euscelidius variegatus, providing just the second host record for this endosymbiont. Circulifer tenellus harbored the facultative endosymbiont Wolbachia, although the average infection rate was only 13% and all males were Wolbachia-uninfected. A significantly greater percentage of Wolbachia-infected Ci. tenellus adults than uninfected adults carried Ca. P. trifolii, suggesting that Wolbachia may increase this insect’s ability to tolerate or acquire this pathogen. Results of our study provide a foundation for continued work on interactions between leafhoppers, bacterial endosymbionts, and phytoplasma.
Within and beyond 12-month efficacy and safety of antithrombotic strategies in patients with established coronary artery disease: two companion network meta-analyses of the 2022 joint clinical consensus statement of the European Association of Percutaneous Cardiovascular Interventions (EAPCI), European Association for Acute CardioVascular Care (ACVC), and European Association of Preventive Cardiology (EAPC)
Authors: Navarese Eliano Pio , Landi Antonio , Oliva Angelo , Piccolo Raffaele , Aboyans Victor , Angiolillo Dominick , Atar Dan , Capodanno Davide , Fox Keith A A , Halvorsen Sigrun , James Stefan , Jüni Peter , Kunadian Vijay , Leonardi Sergio , Mehran Roxana , Montalescot Gilles , Niebauer Josef , Price Susanna , Storey Robert F , Völler Heinz , Vranckx Pascal , Windecker Stephan , Valgimigli Marco 
Published: March 2023

AbstractAimsTo appraise all available antithrombotic treatments within or after 12 months following coronary revascularization and/or acute coronary syndrome in two network meta-analyses.Methods and resultsForty-three (N = 189 261 patients) trials within 12 months and 19 (N = 139 086 patients) trials beyond 12 months were included for efficacy/safety endpoints appraisal. Within 12 months, ticagrelor 90 mg bis in die (b.i.d.) [hazard ratio (HR), 0.66; 95% confidence interval (CI), 0.49–0.88], aspirin and ticagrelor 90 mg (HR, 0.85; 95% CI, 0.76–0.95), or aspirin, clopidogrel and rivaroxaban 2.5 mg b.i.d. (HR, 0.66; 95% CI, 0.51–0.86) were the only treatments associated with lower cardiovascular mortality, compared with aspirin and clopidogrel, without or with greater bleeding risk for the first and the other treatment options, respectively. Beyond 12 months, no strategy lowered mortality; compared with aspirin; the greatest reductions of myocardial infarction (MI) were found with aspirin and clopidogrel (HR, 0.68; 95% CI, 0.55–0.85) or P2Y12 inhibitor monotherapy (HR, 0.76; 95% CI: 0.61–0.95), especially ticagrelor 90 mg (HR, 0.54; 95% CI, 0.32–0.92), and of stroke with VKA (HR, 0.56; 95% CI, 0.44–0.76) or aspirin and rivaroxaban 2.5 mg (HR, 0.58; 95% CI, 0.44–0.76). All treatments increased bleeding except P2Y12 monotherapy, compared with aspirin.ConclusionWithin 12 months, ticagrelor 90 mg monotherapy was the only treatment associated with lower mortality, without bleeding risk trade-off compared with aspirin and clopidogrel. Beyond 12 months, P2Y12 monotherapy, especially ticagrelor 90 mg, was associated with lower MI without bleeding trade-off; aspirin and rivaroxaban 2.5 mg most effectively reduced stroke, with a more acceptable bleeding risk than VKA, compared with aspirin.Registration URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifiers: CRD42021243985 and CRD42021252398.
C2. A Case of Arrhythmogenic Right Ventricular Cardiomyopathy Presenting with Recurrent Ventricular Tachycardia : The Role of Imaging to Confirm Diagnosis
Authors: Permitasari D A , Habibi F N , Ardhianto P 
Published: March 2023

Abstract

Background
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited condition which predominantly affects young people, characterized by fibrofatty replacement of the right ventricle. It is also commonly being underdiagnosed, so that the role of imaging is imperative to confirm diagnosis of ARVC patient.

