Congenital dacryocystocele is a rare clinical condition, more commonly unilateral, secondary to the defective canalization of the nasolacrimal duct. In case of failure of conservative treatment, surgical marsupialization is recommended. We describe the case of a 40-days'old male newborn treated by means of microdebrider marsupialization.
Sir,We welcome Gurol‐Urganci I and Bidwell et al’s evaluation of the impact of the care bundle to reduce obstetric anal sphincter injury (OASI) published in your August edition last year. The article reports much needed evidence on the efficacy of an intervention that has already taken hold in many maternity services across the country.Despite the article’s timely nature, we would like to voice our disappointment in the quality of the evidence of support for the care bundle Meulen and Thakar et al provide, and the recommendations made. The article fails to consider important evidence in this area of maternity care prompting this response. In particular, the authors miss the opportunity to contextualise the relatively low-level evidence they take from five articles – reporting three Scandinavian cohort studies and one educational intervention study on manual assistance during the final part of the second stage of labour (including gripping the baby’s chin through the perineum) - with the compelling findings from the Cochrane review on Perineal techniques during the second stage of labour for reducing perineal trauma.  This omission is important because the Cochrane review indicates that warm compresses have a bigger positive effect on OASI than the OASI care bundle reported by Meulen and Thakar et al’s. Furthermore, the Cochrane review provides evidence suggesting that hands off the perineum may protect women from episiotomy; an outcome which Meulen and Thakar et al acknowledge remained unchanged despite the third component in the care bundle aiming to ‘use of episiotomy when clinically indicated’. The selective nature of the evidence quoted, undermines the credibility of inferences that can be made from the findings. We suggest therefore, that caution should be taken when reading the authors conclusions.Our second concern rests upon the authors failure to account for the surprisingly small positive effect of the care bundle compared with the Scandinavian studies they quote. Meulen and Thakar et al report a 0.3% decrease in OASI compared with a 3.6% reduction;3% reduction; a 2.6% reduction for low risk women; and a 2.1% reduction in the various observational studies  Such a small effect in an open trial could easily be caused by ascertainment bias. Again, the quality of the previous Scandinavian studies make interpretation difficult but the marked difference in results between Scandinavia and England suggests caution should be taken when reading the authors conclusions.Our final concern pertains to women’s experience of the care bundle. Not only is the acceptability of the intervention not considered in this evaluation – a significant oversight given the conspicuous lack of evidence on this – there are ethical issues within the evaluation that deserve attention. The intervention description in figure 1 claims that women were informed about what could be done to reduce OASI. This does not appear to be entirely true given the lack of consideration of warm compresses and hands off to protect against episiotomy. Even more unsettling is the statement ‘MPP should be used unless the woman objects’, implying little consideration for autonomy and informed consent.For the above reasons, we are not only disappointed with the BJOG article but with the professional stakeholder investment in the intervention which seems to have been widely and uncritically supported, with some support even being somewhat evangelical, despite the limited evidence for support.Signatures,
Paraparetic Guillian-Barre Syndrome is an uncommon variant of GBS. We describe a case of a teenage boy, who developed progressive, symmetric weakness of the lower limbs following an upper respiratory tract infection. Post-infectious, monophasic, acute, symmetric course were suggestive of paraparetic GBS which were further confirmed by CSF, electrophysiologic fndings.
The morphology variations of the so-called scimitar vein are many and varied. We present a synthesis of 92 published investigations of the overall scimitar syndrome. We reviewed the clinical presentations, diagnostic modalities, surgical approaches, and outcomes. Diagnostic information was provided by clinical presentations, radiographic findings, transthoracic and transesophageal echocardiography, computed-tomographic angiography, magnetic resonance imaging, angiocardiography, and ventilation/perfusion scans. These investigations served to elucidate the origin, course, and termination of the scimitar vein, the intracardiac anatomy, the presence of associated defects, and the patterns of any accompanying pulmonary lesions. In short, they defined the disease prior to surgical intervention. Of the patients described, up to four-fifths presented during infancy, with cardiac failure, increased pulmonary flow, and pulmonary hypertension. Associated cardiac and extracardiac defects, particularly hypoplasia of the right lung, are present in up to three-quarters of cases. Overall operative mortality has been cited between 4.8% and 5.9%. Mortality was highest in patients with preoperative pulmonary hypertension, and those undergoing surgery in infancy. Despite timely surgical intervention, post-repair obstruction of the scimitar vein, intra-atrial baffle obstruction, or stenosis of the inferior caval vein were reported in up to two-thirds of cases. The venous obstruction could not be related to any particular surgical technique. On long term follow-up, one sixth of patients reported persistent dyspnoea and recurrent respiratory infections. Any infants presenting with heart failure, right-sided heart, and hypoplastic right lung should be evaluated to exclude the syndrome. An increased appreciation of variables will contribute to improved surgical management.
