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International Journal of Surgery Case... May 2024Congenital gangrene of the limb in a newborn child is an extremely rare pathology with polyetiological causes that has not been fully studied. Therefore, each case of...
INTRODUCTION AND IMPORTANCE
Congenital gangrene of the limb in a newborn child is an extremely rare pathology with polyetiological causes that has not been fully studied. Therefore, each case of this pathology has its own characteristics of manifestations and allows you to get closer to solving this problem.
CASE PRESENTATION
We present a clinical case of congenital gangrene of the right upper limb in a newborn child. Analysis of the newborn baby's medical history indicated gestational hypertension and pyelonephritis during pregnancy in the mother, hemostasis disorders in the newborn. Computed tomography (CT) of the vessels of the right upper limb and thoracic segment confirmed brachial artery thrombosis. At the initial stage, conservative treatment was carried out, which included preventive antibacterial therapy and local care of the affected area. Only after a clear delineation of the dead tissue, the amputation of the segment of the right upper limb was performed. Amputation was performed with preservation of the proximal growth zone in order to provide an adequate stump for subsequent prosthetics.
CLINICAL DISCUSSION
Adverse factors during pregnancy can cause increased thrombosis. Through fetal communications, blood clots from the right atrium can enter the left atrium, the left ventricle and further into the large circulatory circle and cause thrombosis of the artery of the right upper limb. Another factor of increased thrombosis is congenital intrauterine infection of the newborn. Conservative treatment is carried out after diagnosis until the final determination of the boundaries of gangrene. When performing amputation, it is important to preserve the proximal bone growth zone in order to form an adequate stump for prosthetics.
CONCLUSION
Congenital gangrene of the limb in a newborn child is an extremely rare pathology. Irreversible changes in the upper limb in the child were caused by a combination of two factors: gestational hypertension and pyelonephritis in a pregnant woman and hemostasis disorders in a newborn due to intrauterine infection. Therefore, the preparation of women for pregnancy, examination for intrauterine infection and treatment of extragenital pathology are important in the prevention of this disease.
PubMed: 38943943
DOI: 10.1016/j.ijscr.2024.109738 -
International Journal of Surgery Case... Jun 2024Subglottic stenosis (SGS) appears to be a commonly encountered condition in the paediatric age group. Single stage cricoid split laryngoplasty with costochondral rib...
INTRODUCTION AND IMPORTANCE
Subglottic stenosis (SGS) appears to be a commonly encountered condition in the paediatric age group. Single stage cricoid split laryngoplasty with costochondral rib grafting in paediatric patients is a unique, innovative, and advanced operation in nature. Morbidity and mortality rates can be minimized with early diagnosis and prompt treatment.
PRESENTATION OF CASE
Presenting the case of a 13-month-old child diagnosed with Grade II SGS who was managed for cricoid split laryngoplasty with a costochondral rib graft. It was a unique strategy for providing infants and neonates with symptomatic SGS with a safe and efficient substitute for long-term tracheostomy. When healing was completed, the patient regained the function of their airway. The approach was successful, and preventable to long-term tracheostomy.
DISCUSSION
Performing this procedure early in children has shown higher rates of success and it is safe and effective. Further extensive research and studies need to be conducted in this domain, and every patient's status should be reviewed time and again to tend to their specific needs, and the choice of procedure should be made optimally based on clinical evaluations.
CONCLUSION
Successful management of a 13-month-old child with Grade II subglottic stenosis through cricoid split laryngoplasty with costochondral rib grafting is a challenging and novel approach to treating single-stage SGS.
PubMed: 38943940
DOI: 10.1016/j.ijscr.2024.109952 -
International Journal of Surgery Case... Jun 2024Transverse testicular ectopia (TTE) is a rare congenital condition characterized by migration of both testes through the same inguinal canal and often presents with an...
INTRODUCTION
Transverse testicular ectopia (TTE) is a rare congenital condition characterized by migration of both testes through the same inguinal canal and often presents with an inguinal hernia. TTE is associated with various genitourinary anomalies.
CASE PRESENTATION
A three-year-old boy presented with a non-palpable right testis and a palpable undescended left testis in the left inguinal area. Ultrasound (US) indicated the presence of both testes in the left inguinal canal. In surgery, the two testes were found with separated cord and one hernia sac which was dissected and ligated thus the two cords freed. Next, subdartos pouches were created on both scrotum sides, so that testes placed into the left side first, and then a window created in the scrotal septum which allowed the right testis to be translocated and secured in the right subdartos pouch without tension.