Case Summary
A 57-year-old man presented with palpitation, syncope and chest pain. The symptoms had begun since 3 month prior to hospital admission with no family history of premature sudden death. He had been hospitalized 3 times before due to palpitation. Electrocardiogram (ECG) revealed ventricular tachycardia with LBBB morphology and superior axis. Patient was undergoing 100 Joule cardioversion, and the ECG post-cardioversion showed sinus rhythm with inverted T-wave in inferior and anterior leads. Echocardiography revealed enlargement and reduced function of right ventricle (RV). Coroangiography revealed nonsignificant stenosis coronary artery disease. Cardiac MRI showed dyssynchrony RV contraction, reduced RV ejection fraction &lt;40%, hyperintensity in RV endocardium and posteroinferior aspect of endocardium to myocardium left ventricle, representing the fatty infiltration. Our patient had 2 major criteria which established the diagnosis of definite ARVC according to revised Task Force Criteria. Patient was planned to have an implantable cardiac defibrillator.

Discussion
Late clinical presentation of ARVC is rare, thus it should be included in the differential diagnosis when treating older patient with ventricular tachyarrhythmia. This case highlights the importance of imaging, either with echocardiography and cardiac MRI to confirm the diagnosis of ARVC as the potential cause sudden cardiac death.
C6. Acute Limb Ischemia Patient with Covid 19 Progressing to Chronic Limb-Threatening Ischemia: a Case Report
Authors: Wicaksono  , Kurnianingsih N 
Published: March 2023

Abstract

Background
Acute Limb Ischemia (ALI) and Chronic Limb-Threatening Ischemia (CLTI) are manifestations of Peripheral Artery Disease (PAD). The management of ALI and CLTI, apart from optimal medical treatment and lifestyle control, also includes surgery and endovascular revascularization. ALI and CLTI conditions can be a thromboembolic complication of Covid 19.

Case Description
A 58-year-old woman with risk factor Diabetes Mellitus presents with a black leg on the digiti I and digiti II of the right inferior extremity. She also complains of walking pain for 2 months. Previously, She had been treated with complaints of ischemic leg pain 2 months earlier and had performed a Doppler Ultrasound. At that time, she was diagnosed as ALI Grade II-A and was positive for Covid 19, from the laboratory examinations it was found an increase in fibrinogen, 419 mg/dl (Reference value 154.3-397.9) and D-Dimer increased to 0.9 mg/L (Reference value ≤ 0.5), She had undergone a surgical embolectomy procedure. At the time of the last control and based on CT-angiography, she was assessed as CLTI with Fontaine IV, Rutherford V, WIfI 1-1-0 and decided to do endovascular revascularization.

Discussion
The choice of either a surgical procedure or endovascular revascularization depends on grading and the initial assessment. Correct timing of ALI and CLTI treatment will increase limb salvage rate. Covid 19 can also manifest as a condition associated with a hypercoagulable state that can, in turn, lead to both arterial and venous thrombosis.
C9. An Extremely Rare Dual Congenital Disorder of The Heart: Aberrant Tendinous Chords with Tethering of The Tricuspid Leaflet Associated with Wolff-Parkinson-White Syndrome
Authors: Hartoko A , Nugraha M T 
Published: March 2023

Abstract

Background
Aberrant tendinous chords with tethering of the tricuspid leaflets is a rare congenital etiology of tricuspid regurgitation (TR), defined as abnormal insertion of tendinous cords at the clear zone of the tricuspid leaflet and connect to the endocardium instead of the papillary muscles. Wolff-Parkinson-White (WPW) syndrome defined as a congenital condition involving additional conductive cardiac tissue between the atria and the ventricles that provides a pathway for a reentrant tachycardia circuit. Ebstein's anomaly (EA) is the most commonly occurring congenital abnormality that caused TR associated with the WPW. Until now, there is no case report of aberrant tendinous chords with tethering of the tricuspid leaflets that associated with WPW.

Case Illustration
A 26-year-old female with history of recurrent palpitation she was given was referred to our hospital. Resting ECG revealed sinus rhythm with delta wave suggesting diagnostic of WPW. On physical examination we found loud systolic murmur on left lower sternal border. Echocardiography examination revealed dilated right atrial and right ventricle, severe tricuspid regurgitation with restricted septal TV caused by aberrant tendinous chords. No apical displacement of tricuspid leaflet &gt;8 mm/m2 excluding the diagnosis of EA.

