Two cases of unidentified acute compartment syndrome

Acute compartment syndrome (ACS) is a surgical emergency that requires urgent fasciotomy to prevent irreversible sequelae. We report two cases of unidentified ACS, which did not result from traumatic injuries such as fractures or crush injury, iatrogenic injury or diseases such as haematological malignancies. Both patients complained of severe pain and swelling of their extremity. No bite marks, blisters or skin necrosis was noted. They also complained of marked symptoms of third cranial nerve injury, including divergent squint and diplopia. The diagnosis of ACS was made following continuous intracompartmental pressure measurement, and both patients underwent urgent fasciotomy with partial incision. Considering the season and location of the injuries, together with the rapid progression of signs and symptoms that included thrombocytopaenia, acute renal failure, rhabdomyolysis and especially that of third cranial nerve injury, we postulate that these two cases may have developed following mamushi (Gloydiusblomhoffii) bites.

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Plasticity and biological diversity of myeloid derived suppressor cells

Kerem Ben-Meir | Nira Twaik | Michal Baniyash

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How to cope with food allergy symptoms?

Purpose of review Food allergy symptoms may involve a wide variety of organs (skin, gastrointestinal tract, and eyes) and systems (respiratory, circulatory, and neurological). They are often associated. Their severity ranges from mild to potentially life-threatening reactions and the presentation from acute to chronic. Recent findings Food allergies have been the focus of multiple studies, position papers, and guidelines in recent years. They have defined an approach in classifying symptoms as mild to anaphylactic, distinguishing objective from subjective symptoms, and describing their heterogeneity, specific phenotypes or syndromes (e.g., lipid transfer protein syndrome or pollen food syndrome). Cofactors can also influence food allergy reactions. Symptoms of non-IgE-gastrointestinal food allergies, illustrated by eosinophilic esophagitis and food-protein-induced enterocolitis syndrome, are also now better understood and defined. Improvement in the knowledge of food allergy symptoms is crucial for correct diagnosis and a personalized treatment approach. Summary Through a better description and understanding of symptoms, the diversity of food allergies is now better known. The next step is to harmonize symptom assessment not only for clinicians but also for patients, researchers, and public health stakeholders, to describe food allergy phenotypes and their underlying mechanisms and endotypes, to develop targeted management. Correspondence to Antoine Deschildre, Pneumologie et Allergologie Pédiatriques, Hôpital Jeanne de Flandre, CHRU de Lille, Avenue Avinée, 59037 Lille Cedex, France. Tel: +33 320445072; e-mail: antoine.deschildre@chru-lille.fr Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Oral food challenge using different target doses and time intervals between doses

Purpose of review The oral food challenge (OFC) is a specific and vital tool used in clinical practice to identify the level of tolerance a person exhibits toward certain foods while diagnosing food-related allergies. OFC methods differ among countries. The aim of this review is to evaluate different target doses and determine the time interval between doses used for OFC. Recent findings We analyzed recent articles on target doses and time between doses, and noted that some papers reported low target doses and less time between doses. A low-dose OFC appears to be a useful strategy; a time interval of 15 min between doses is short and that of at least 1 h is appropriate. Summary Low-dose OFCs appear to be well tolerated and effective to avoid complete elimination of the consumption of foods causing allergies. For the safety of the OFC method, the time interval between doses should be more than 30 min. Correspondence to Noriyuki Yanagida, Department of Pediatrics, Sagamihara National Hospital, 18-1, Sakuradai, Minami-ku, Sagamihara, Kanagawa 252-0392, Japan. Tel: +81 42 742 8311; fax: +81 42 742 5314; e-mail: n-yanagida@sagamihara-hosp.gr.jp Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Dermal Fillers: The Risks to Eliminating Wrinkles

In 2016, more than 2.4 million filler procedures were done with one type alone, hyaluronic acid (Juvederm, Restylane), in the U.S. That's a 56% increase over the last decade.
WebMD Health News

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Passive sentence comprehension difficulties and its related factors in children with cochlear implants

Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Youngmee Lee, Jee Eun Sung, Hyunsub Sim
ObjectivesThe purposes of this study were to investigate which syntactic structures, from active and passive sentences, sensitively differentiate children with cochlear implants (CIs) from children with normal hearing (NH), to explore the correlations among working memory (WM) and other factors for each group, and to examine predictors of the active and passive sentence scores for both groups.MethodsTwenty deaf children with CIs and 20 children with NH, aged 8–14 years, were included in this study. Sentence comprehension skills were measured using the picture-pointing comprehension task, which consisted of active and passive sentences. The WM capacity was tested by the digit forward, digit backward, word forward, and word backward span tasks.ResultsPassive sentence type was a significant predictor to differentiate between the two groups (p < .05). In the CI group, passive sentence scores were significantly correlated with age, duration of an implant use, receptive vocabulary scores, and WM scores (all p values < .05). In the stepwise regression analysis, WM capacity was a significant factor in predicting the passive sentence scores of children with CIs (p < .05).ConclusionPassive sentence type was a significant factor in distinguishing the CI group from the NH group. The WM capacity was an important predictor accounting for individual differences in processing complex sentence types for children with CIs. The results indicate that a complex syntactic form may serve as a clinically critical index in detecting higher-level cognitive and linguistic processing difficulties in good performers after implantation.