DISCUSSION
TTE is a rare condition and the etiology is not definitively known. TTE usually presents with an inguinal hernia and contralateral cryptorchidism. The diagnosis is made during surgery, but some radiological methods can help in diagnosis. Management is usually surgical and involves interventions such as hernia repair, reduction of the testis and orchiopexy. Continuous monitoring is essential for ensuring postoperative testes health and evaluating the risk of malignancy.
CONCLUSION
TTE should be suspected in cases with unilateral empty scrotum and family history of genital disorders. US is critical for accurately localizing the testes, along with surgical exploration, to proceed with the appropriate surgical intervention.
PubMed: 38943934
DOI: 10.1016/j.ijscr.2024.109949 -
Environment International Jun 2024This study examines longitudinal associations of air pollution and green space with cardiometabolic risk among children in the Netherlands.
BACKGROUND
This study examines longitudinal associations of air pollution and green space with cardiometabolic risk among children in the Netherlands.
METHODS
Three Dutch prospective cohorts with a total of 13,822 participants aged 5 to 17 years were included: (1) the Amsterdam Born Children and their Development (ABCD) study from Amsterdam (n = 2,547), (2) the Generation R study from Rotterdam (n = 5,431), and (3) the Lifelines study from northern Netherlands (n = 5,844). Air pollution (PM, PM, NO, and elemental carbon (EC)) and green space exposures (density in multiple Euclidean buffer sizes) from 2006 to 2017 at home address level were used. Cardiometabolic risk factor clustering was assessed by a MetScore, which was derived from a confirmatory factor analysis of six cardiometabolic risk factors to assess the overall risk. Linear regression models with change in Metscore as the dependent variable, adjusted for multiple confounders, were conducted for each cohort separately. Meta-analyses were used to pool cohort-specific estimates.
RESULTS
Exposure to higher levels of NO and EC was significantly associated with increases in MetScore in Lifelines (per SD higher exposure: β = 0.006, 95 % CI = 0.001 to 0.010; β = 0.008, 95 % CI = 0.002 to 0.014). In the other two cohort studies, these associations were in the same direction but these were not significant. Higher green space density in 500-meter buffer zones around participants' residential addresses was not significantly associated with decreases of MetScore in all three cohorts. Higher green space density in 2000-meter buffer zones was significantly associated with decreases of MetScore in ABCD and Lifelines (per SD higher green space density: β = -0.008, 95 % CI = -0.013 to -0.003; β = -0.002, 95 % CI = -0.003 to -0.00003). The pooled estimates were β = 0.003 (95 % CI = -0.001 to 0.006) for NO, β = 0.003 (95 % CI = -0.001, 0.007) for EC, and β = -0.0014 (95 % CI = -0.0026 to -0.0001) for green space.
CONCLUSIONS
More green space exposure at residence was associated with decreased cardiometabolic risk in children. Exposure to more NO and EC was also associated with increased cardiometabolic risk.
PubMed: 38943924
DOI: 10.1016/j.envint.2024.108852 -
Drug Resistance Updates : Reviews and... Jun 2024Cell cycle dysregulation is a hallmark of cancer that promotes eccessive cell division. Cyclin-dependent kinase 4 (CDK4) and cyclin-dependent kinase 6 (CDK6) are key... (Review)
Review
Cell cycle dysregulation is a hallmark of cancer that promotes eccessive cell division. Cyclin-dependent kinase 4 (CDK4) and cyclin-dependent kinase 6 (CDK6) are key molecules in the G1-to-S phase cell cycle transition and are crucial for the onset, survival, and progression of breast cancer (BC). Small-molecule CDK4/CDK6 inhibitors (CDK4/6i) block phosphorylation of tumor suppressor Rb and thus restrain susceptible BC cells in G1 phase. Three CDK4/6i are approved for the first-line treatment of patients with advanced/metastatic hormone receptor-positive (HR)/human epidermal growth factor receptor 2-negative (HER2) BC in combination with endocrine therapy (ET). Though this has improved the clinical outcomes for survival of BC patients, there is no established standard next-line treatment to tackle drug resistance. Recent studies suggest that CDK4/6i can modulate other distinct effects in both BC and breast stromal compartments, which may provide new insights into aspects of their clinical activity. This review describes the biochemistry of the CDK4/6-Rb-E2F pathway in HR BC, then discusses how CDK4/6i can trigger other effects in BC/breast stromal compartments, and finally outlines the mechanisms of CDK4/6i resistance that have emerged in recent preclinical studies and clinical cohorts, emphasizing the impact of these findings on novel therapeutic opportunities in BC.
PubMed: 38943828
DOI: 10.1016/j.drup.2024.101103 -
The American Journal of Emergency... Jun 2024We aimed to investigate the prognostic factors of pediatric extracorporeal cardiopulmonary resuscitation (ECPR).