Discussion
Both WPW and aberrant tendinous chords with tethering of the tricuspid leaflet are rare congenital disorder of the heart. EA is most common congenital TR associated with WPW, there are rarely reported other congenital TR associated with WPW. This case illustrates extremely rare case where we found both WPW and Aberrant Tendinous Chords.
C15. Biventricular Heart Failure and Pulmonary Hypertension in Systemic Sclerosis: a rare and unusual case report
Authors: Farissa I P , Trisnawan M H , Ahnaf M F , Hellmi R Y 
Published: March 2023

Abstract

Backgrounds
Systemic sclerosis (SSc), chronic multisystem autoimmune disease, characterized by excessive fibrosis and vascular endothelial dysfunction. Cardiovascular involvement may be induced by various pathways, either primary or secondary to pulmonary hypertension or renal involvement.

Case Summary
A 46 years old woman presented to emergency department with cold, dark purplish ulcers in fingertips with progressive worsening pain in upper extremities, claudication intermitten, and dyspneu since 4 months ago. She had a mask-like facial, shiny skin, microstomia, restricted mouth opening, calcinosis cutis, Raynauds phenomenon, and sclerodactyly. There were pansystolic murmur grade III/6 in tricuspid area, and rales in basal lungs. ECG showed sinus rhythm with fragmented QRS, poor R-wave progression. Chest X-Ray revealed pancardiomegaly with pleural effusion and HRCT thorax revealed interstitial lungs disease. The laboratory revealed leucocytosis, increase D-dimer (870 ug/L), negative ANA and ds-DNA test, positive anti SCl test. Echocardiography showed biventricular dysfunction with decreased LVEF 37% (Teichz) and TAPSE 10 mm, RA RV dilatation, severe TR with high probability for PH. Extremities Doppler showed normal arteries and veins system. These findings indicates that primary and secondary cardiac involvement in SSc. Heart failure, pulmonary hypertension, and cyclophosphamide medication were administered

Discussion
Primary cardiac involvement, a direct consequence of SSc, may manifest as fibrosis of the myocardial, conduction system, pericardial and, valvular disease. Furthermore, a secondary phenomenon due to pulmonary arterial hypertension (PAH), and kidney pathology. Though the burden remains low, it may worsen the outcome, consequently, all patients with SSc should undergo screening.
C16. BRASH (Bradycardia, Renal Failure, AV Nodal Blocker, Shock, and Hyperkalemia) Syndrome: Lost in Plain Sight
Authors: Hazzy Fandy , Rohman M Saifur 
Published: March 2023

Abstract

Background
Bradycardia, Renal failure, AV-Nodal blockers, Shock, Hyperkalemia (BRASH) Syndrome new clinical entities due to a vicious cycle in which hyperkalemia from renal failure synergizes with AV-nodal blockers, consequently between the clinical condition of patients with the degree of hyperkalemia and bradycardia are inappropriate, Furthermore, the symptoms may be refractory to typical positive chronotropic interventions or overdose antidotes.

Case Illustration
A hypertensive 70-years old female with history of heart failure with routinely consume spironolactone, diltiazem, and beta blocker admitted with bradycardia and shock after watery diarrhea and vomit 3 days before. The electrocardiogram showed junctional rhythm 40 beats per minutes. Laboratory findings Hyperkalemia (6.8 mEq/L) and acute kidney injury (urea 58.6 mg/dL, creatinine 3.13 mg/dL, eGFR 16.23) was presented. Refractory hyperkalemia occured, but by using pacemaker, providing adequate fluids, and the return of renal perfusion, hyperkalemia can be overcome.

Discussion
BRASH syndrome usually triggered by hypotension in the elderly due to hypovolemia or an overdose of antihypertensive drugs. The natural compensation response for hypotension is to increase heart rate, but AV-nodal blockers blunt this response, which causes a decrease in renal perfusion. This ultimately results in hyperkalemia and accumulation of AV-nodal blockers which produce a synergistic effect causes bradycardia and decreased renal perfusion. Treatment involves supportive care including hemodynamic support with fluids and management of bradycardia, and also avoid trigger factor.
C17. Can we improve the clinical manifestation of superior vena cava syndrome without treat the underlying disease?
Authors: Mappangara Idar , Syamsuddin Deni , Idul Hafiz 
Published: March 2023

Abstract

Background
Superior vena cava syndrome (SVCS) is a clinical manifestations from obstruction of superior vena cava that has thin wall. The main goals of SVCS management are to relieve the symptom and give therapy for the underlying disease. For now, there some additional therapies that connected to this disease such as steroid, diuretic, and anticoagulant. Flavonoid which a derivate from gamma benzopyrone has pharmacodynamics mechanism that appropriate with SVCS.