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Effect of electronic cigarettes on human middle ear

Publication date: June 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 109
Author(s): Jae-Jun Song, Yoon Young Go, Ji Yoen Mun, Sehee Lee, Gi Jung Im, Yoo yon Kim, Jun Ho Lee, Jiwon Chang
ObjectiveElectronic cigarettes (e-cigarettes) are the most commonly used electronic nicotine delivery systems and are a relatively new product designed for smoking cessation. The market scale of electronic cigarettes is growing rapidly, but the potential impact of e-cigarettes on public health has not yet been verified. In this study, we examined the effect of e-liquids on a human middle ear epithelial cell (HMEEC) line.Material and methodsThe main components of e-liquids are propylene glycol, vegetable glycerin and flavoring agents with or without nicotine. We analyzed 73 bottles of e-liquids from 12 different manufacturers, evaluated the trace elements in e-liquids, and identified the cytotoxicity of e-liquids on HMEECs in the presence or absence of nicotine.ResultsIn the trace elements analysis, nickel, arsenic, cadmium, and lead were detected in the e-liquids. E-liquids without nicotine decreased cell viability, and the average IC 50 value of total e-liquids (n = 73) was 2.48 ± 0.93%. Among the different flavors, menthol-flavored e-liquids significantly reduced cell viability, and their average IC 50 value (n = 28) was 1.85 ± 0.80%. The average IC 50 values were distinct among manufacturers and the proportion of the solvents.ConclusionThe present study provides evidence that e-cigarettes influence and reduce human middle ear cell viability even without the application of nicotine. Additionally, the cytotoxicity of e-liquids was affected by the flavoring agents.



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An intramural uterine fibroid became submucosal in the puerperium – proposed probable mechanism: a case report

Vaginal prolapse of a large uterine fibroid is a rare phenomenon in a woman who delivered vaginally recently, given that this fibroid might have obstructed labor. The author presents a case report of a vaginal...

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Factors Influencing Hemoglobin Variability and Its Association with Mortality in Hemodialysis Patients

Purpose. We aimed to investigate the factors influencing hemoglobin variability with inflammatory and nutritional parameters and its associations with all-cause mortality among hemodialysis patients. Methods. One hundred and sixty-nine patients during the entire 12 months were enrolled into the study. Fasting plasma glucose, creatinine, calcium, phosphorus, alkaline phosphatase, parathyroid hormone (PTH), C-reactive protein (CRP), serum iron, serum iron-binding capacity, and transferrin saturation were analyzed. We defined six groups: low, target range, high, low-amplitude fluctuation with low hemoglobin levels, low-amplitude fluctuation with high hemoglobin levels, and high-amplitude fluctuation. Body mass index (BMI), malnutrition-inflammation score (MIS), and Charlson Comorbidity Index were evaluated. Results. Hemoglobin variability was significantly correlated with age, platelet count, and number of hospitalization instances and inversely correlated with erythropoietin dose per body surface area. The coefficient of variation of hemoglobin showed a correlation with MIS and ferritin. The absolute level of hemoglobin showed a negative correlation between PTH, CRP, MIS, number of hospitalization instances and a positive correlation with albumin and BMI. High, low, and target-range groups showed survival advantage compared to the other three groups. In regression analysis, age, CRP levels, MIS, and BMI were the predictors of mortality. Conclusion. Inflammation and duration of anemia were the major predictors of hemoglobin variability. High-amplitude fluctuation predicts high mortality; on the contrary low-amplitude fluctuations is related to better survival. MIS was independently associated with mortality. This trial is registered with NCT03454906.

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Hypoparathyroidism Causing Seizures: When Epilepsy Does Not Fit

A 24-year-old man presented to the Chris Hani Baragwanath Academic Hospital emergency department with recurrent seizures having previously been diagnosed with epilepsy from age 14. The biochemical investigations and brain imaging were suggestive of seizures secondary to hypocalcemia, and a diagnosis of idiopathic hypoparathyroidism was confirmed. After calcium and vitamin D replacement, the patient recovered well and is seizure free, and off antiepileptic therapy. This case highlights the occurrence of brain calcinosis in idiopathic hypoparathyroidism; the occurrence of acute symptomatic seizures due to provoking factors other than epilepsy; and the importance, in the correct clinical setting, of considering alternative, and sometimes treatable, causes of seizures other than epilepsy.

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Osteomyelitis in Cat-Scratch Disease: A Never-Ending Dilemma—A Case Report and Literature Review

Background. We performed a review of published case studies of osteomyelitis associated with cat-scratch disease to consolidate existing information on clinical presentation, diagnostic tools, therapy, and outcome, as well as presenting a case of disseminated cat-scratch disease in a 12-year-old female with skull osteomyelitis and spleen involvement. Methods. A search for articles indexed in PubMed, Embase, and Google Scholar was performed with the search terms "Bartonella," "bone," "osteomyelitis," "osteolytic," and "cat-scratch disease" limited to the immunocompetent pediatric population and articles in English. Results. 51 cases were identified. The average age was 7.8 years with equal sex distribution. Fever (84.3%), often with a prolonged course (64.7%), and osteoarticular pain (88.2%) were the most common clinical findings. Lymphadenopathy was present in 64.7% of patients. Vertebral body was mainly involved (51.9%). MRI (50%) and bone scintigraphy (48.1%) were favored to confirm osteomyelitis, while serology was the preferred microbiological diagnostic. Various antibiotics were prescribed in combined or sequential regimens, with median duration of therapy of 23 days. About 12.5% of patients did not receive any treatment. Most patients had excellent prognosis; in particular, all patients not receiving any therapy showed complete recovery and no recurrence of symptoms. Conclusions. Bartonella henselae should be considered in differential diagnosis of localized lymphadentitis. Osteoarticular pain or limitation during cat-scratch disease in children should always be investigated for bone spreading. Owing to good prognosis, invasive procedures to obtain the bone material should be avoided. Serology is the gold standard diagnostic tool and MRI is the best radiographic technique to define bone and surrounding tissue involvement. Treatment represents a never-ending dilemma: surgical intervention or use of antibiotics is still controversial, and more studies are needed to define the best antimicrobial regimen.

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