OBJECTIVE
We aimed to investigate the prognostic factors of pediatric extracorporeal cardiopulmonary resuscitation (ECPR).
METHODS
The retrospective study included a total of 77 pediatric cases (7 neonates and 70 children) who underwent ECPR after in-hospital and out-of-hospital cardiac arrest between July 2007 and December 2022. Primary endpoints were complications, while secondary endpoints included all-cause in-hospital mortality.
RESULTS
Among the 45 cases experiencing complications, 4 neonates and 41 children had multiple simultaneous complications, primarily neurological issues in 25 cases. Additionally, organ failure occurred in 11 cases, and immunodeficiency was present in two cases. Furthermore, 9 cases experienced bleeding events, and 13 cases showed thrombosis. Patients with complications had lower weight, shorter ECMO durations, and longer CPR durations. Non-survivors had longer CPR durations and shorter durations of ECMO, ICU stay, and mechanical ventilation compared to survivors. Complications were more prevalent in non-survivors, particularly organ failure and bleeding events.
CONCLUSION
Weight, CPR duration, and ECMO duration were associated with complications, suggesting areas for treatment optimization. The higher occurrence of complications in non-survivors underscores the importance of early detection and management to improve survival rates. Our findings suggest clinicians consider these factors in prognostic assessments to enhance the effectiveness of ECPR programs.
PubMed: 38943709
DOI: 10.1016/j.ajem.2024.06.034 -
Cell Reports Jun 2024Ferroptosis is a type of regulated cell death characterized by iron-dependent lipid peroxidation. A model cell system is constructed to induce ferroptosis by...
Ferroptosis is a type of regulated cell death characterized by iron-dependent lipid peroxidation. A model cell system is constructed to induce ferroptosis by re-expressing the transcription factor BACH1, a potent ferroptosis inducer, in immortalized mouse embryonic fibroblasts (iMEFs). The transfer of the culture supernatant from ferroptotic iMEFs activates the proliferation of hepatoma cells and other fibroblasts and suppresses cellular senescence-like features. The BACH1-dependent secretion of the longevity factor FGF21 is increased in ferroptotic iMEFs. The anti-senescent effects of the culture supernatant from these iMEFs are abrogated by Fgf21 knockout. BACH1 activates the transcription of Fgf21 by promoting ferroptotic stress and increases FGF21 protein expression by suppressing its autophagic degradation through transcriptional Sqstm1 and Lamp2 repression. The BACH1-induced ferroptotic FGF21 secretion suppresses obesity in high-fat diet-fed mice and the short lifespan of progeria mice. The inhibition of these aging-related phenotypes can be physiologically significant regarding ferroptosis.
PubMed: 38943639
DOI: 10.1016/j.celrep.2024.114403 -
Iranian Journal of Immunology : IJI Jun 2024Hematopoietic stem cell transplantation (HSCT) is the only curative therapy for β-thalassemia major in children. However, it often induces graft-versus-host-disease...
Hematopoietic stem cell transplantation (HSCT) is the only curative therapy for β-thalassemia major in children. However, it often induces graft-versus-host-disease (GVHD), which is associated with complications. In the present study, we used cyclophosphamide (Cy) to treat a thalassemia patient post-HSCT to reduce the adverse effects of GVHD. We monitored the numbers and phenotype of granulocytes. In this case study, an 11-year-old female patient, diagnosed with β-thalassemia major (Pesaro class II), was treated with Cy before and after HSCT with mobilized CD34+ cells. Both the relative and absolute granulocyte counts, as well as CD33+CD11b+ cell counts, increased significantly after HSCT until day 56. However, they suddenly began to decrease after day 56, accompanied by severe diarrhea, skin rash, and a decrease in bilirubin levels compared to day -12. Furthermore, compared to day -12, IL-22 levels increased until day 56, and then decreased, while IDO levels continued to rise after day 56. Our data suggest the potential use of IL-22 and IDO as biomarkers for GVHD assessment. It also indicates that Cy promotes HSCT reconstitution by increasing CD33+CD11b+ cells, which may play a crucial role in reducing GVHD risks. However, further studies are needed to elucidate the mechanism behind GVHD recurrence.
Topics: Humans; Female; Hematopoietic Stem Cell Transplantation; Cyclophosphamide; Child; Graft vs Host Disease; beta-Thalassemia; Treatment Outcome; Biomarkers; Immunosuppressive Agents
PubMed: 38943529
DOI: 10.22034/iji.2024.101584.2752 -
Nigerian Journal of Clinical Practice Jun 2024The burden of perinatal asphyxia remains high in our environment and when asphyxia is severe, vital organs are affected, with resultant multiorgan hypoxic-iscahemic...