Case Summary
We reported a male 35 years old came with SVCS typical manifestations. Then, we done some additional examinations, and we establish the diagnose with SVCS et cause anterior mediastinum mass suspected thymoma. The patient was planned to done histology biopsy, but the patient was refused to done any examination or interventions. We already gave diuretic, Vit-K antagonist anticoagulant, and high dose in short period steroid, but there was no any clinical improvement. Then, we add flavonoid hesperidin-diosmin, and there was clinical improvement after 1 months.

Discussion
Based on the management algorithm of SVCS, we should done histology biopsy to this patient to establish the main cause of SVCS, so we can treat the patient by the cause. In literatures about SVCS, there was no any pharmacotherapies that believed can give clinical improvement, including steroid, diuretics, and anticoagulant. Flavonoid that has pharmacodynamics such as anti-inflammation, improve venous tone, increase lymphatic drainage appropriate with the clinical pathomechanism of SVCS. So it may has rational therapeutic effect to this patient.
C28. Chronic Limb Threatening Ischemia in Patient With Aortoiliac Occlusive Disease (Leriche Syndrome) and Pulmonary Hypertension
Authors: Permana E , Suwirya A P , Sutanegara B A 
Published: March 2023

Abstract

Background
Chronic limb-threatening ischemia (CLTI) is a manifestation of peripheral arterial disease (PAD) which is characterized by stenosis or occlusion of peripheral arteries causing impaired perfusion to the extremities, especially during rest and chronic progresses, which are associated with decreased quality of life and increased morbidity and mortality.

Case Description
A 51-year-old man complained of wound on both legs and pain during light activity. Risk factor is smoking for 30 years. History of primary pulmonary hypertension since 30 years. Physical examination revealed decreased pulsation from femoral artery to dorsalis pedis arteries in both leg. Echocardiography with RA and RV dilatation, D-shaped LV during systolic, mild TR and normal LV systolic function. Dupplex ultrasound and MSCT scan pulmonary-abdominal angiography shows thrombus in the abdominal aorta causing occlusion of blood flow distally. There is a comorbid pulmonary hypertension which causes right heart failure with symptoms of dyspnea. This patient is at high risk of undergoing revascularization surgery, so that in severe comorbid conditions an extraanatomical bypass with axillobifemoral bypass graft is considered.

Discussion
Atherosclerosis that occurs in the abdominal aorta, iliac artery, and femoropopliteal artery is called aortoiliac occlusive disease (AIOD). This condition when symptomatic is known as Leriche syndrome with a triad of symptoms of claudication, impotence, and reduced or no palpable pulsation of the femoral artery. Medical management include antiplatelet, statin, analgetic, and therapy according to risk factors. The main purpose is revascularization by surgery or endovascular which aims to improve blood flow to the distal artery.
C29. Chronic Pericardial effusion associated with Cytomegalovirus
Authors: Hutabarat H , Lukito A A , Chandra S , Fernandes R A P 
Published: March 2023

Abstract
Pericardial effusion is one of the most challenging clinical condition to determine the etiologies. A 60 yo woman presented with atypical sign of pericardial effusion. She visited several physicians and without any clinical improvement. Echocardiography revealed 133.5 ml pericardial effusion and pericardial thickness of 12,14 mm. Cardiac MRI was then performed and indicated, thickening of pericardium (4.8-5.1mm) at lateral right atrium, RV free wall and apical RV. The thickened part of the pericardium at apical RV has rigid, immobile appearance. Moderate amount of pericardial effusion prominently located at basal of heart. Pericardial effusion was at superior and lateral right atrium, apical RV and LV, and lateral, inferior, anterior left ventricle. Serology tests Anti CMV IgG reactive, anti CMV IgM non reactive and TB quantiferon negative. These results confirmed the pericarditis associated with CMV infection. The biggest challenge for the clinician is to find out an etiologic diagnosis. The common causes of pericarditis are infection (viral, bacterial), metabolic (renal failure, hypothyroidsism), cancer, myocardial infarction, and post traumatic. Among infectious causes, the enteroviruses, herpesviruses and mycobacterium tuberculosis are the most common causes. Cytomegalovirus belongs to the herpesviruses group. Clinician should be aware about the possible etiologies, as chronic pericarditis is a condition that requires comprehensive and multidisciplinary approaches.
C33. Complex ebstein anomaly in adult patient: a case report
Authors: Ratnasari A B , Fagi R A 
Published: March 2023