The aim of this article is to study the relationships and models among the Van den Dool and Kratz equation, the gas chromatography, and the Bézier curves constructed by aid of the Bernstein polynomials. Another aim of this article is to introduce open problems that contribute to real-world problems involving mathematics, chemistry, and plant biology, including the Van den Dool and Kratz equation, the gas chromatography, and Bézier curves. Searching for the solutions of these problems may have qualities that will create the potential that can enter the field of study of many researchers. As a result of these goals, the usability of Bézier curves was investigated while determining the chemical composition of essential oil obtained from P. Aladaghensis Leblebici. By applying the retention index from the Van den Dool and Kratz equation and evaluating chemical compositions of the essential oil are characterized by gas chromatography-mass spectrometry (GC-MS). The Van den Dool and Kratz equation results have the potential to be used not only in the chemical compositions of the oils, but also in applied mathematics and other fields. Moreover, we construct a new special finite sum. A lower bound and inequality are also given for the finite special sum involving the dead time associated with the isocratic step. Some applications and criticisms are given that include this lower bound and inequality for these sums and its effects on the chemical compositions of essential oil and the Van den Dool and Kratz equation.
SARS-CoV-2 caused one of the most devastating pandemics in the recent history of mankind. Due to various countermeasures, including lock-downs, wearing masks and increased hygiene, the virus has been controlled in some parts of the world. More recently, the availability of vaccines, based on RNA or Adenoviruses, have greatly added to our ability to keep the virus at bay, again in some parts of the world only. While available vaccines are effective, it would be desirable to also have more classical vaccines at hand for the future. Key feature of vaccines for long-term control of SARS-CoV-2 would be inexpensive production at large scale, ability to make multiple booster injections and long-term stability at +4 oC. Here we describe such a vaccine candidate, consisting of the SARS-CoV-2 receptor binding motif grafted genetically onto the surface of the immunologically optimized cucumber mosaic virus, called CuMV TT-RBM. Using bacterial fermenter production and continuous flow centrifugation, the productivity of the production process is estimated to be >2.5 million doses per 1000 liter fermenter run and the vaccine candidate is stable for at least 14 months at 4°C. We further demonstrate that the candidate vaccine is highly immunogenic in mice and rabbits and induces more high avidity antibodies compared to convalescent human sera and antibodies induced are more cross-reactive to mutant RBDs for variants of concern (VoC). Furthermore, antibody responses are neutralizing and long-lived. This, the here presented VLP-based vaccine may be a good candidate for use as conventional vaccine in the long-term.
WeChat and access to wireless communication may offer a continuum of care following medical and surgical intervention. This cardiac surgery research study evaluates the process of parental education and social support following pediatric cardiac surgery utilizing standard of care compared to telehealth.