BACKGROUND
The burden of perinatal asphyxia remains high in our environment and when asphyxia is severe, vital organs are affected, with resultant multiorgan hypoxic-iscahemic injury to the heart, the brain, adrenals and other organs.
STUDY AIM
To evaluate for myocardial injury in asphyxiated term neonates with hypoxic ischaemic encephalopathy using serum cardiac troponin-I (cTnI).
METHODS
The study was a hospital-based descriptive cross-sectional study involving sixty term asphyxiated neonates and sixty gestational age-and sex-matched controls. The subjects were term neonates with five-minute Apgar score ≤ 6 and HIE while the controls were healthy term neonates with five-minute Apgar score > 6. Five-minute Apgar score was utilized to classify asphyxia into mild, moderate and severe asphyxia. The degree of encephalopathy was determined by modified Sarnat and Sarnat criteria. The serum cTnI was measured in subjects and controls at 12-24 hours of life using Enzyme-linked immunosorbent assay technique. The serum bilirubin levels were also measured in participants to exclude hyperbilirubinemia.
RESULTS
The median serum cTnI levels was significantly higher in the subjects (0.56ng/mL; 0.25-0.94ng/mL) than in the controls (0.50ng/mL; 0.00-0.67ng/mL), respectively; p=0.001. Similarly, the median serum cTnI level in HIE stage II (0.56ng/mL; 0.38-0.72ng/mL) or III (0.56ng/ml; 0.50-0.94ng/mL) was also significantly higher than the median value in HIE stage I (0.38ng/mL;0.25-0.72ng/mL) or in controls (0.50ng/mL; 0.00-0.67ng/mL); p<0.001. There was significant positive correlation between serum cTnI levels and severity of HIE in asphyxiated neonates (rs = 0.505, p < 0.001).
CONCLUSION
serum cTnI levels were elevated in severely asphyxiated neonates with HIE. The concentration of serum cTnI demonstrated significant positive correlation with HIE severity. Hence, the presence of HIE in asphyxiated neonates should prompt an evaluation for myocardial injury using serum cTnI. Any derangement noted should warrant instituting cardiovascular support in order to improve outcome and reduce asphyxia-related mortality.
Topics: Humans; Infant, Newborn; Asphyxia Neonatorum; Troponin I; Female; Nigeria; Male; Cross-Sectional Studies; Case-Control Studies; Hospitals, Teaching; Apgar Score; Biomarkers; Hypoxia-Ischemia, Brain
PubMed: 38943306
DOI: 10.4103/njcp.njcp_169_24 -
Nigerian Journal of Clinical Practice Jun 2024This study aims to assess the diagnostic accuracy of an artificial intelligence (AI) system employing deep learning for identifying dental plaque, utilizing a dataset...
OBJECTIVES
This study aims to assess the diagnostic accuracy of an artificial intelligence (AI) system employing deep learning for identifying dental plaque, utilizing a dataset comprising photographs of permanent teeth.
MATERIALS AND METHODS
In this study, photographs of 168 teeth belonging to 20 patients aged between 10 and 15 years, who met our criteria, were included. Intraoral photographs were taken of the patients in two stages, before and after the application of the plaque staining agent. To train the AI system to identify plaque on teeth with dental plaque that is not discolored, plaque and teeth were marked on photos with exposed dental plaque. One hundred forty teeth were used to construct the training group, while 28 teeth were used to create the test group. Another dentist reviewed images of teeth with dental plaque that was not discolored, and the effectiveness of AI in detecting plaque was evaluated using pertinent performance indicators. To compare the AI model and the dentist's evaluation outcomes, the mean intersection over union (IoU) values were evaluated by the Wilcoxon test.
RESULTS
The AI system showed higher performance in our study with a precision of 82% accuracy, 84% sensitivity, 83% F1 score, 87% accuracy, and 89% specificity in plaque detection. The area under the curve (AUC) value was found to be 0.922, and the IoU value was 76%. Subsequently, the dentist's plaque diagnosis performance was also evaluated. The IoU value was 0.71, and the AUC was 0.833. The AI model showed statistically significantly higher performance than the dentist (P < 0.05).
CONCLUSIONS
The AI algorithm that we developed has achieved promising results and demonstrated clinically acceptable performance in detecting dental plaque compared to a dentist.
Topics: Humans; Artificial Intelligence; Adolescent; Child; Dental Plaque; Female; Male; Sensitivity and Specificity; Deep Learning
PubMed: 38943301
DOI: 10.4103/njcp.njcp_862_23