Abstract

Background
Ebstein’s anomaly is a rare form of congenital heart disease. In adult often present with arrhythmias, progressive cyanosis, and right heart failure. Management is complex and individualized.

Case Summary
A 24-year-old woman presented to the emergency room with heart failure presentation, palpitations and fainting. ECG examination shows abberant SVT with pulse, hemodinamically was stable with peripheral saturation 94% without oxygen supplementation. The patient then carried out cardioversion and got anti-arrhythmia amiodarone. Resting ECG obtained sinus rhythm right axis deviation with incomplete LBBB (splintered QRS). Echocardiography examination revealed displacement of the tricuspid valve, a large atrialized component of the right ventricle, the anterior leaflet of the tricuspid valve moves freely with bidirectional shunt ASD and moderate pericardial effusion, confirmed for Ebstein's anomaly type B .
Diuresis therapy was given and anti-arrhythmic therapy was continued. Echocardiographic evaluation showed reduced pericardial effusion to a minimum. Patients were scheduled for electrophysiological studies and angiographic evaluation and total corrections were planned.

Discussion
Ebstein anomaly is a characterized by abnormally formed and apically displaced leaflets of Tricuspid caused by is failure of proper delamination of the tricuspid valve, primarily of the septal and anterior leaflets from ventricular myocardium. The cardinal symptoms in Ebstein’s anomaly are cyanosis, right-sided heart failure, arrhythmias, and sudden cardiac death. Surgery is indicated in adults with symptoms of heart failure. Medical therapy is generally used only for temporary stabilization : diuretic therapy for volume overload, control of heart rhythm abnormalities, and standard medical therapy for left ventricular systolic dysfunction.
C37. Device Closure of Perimembranous Ventricle Septal Defect with Zero Fluoroscopy : The First case in Eastern region of Indonesia
Authors: Yoseph Hendry , Fitriani Aussie , Patimang Yulius , Alief Andi 
Published: March 2023

Abstract

Background
Ventricular septal defects (VSDs) are the most common Congenital Heart Defects (CHD) lesion in children. Transcatheter closure is considered as an alternative to surgery, for past few decades transcatheter closure were performed under fluoroscopy, recently guidance under Transesophageal Echocardiography (TEE) is increased. Transcatheter closure under TEE Guidance remains challenging but an alternative to overcome the radiation effect.

Case Summary
We reported 3-year-old female patient admitted to RSUP Dr. Wahidin Sudirohusodo with chief complaint was easily fatigue, Physical finding revealed regular heart sound with a grade 4/6 pansystolic murmur at the left lower sternal border, Transthoracal Echocardiography (TTE) has shown perimembranous VSD (pm-VSD) 6-7 mm L-R shunt with VSD Gradient 58 mmHg and aortic rim 4,5 mm. The patient was diagnosed with pm-VSD without Pulmonary hypertension and suitable for device closure under TEE Guidance. TEE Procedure was performed under general anesthesia and we found pm-VSD 3-4 mm, we decided to close the defect with Amplatzer Duct Occluder II (AGA) no 4/4 with delivery sheath amplatzer Torqvue LP 4F via retrograde approach with zero fluoroscopy, the device was well fixated with small central residual shunt 1,6 mm with hemodynamically unsignificant, The device was released and the procedure was finished without any significant problem.

Conclusion
We reported first case of VSD closure under TEE guidance in Eastern region of Indonesia, Transcatheter closure of pm-VSD under TEE Guidance are feasible and safe and can be an alternative to surgery and conventional technique under fluoroscopy to prevent radiation effect.