Abstract Objective: Although various guidelines have been established for the management of antithrombotic therapy during surgical treatments, surgical tracheostomy (ST) under continued antithrombotic therapy (CAT) remains a challenge. We investigated the risk factors for complications after ST by focusing on CAT use during ST. Method: Patients’ medical records from 2009 to 2020 were reviewed in this retrospective study. We selected patients who underwent ST at the Department of Otolaryngology of the University of Tokyo Hospital. Patient demographics, complications, and blood test values were recorded and statistically analyzed to identify the risk factors for postoperative complications. Results: We identified 288 patients (median age: 64 years; 184 men [64%]), among whom 40 (median age: 67 years; 29 men [73%]) underwent CAT. Although the patients undergoing CAT had significantly higher values of activated partial thromboplastin time (p = 0.002) and prothrombin time-international normalized ratio (p = 0.006) than those of antithrombotic naïve patients, no statistically significant intergroup differences were observed in the risks of bleeding, infection, or subcutaneous emphysema. Instead, ST under local anesthesia (p = 0.01) and ST for airway emergency (p = 0.02) significantly increased the risk of early postoperative complications. Conclusion: The results of the present study suggest that ST under CAT can be safely performed without any increased risk of postoperative complications. Nevertheless, surgeons should be extra cautious about early complications after ST under local anesthesia without intubation or ST for airway emergency. Key points: 1. We aimed to investigate the risk factors for complications after ST by focusing on CAT use during ST. 2. Patients undergoing CAT had significantly higher values of APTT and PT-INR than those of antithrombotic naïve patients. 3. ST under CAT can be safely performed without any increased risk of postoperative complications. 4. ST under local anesthesia and airway emergency was a risk factor for complications after ST. 5. Among the complications, subcutaneous emphysema was significantly more frequent in ST under local anesthesia and under airway emergency.
COVID-19 vaccination with BNT162b2 and ChAdOx1 vaccines induces nasal neutralizing antibodiesDeclercq Jozefien(1,2,5)*, Tobback Els(3)*, Vanhee Stijn(2,5), Natalie De Ruyck(1), Gerlo Sarah(4), Gevaert Philippe(1)**, Vandekerckhove Linos(3,4)***shared co-first authorship** shared last authorshipUpper Airways Research Lab URL, Department of Otorhinolaryngology, Ghent University, Ghent, BelgiumLaboratory of immunoregulation, VIB Center for Inflammation Research, Ghent, BelgiumDepartment of General Internal Medicine, Ghent University Hospital, Ghent, BelgiumHIV Cure Research Centre, Department of Internal Medicine and Pediatrics, Ghent University, Ghent, BelgiumDepartment of Internal Medicine and Pediatrics, Ghent University, Ghent, BelgiumCorresponding author:Prof. Dr. Philippe GevaertUpper Airways Research Lab URL, Department of Otorhinolaryngology, Ghent University,C Heymanslaan 10, 1P1Ghent, Belgium+3293324922Philippe.firstname.lastname@example.orgFinancial support: no fundingWord count: 591
The Antarctic green alga Chlamydomonas sp. UWO241 is an obligate psychrophile that thrives in the cold (4-6°C) but is unable to survive at temperatures ≥18°C. Little is known how exposure to heat affects its physiology or whether it mounts a heat stress response in a manner comparable to mesophiles. Here, we dissect the responses of UWO241 to temperature stress by examining its growth, primary metabolome and transcriptome under steady-state low temperature and heat stress conditions. In comparison with Chlamydomonas reinhardtii, UWO241 constitutively accumulates metabolites and proteins commonly considered as stress markers, including soluble sugars, antioxidants, polyamines, and heat shock proteins to ensure efficient protein folding at low temperatures. We propose that this permanent stress metabolism is an adaptive advantage to life at extreme conditions. A shift from 4°C to a non-permissive temperature of 24°C alters the UWO241 primary metabolome and transcriptome, but growth of UWO241 at higher permissive temperatures (10°C and 15°C) does not provide enhanced heat protection. UWO241 also fails to induce the accumulation of HSPs when exposed to heat, suggesting that it has lost the ability to fine-tune its heat stress response. Our work adds to the growing body of research on temperature stress in psychrophiles, many of which are threatened by climate change.
Lipofibromatous hamartoma is an uncommon tumor that causes nerve enlargement due to fatty adipose tissue infiltration in peripheral nerves being the median nerve at the carpal tunnel the most commonly affected site, typically associated with macrodactyly. Here we present a case which affected a digital branch of the median nerve
Aims In older adults with type 2 diabetes (T2D), overtreatment remains prevalent and undertreatment ignored. The main objective is to estimate the prevalence and examine factors associated with potential overtreatment and undertreatment Method Observational study conducted within an administrative database of older adults with T2D who registered in 2018 at the Portuguese Diabetes Association. Participants were categorized either as potentially overtreated (HbA1c≤7.5%), appropriately on target (HbA1c≥7.5–≤9%), or potentially undertreated (HbA1c>9%). Results of 444 participants, potential overtreatment, and undertreatment were found in 60.5% and 12.6% of the study population. Taking the patients on target as a comparator, the group of potentially overtreated showed to be more males (61.3% vs.52.2%), less-obese (34.1% vs.39.2), higher cardiovascular diseases (13.7% vs.11%), peripheral vascular diseases (16.7% vs.12.8%), diabetic foot (10% vs.4.5%), and severe kidney disease (5.2% vs.4.5%). Conversely, the potentially undertreated participants were more females (64.2% vs.47.7%), obese (49% vs.39.2%), had more dyslipidemia (69% vs.63.1%), peripheral vascular disease (14.2% vs.12.8%), diabetic foot (8.9% vs.4.5%), and infections (14.2% vs.11.9%). The odds of potential overtreatment were mostly decreased by 59% of females, 73.5% in those with retinopathy, and 86.3% in insulin, 65.4% sulfonylureas, and 66.8% in SGLT2 inhibitors users. Contrariwise, an increase in the odds of potential undertreatment was more than 4.8times higher in insulin, and more than 3.1times higher in sulfonylureas users. Conclusion potential overtreatment and undertreatment in older adults with T2D in routine clinical practice should guide the clinicians to balance the use of newer oral antidiabetic agents considering its safety profile regarding hypoglycemia.
Jejunal diverticulitis is a rare condition and usually occurs in the elderly. Its association with extensive diverticulosis is exceptional and makes the management more challenging. We report a case of a 74-year-old man with perforated jejunal diverticulitis with extensive diverticulosis who underwent a surgical management.
The current pandemic caused by a novel coronavirus named as SARS-CoV2 has underlined the importance of emerging diseases of zoonotic importance. Along with human beings, several species of wild and pet animals have been demonstrated to be infected by SARS-CoV2, both naturally and experimentally. Additionally, with constant emergence of new variants, the species susceptibility might further change, warranting intensification of screening efforts. India is a vast and second most populated country, with a habitat of a very diverse range of animal species. In this study we are reporting infection of SARS-CoV2 in captive Asiatic lions. Detailed characterization revealed involvement of delta mutant (Pango lineage B.1.617.2) of SARS-CoV2 at two different locations. Interestingly, no other feline species enclosed in the zoo/park was found infected. The epidemiological and molecular analysis in this study will contribute to the understanding of SARS-CoV2 emerging mutants in wild and domesticated animals.
Aridity and intensive grazing have been confirmed to affect the facilitative effects of dryland shrubs. However, their combined effects on plant-plant interactions have rarely been tested. To test how these two factors affect relations between plants, we analyzed 144 plots (under shrub canopy vs. open areas) at 12 sampling areas established in the conditions of two grazing regimes (high grazing vs. low grazing intensity) and two different climatic regions (arid vs. semi-arid) in northeastern Iran. A dominant shrub, Artemisia kopetdaghensis, was selected as the model species. Further, we studied changes in plant life strategies along the combined grazing and aridity stress gradients. We used relative interaction indices to test the outcomes of plant-plant interactions, calculated for species richness, Shannon diversity and species abundances. Then we compared them using linear mixed-effect models (LMM). The indicator species analysis was used to identify species typical for the under-canopy of shrub and for the adjacent open areas. The combination of stress factors affected the type and intensity of plant-plant interactions and plant life strategies (CSR) of the indicator species. Artemisia kopetdaghensis showed the highest facilitation effect under the most intensive stress conditions (high aridity/high grazing), which turned into competition under the low stress conditions (low aridity/low grazing). In the arid region, the canopy of shrub protected ruderal annual forbs and grasses with SR and R-strategy, respectively, in both high (high aridity/high grazing) and low grazing intensity (high aridity/low grazing). In the semi-arid region and high grazing intensity (low aridity/high grazing), the shrubs protected perennial forbs with C-strategy. Our FINDINGS highlight the importance of context-dependent shrub management in the restoration of vegetation damaged by intensive grazing.